증례: 호흡곤란: Coronary artery disease

Profile	M/70
C/C	dyspnea
P/I	수개월부터 시작된 호흡곤란을 주소로 내원 움직이면 숨이 차다. 간헐적인 흉통, 뻐근하게
PHx	DM/HTN/Tbc/Hepatitis/Asthma(+/+/-/-/-) 오른팔 부러짐 - pathological Fx Prev. Op Hx(+) Social Hx -alcohol/smoking : denied Familial Hx(-)
ROS	-
P/E	121/65 mmHg-63회/분 Chest: RHB, CBS Extremity: No pitting edema
A	DM HTN Rt. Humererus pathologic Fx. s/p op.
P	ECG CT Coronary Angio 3D (enhance) Echocardiogram (Doppler, Color)

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S/O

Lab

EKG - R/O Anterior wall ischemia

CT Coronary Angio 3D (enhance)

L main: Calcified plaque without significant stenosis.
LAD and diagonals: Mixed, non-calcified, and calcified plaques of whole LAD with occlusion at pLAD (non-calcified)
Non-calcified and calcified plaque of D2, causing upto 80-90% stenosis.
LCx and obtuse marginal: Focal and diffuse non-calcified plaque of mLCx and OM1, causing 40-50% stenosis.
RCA and PDA: Multifocal mixed and non-calcified palques of RCA, causing upto 60-70% stenosis at mRCA (non-calcified)

TTE

LVEF 57%, RVSP 12 mmHg
Akinesia on mid to apical anteroseptum wall and hypokinesia on inferoseptum wall of LV is suggested
- When compared to the prior study, regional wall motion abnormalities has been newly developed

A

P

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	S/O	P
HD#2	<CAG> Left main : No stenosis or thrombus LAD diffuse concentric stenosis up to 90% on p-d LAD - TIMI 1 diffuse concentric stenosis up to 50% on D1 LCX : diffuse concentric stenosis up to 50% on m-d LCx and pOM RCA : tubular eccentric stenosis upto 70% on mRCA Imp> 3Vd Plan> On site PCI 으로 PCI 시행함	PCI on LAD, mRCA === anti platelet agent
HD#3	ABI-within the normal range 1.30/1.17 cardiac enzyme post 금일 Troponin-I/CK-MB 0.024/0.55→0.320/2.75 lab Lipid profile: C/T/H/L 114/66/23/74 BUN/Cr 25.8/1.44 (31.1/1.67 에서 hydration 유지하며 감소추세, 이전에 base line 1.08~0.85 유지됨) ★ Platelet Drug Response Assay (P2Y12) P2Y12 : 316PRU Base : 318PRU Inhibition : 0%	P2Y12 검사결과 저항성 확인되어 clopidogrel → ticagrelor 로 변경하여 처방함
HD#4	V/S stable s fever chest pain(-)	d/c & opd f/u === Dichlozid tab. 25 mg (Hydrochlorothiazide) 0.5T #1 × 14days Pritor tab. 80 mg (Telmisartan) 1T #1 × 14days Aspirin protect tab. 100 mg (Aspirin) 1T #1 × 14days Sigmart tab. 5 mg (Nicorandil) 2T #2 × 14days Stillen tab. 60 mg (Artemisia asiatica) 2T #2 × 14days Cardiazem tab. 30 mg (Diltiazem) 2T #2 × 14days Dilatren tab. 12.5 mg (Carvedilol) 2T #2 × 14days Brilinta tab. 90 mg (Ticagrelor) 2T #2 × 14days Isoket Spray 15 mL (Isosorbide dinitrate) 1ea #1 × 1days

▼ 퇴원 후 외래 f/u

S/O

P

OPD#1

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OPD#2

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[증례] 호흡곤란(Dyspnea): 심혈관 쪽 원인에 의한 호흡곤란