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What Causes Jaw Pain And Increased Sweating?
Question: Chief complaints/Reason for admission:
This is a 33-year-old gentleman who presented with a jaw pain and sweating.
History of present Illness
This member presented to the Emergency Department on 29th August 2015 at 02:00 PM, with complaints of jaw pain and increased sweating. The ECG was done which was positive for inferolateral myocardial infarction. Based on the clinical findings and signs & symptoms, the member was admitted for further evaluation and management.
Past medical/surgical history:
He is a known case of Diabetes Mellitus and Hyperlipidemia.
Investigations:
Cardiac Enzymes (29.08.2015):
• CKMB: 9.4 ng/mL (elevated)
• Myoglobin: 89.1 ng/mL
• Troponin I: 1.6 ng/mL (elevated)
Coronary Angiogram (29.08.2015):
• LMCA : about 1 cm, intact
• LAD : Large vessel, diffusely diseased with multiple irregularities, proximal 80% lesion at the site of S1, another mid lesion of 80% after origin of D1 which showed proximal 50-60% lesion.
• LCX : Co-dominant, diffusely diseased but no significant lesion.
• RCA : Co-dominant, severely diffusely diseased and tortuous. Gives multiple PDA and PLV branches. PL showed ostial 95%, distal 99% lesions just before bifurcation into PDA branch.
• Impression: Double vessel disease (Normal LVEF by echo). Recommended to undergo PTCA stent to proximal-mid LAD and PLV.
Coronary Angioplasty OT notes (29.08.2015):
• LCA cannulated with 6F XB 3.5 guiding catheter and the LAD lesion crossed with 0.014" XXXXXXX wire. Pre-dilated with 2.5 x 10 mm XXXXXXX Supercross balloon. Proximal LAD stented with 3.5 x 14 mm Biomatrix neoflex stent at 14 atms. Mid LAD stented with 2.5 x 24 mm Bomatrix neoflex stent at 16 atms overlapping the proximal stent. Post dilatation in proximal stent done with 3.5 x 15 mm Hiryu balloon at 20 atms. Post dilatation in between two stents done with 3.5 x 15 mm Hiryu balloon at nominal 10atms.
• RCA cannulated with 6F JR 3.5 guiding catheter and PLV lesion crossed with 0.014" XXXXXXX wire. Multiple predilatations done with 1.2 x 8 mm Minitrek and 2.5 x 12 mm XXXXXXX Supercross balloons respectively. Stent was not put in this location as it was very distal and result was very satisfactory.
• Final angio showed well deployed stents with good distal flow and right femoral artery closed with 6F Angioseal. The procedure was uneventful.
• Hardware used:
o 6F XB 3.5 guiding catheter.
o 6F JR 3.5 guiding catheter.
o 0.014'" XXXXXXX wire.
o 2.50 X 12 mm XXXXXXX Supercross balloon.
o 3.5 X 14 mm Biomatrix Neoflex stent.
o 2.5 X 24 mm Biomatrix Neoflex stent.
o 3.5 X 15 mm Hiryu balloon.
o 1.2 X 8 mm Minitrek balloon.
Diagnosis:
Non ST- elevation MI.
Hospital plan:
• Medical treatment
o Days of admission: 1 day admission in ICU.
o Management plan: Pre and Post surgery management.
• Surgical treatment
o Procedure: Coronary Angiography with Angioplasty + 2DES + 2 balloons.
o Indication: Non ST elevation myocardial infarction.
concern:
Could you confirm whether he is a candidate for CABG and whether PCI done in this case is first preferred treatment or not?
This is a 33-year-old gentleman who presented with a jaw pain and sweating.
History of present Illness
This member presented to the Emergency Department on 29th August 2015 at 02:00 PM, with complaints of jaw pain and increased sweating. The ECG was done which was positive for inferolateral myocardial infarction. Based on the clinical findings and signs & symptoms, the member was admitted for further evaluation and management.
Past medical/surgical history:
He is a known case of Diabetes Mellitus and Hyperlipidemia.
Investigations:
Cardiac Enzymes (29.08.2015):
• CKMB: 9.4 ng/mL (elevated)
• Myoglobin: 89.1 ng/mL
• Troponin I: 1.6 ng/mL (elevated)
Coronary Angiogram (29.08.2015):
• LMCA : about 1 cm, intact
• LAD : Large vessel, diffusely diseased with multiple irregularities, proximal 80% lesion at the site of S1, another mid lesion of 80% after origin of D1 which showed proximal 50-60% lesion.
• LCX : Co-dominant, diffusely diseased but no significant lesion.
• RCA : Co-dominant, severely diffusely diseased and tortuous. Gives multiple PDA and PLV branches. PL showed ostial 95%, distal 99% lesions just before bifurcation into PDA branch.
• Impression: Double vessel disease (Normal LVEF by echo). Recommended to undergo PTCA stent to proximal-mid LAD and PLV.
Coronary Angioplasty OT notes (29.08.2015):
• LCA cannulated with 6F XB 3.5 guiding catheter and the LAD lesion crossed with 0.014" XXXXXXX wire. Pre-dilated with 2.5 x 10 mm XXXXXXX Supercross balloon. Proximal LAD stented with 3.5 x 14 mm Biomatrix neoflex stent at 14 atms. Mid LAD stented with 2.5 x 24 mm Bomatrix neoflex stent at 16 atms overlapping the proximal stent. Post dilatation in proximal stent done with 3.5 x 15 mm Hiryu balloon at 20 atms. Post dilatation in between two stents done with 3.5 x 15 mm Hiryu balloon at nominal 10atms.
• RCA cannulated with 6F JR 3.5 guiding catheter and PLV lesion crossed with 0.014" XXXXXXX wire. Multiple predilatations done with 1.2 x 8 mm Minitrek and 2.5 x 12 mm XXXXXXX Supercross balloons respectively. Stent was not put in this location as it was very distal and result was very satisfactory.
• Final angio showed well deployed stents with good distal flow and right femoral artery closed with 6F Angioseal. The procedure was uneventful.
• Hardware used:
o 6F XB 3.5 guiding catheter.
o 6F JR 3.5 guiding catheter.
o 0.014'" XXXXXXX wire.
o 2.50 X 12 mm XXXXXXX Supercross balloon.
o 3.5 X 14 mm Biomatrix Neoflex stent.
o 2.5 X 24 mm Biomatrix Neoflex stent.
o 3.5 X 15 mm Hiryu balloon.
o 1.2 X 8 mm Minitrek balloon.
Diagnosis:
Non ST- elevation MI.
Hospital plan:
• Medical treatment
o Days of admission: 1 day admission in ICU.
o Management plan: Pre and Post surgery management.
• Surgical treatment
o Procedure: Coronary Angiography with Angioplasty + 2DES + 2 balloons.
o Indication: Non ST elevation myocardial infarction.
concern:
Could you confirm whether he is a candidate for CABG and whether PCI done in this case is first preferred treatment or not?
Brief Answer:
CABG preffered, however by angioplasty report, they have done a good job
Detailed Answer:
Hello, I am Dr. Mody and I would be addressing your concern.
Firstly I would thank you for such detailed history.
I could only upload the ekg pdf. The other doesn't seem to have any content, so if you want me to go through it please do upload it again.
Now if we go by the fact that he is diabetic, had severe and diffuse vessels and the ecg shows stable rhythm and echo, according to me a bypass surgery with Lima to lad & end arterectomy would be the first choice. Here my advice is based on XXXXXXX and European guidelines of 2014-15 for such case, as they are known to give good long term results.
However before you draw conclusion, the decision would vary case to case and in case your doctor feels that establishing flow at earliest will help the patient he will have taken the same decision.
Sometime when the patient has ongoing chest pain (ischaemia), hemodynamically unstable, blood pressure going low, pulse falling,then rescue angioplasty is a option.
Now as the patient is young, the doctor and patient after discussion of pros and cons can opt, for angioplasty as it may buy him some years (a decade or so) from a bypass.
All said and done I would like to reinforce the fact that as per his age the patient has severe coronary artery disease. He should be now strict with the medication and lifestyle change. If not now it will be too late.
If you have any doubt you may ask me and I will be happy to clear it.
Bypass or angioplasty depends on many factors, but of all the information given for this case bypass would have been the preferred option.
CABG preffered, however by angioplasty report, they have done a good job
Detailed Answer:
Hello, I am Dr. Mody and I would be addressing your concern.
Firstly I would thank you for such detailed history.
I could only upload the ekg pdf. The other doesn't seem to have any content, so if you want me to go through it please do upload it again.
Now if we go by the fact that he is diabetic, had severe and diffuse vessels and the ecg shows stable rhythm and echo, according to me a bypass surgery with Lima to lad & end arterectomy would be the first choice. Here my advice is based on XXXXXXX and European guidelines of 2014-15 for such case, as they are known to give good long term results.
However before you draw conclusion, the decision would vary case to case and in case your doctor feels that establishing flow at earliest will help the patient he will have taken the same decision.
Sometime when the patient has ongoing chest pain (ischaemia), hemodynamically unstable, blood pressure going low, pulse falling,then rescue angioplasty is a option.
Now as the patient is young, the doctor and patient after discussion of pros and cons can opt, for angioplasty as it may buy him some years (a decade or so) from a bypass.
All said and done I would like to reinforce the fact that as per his age the patient has severe coronary artery disease. He should be now strict with the medication and lifestyle change. If not now it will be too late.
If you have any doubt you may ask me and I will be happy to clear it.
Bypass or angioplasty depends on many factors, but of all the information given for this case bypass would have been the preferred option.
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Sonia Raina
Answered by
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