Welkom bij THIM Hogeschool voor Fysiotherapie & Bohn Stafleu van Loghum
THIM Hogeschool voor Fysiotherapie heeft ervoor gezorgd dat je Mijn BSL eenvoudig en snel kunt raadplegen. Je kunt je links eenvoudig registreren. Met deze gegevens kun je thuis, of waar ook ter wereld toegang krijgen tot Mijn BSL. Heb je een vraag, neem dan contact op met helpdesk@thim.nl.
Om ook buiten de locaties van THIM, thuis bijvoorbeeld, van Mijn BSL gebruik te kunnen maken, moet je jezelf eenmalig registreren. Dit kan alleen vanaf een computer op een van de locaties van THIM.
Eenmaal geregistreerd kun je thuis of waar ook ter wereld onbeperkt toegang krijgen tot Mijn BSL.
Login
Als u al geregistreerd bent, hoeft u alleen maar in te loggen om onbeperkt toegang te krijgen tot Mijn BSL.
A 66-year-old female with a history of cigarette smoking experienced acute pain in the left arm and shoulder with nausea and transpiration. She had not complained of cardiac symptoms before. She was recently treated by her general practitioner with ciprofloxacin because of urinary tract infection. The ambulance electrocardiogram (ECG) showed atrial fibrillation with ST-segment elevation in the inferior leads and reciprocal ST-segment depression in leads I and aVL (figure 1). The diagnosis of ST-segment elevation myocardial infarction (STEMI) was made and treatment with 600 mg clopidogrel, 5000 units of heparin and 250 mg aspirin was initiated in the ambulance. Subsequently she was transported directly to our catheterisation laboratory for primary coronary intervention (PCI). At presentation to the catheterisation laboratory she had less pain, but the nausea was still present. A quick physical examination revealed a height of 172 cm and a weight of 120 kg. The blood pressure was 135/90 mmHg and the pulse irregular at 90 beats/min. Auscultation of the heart and lungs revealed no abnormalities. Coronary angiography (CAG) was performed via the right radial artery, because of extreme obesity. This revealed a normal left coronary artery. The right coronary artery (RCA) was dominant with an abrupt occlusion in the distal RCA after two posterolateral branches (figure 2). After an attempt to pass the occlusion with a rather floppy wire (Wizdom wire, Cordis) the occlusion moved slowly a few centimetres more distally; a new stiffer wire (PT2 light support, Medtronic) could not successfully pass the thrombus but pushed it gradually more distally, revealing several small side branches. Because of the very distal location it was not possible to try to remove the thrombus with a suction device. At the location of occlusion and further on in the course of the recanalised part of the vessel no coronary abnormalities were seen (figure 3). At this point the clinical suspicion of coronary artery embolism as the cause of the STEMI was high. This angiographic appearance together with the atrial fibrillation was highly suggestive. No further intervention was or could be performed because of the distal location of the occlusion with a relatively small area of myocardium at jeopardy with, in the meanwhile, resolution of the anginal complaints. An abciximab bolus was given during the procedure. Heparin IV was given intravenously until the acenocoumarol was in the therapeutic range of the international normalised ratio (INR) and aspirin was continued in a dose of 80 mg. Rate-control strategy was initiated for the atrial fibrillation because it was unclear how long the abnormal rhythm had been present. During further observation, no complications occurred and the day after presentation the patient was transported to a hospital near her home; a few days later she was discharged in good clinical condition.
