Doctor & Patient Education Cardiac Specialist Centre
Intervention
5. Be careful with that wire
  • Presently, the standard treatment for heart attack is with stenting
  • Most hospitals in Singapore have protocols in placed to establish blood flow in the infarct artery within 90 minutes of patient’s arrival in Accident and Emergency department
  • This was a case of a 70 year old gentleman who presented with heart attack
  • The case was performed by a newly qualified doctor

This was the initial angiogram showing the Left Anterior Descending artery is totally occluded





Wire was pushed down

What the doctor has failed to notice was that the wire had gone into the plaque

Not realising this, a thrombus aspiration catheter was forced down the artery

  • This angiogram shows a Thrombuster (thrombectomy device) been pushed down
  • No thrombus was aspirated

The dissection plane has been extended with resultant obstructed flow

  • Earlier angiogram showed blood flowing to the distal LAD

He proceeded to dilated the lesion making the dissection worse

The flow is completely lost

  • While taking the balloon out
  • He inadvertently pulled out the wire
  • The wire has been pulled up
  • There is now no flow beyond the diagonal branch
  • Despite trying with different wires and asking other doctors for assistance, the wire could not be recrossed into the LAD
  • Since the patient no longer had any chest pain, the procedure was abandoned

Lesson
  • Primary PCI is, more often than not, easy to treat because the thrombus is soft
  • The wire can often cross easily
  • However, one must not take this for granted
  • The placement of wire must be meticulous
  • In the angiogram that shows wire traversing the plaque, the operator should re-cross the vessel with the wire taking the path on the left
  • I would use a 2nd wire to do this as pulling the 1st wire out may cause lost of flow
  • Other device should not have been forced down
  • This caused extension of dissection with haematoma in the sub-intimal space
  • This will compress the true lumen
  • Making entrance to the true lumen impossible as this operator found out
Consultation
Know Your Cardiologists

I feel breathless when walking.

I feel a tightness over my chest.

Do I need to take my medicine for my blood pressure?

Do I need to take my medicine for my cholesterol?

Do I really need stents for my artery?

Do I really need to have a bypass operation?

When should I go for health screening?

I have heart problem, can I take Viagra?

I have heart problem, should I exercise?

Heart Disease
Learn about your heart Conditions

You may need an ultra sound scan of your heart to assess its function.

You may need a treadmill stress test.

You may need closer monitoring.

You may need a more thorough risk assessment and life style change.

You may only need to take your medicine.

You may get away with just stenting.

This generally should start at 40 years old.

Yes, but there are certain strict conditions to fulfill.

Yes, but you will need to find out the appropriate intensity.