WHAT TO DO FIRST? A 72 yrs. old man was carried to my clinic by 3 men. He had severe chest pain with sweating and had already spent 48 hrs. in another hospital. He had ongoing chest pain, and ecg showed inverted T waves in all anterior leads. Trop +ve. He was not thrombolysed. Why? Well, he had Hb of 6 Gm% and perhaps had a gastric ulcer or carcinoma. Thrombolysis would have been disastrous and led to bleeding to death. I did his Echo and it showed a large area of myocardium akinetic suggesting a full heart attack and his overall heart function was (EF) 30-40%. I decided that he should have Primary Angioplasty, PC transfusion of 3 units simultaneously. An ambulance transferred him to Escorts, Delhi via Yamuna Expressway. There, they gave the transfusion and took him to Cath lab, did angiography, found his proxima LAD 100% blocked with thrombus which they removed and stented the lesion. This was done using minimum heparin. Post angioplasty investigations showed macrocytic anemia, no ulcer or carcinoma in stomach and diagnosed as pernicious anemia due to B12 deficiency. He returned well and is on parenteral B12 for anemia (along with Iron) and ancillary cardiac treatment..I saw him walk to my clinic all smiles yesterday! In this case, though elderly, but still active, needed active cardiac management not withstanding the anemia. The best option was primary angioplasty. Anemia can be treated easily with few units of packed cells. If he had been investigated for anemia first, endoscopy, bone marrow etc his heart would have been further compromised and would have ended as a cardiac cripple.
Posted on: Fri, 14 Mar 2014 16:55:48 +0000
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