Mr. Phan, 43 years old, had an acute myocardial infarction and severe chest pain. The doctor discovered hundreds of blood clots blocking most of the coronary arteries.
The patient went to the hospital in Ninh Thuan for emergency treatment after 5 hours of onset of chest pain behind the sternum spreading to the left shoulder and difficulty breathing. After a few hours of medical treatment, his chest pain gradually subsided. Results of cardiac enzyme testing, electrocardiography, and coronary angiography determined that the patient had a myocardial infarction due to complete occlusion of the anterior interventricular artery.
The patient was given anticoagulants and then transferred to Tam Anh General Hospital in Ho Chi Minh City in critical condition due to dense blood clots in the largest blood vessel that feeds the heart.
“In the world, it is very rare for many thrombi to block coronary arteries like this patient,” said Dr. Huynh Ngoc Long, Director of the Vascular Intervention Center, Cardiovascular Center, on June 17.
The patient smoked heavily, more than a pack per day for nearly 20 years. According to Dr. Long, this is a factor that increases the risk of blood clots forming in the coronary arteries, leading to acute myocardial infarction. Tests on hemostasis show that patients are more susceptible to blood clotting than normal people, causing more thrombi to form when there is a rupture or erosion of atherosclerotic plaques in the coronary arteries.
The patient’s coronary artery was filled with a clot (picture A) and after being cleaned, it was recanalized (picture B). Image: Tam Anh Hospital
According to Vo Anh Minh, Head of Coronary Intervention Unit, Cardiovascular Center, Mr. Phan needs thrombectomy intervention, then stent placement to revascularize the coronary artery. However, during intervention, clots can break off and float away, blocking other blood vessels, cutting off blood flow to the heart and causing the patient to have cardiac arrest and sudden death. Blood clots can also float up to the brain’s blood vessels, causing a stroke, or down, causing a blockage in the peripheral blood vessels.
The doctor thought of a plan to continue giving Mr. Phan anticoagulants, after 2-3 days the clot had completely dissolved before inserting a stent. But the patient’s heart function is only 20% (normal people have more than 50%), indicating severe heart failure.
“If you wait a few more days, the patient may develop cardiogenic shock or sudden cardiac arrest,” Dr. Long said. The team decided to perform a “dual procedure”, that is, thrombectomy combined with coronary microvascular dilation drugs and angioplasty and stent placement for the patient.
Mr. Phan was given optimal doses of anticoagulants and antiplatelet drugs to ensure the most effective anticoagulant threshold (ACT). At the same time, the team used a large catheter to vacuum out the blood clot. The cardiopulmonary bypass system (ECMO) is prepared to provide first aid to patients in case of cardiogenic shock due to low blood pressure or arrhythmia.
After 5 suction cycles, hundreds of thrombi were removed from the anterior interventricular artery, paving the way for the team to place a 4.5×15 mm stent to clear the flow. Mr. Phan experienced relief from chest pain and shortness of breath immediately after the intervention. One day later, heart function increased by 43%, blood pressure stabilized, and he was discharged from the hospital after 5 days.
Doctors perform coronary angioplasty for patients. Illustration: Tam Anh Hospital
Myocardial infarction in young people (under 45 years old) often occurs due to thrombosis causing complete blockage or narrowing of one or more coronary artery branches. Causes are stress, obesity, dyslipidemia, unhealthy lifestyle (sedentary, diet high in bad cholesterol…), smoking, alcohol abuse, and stimulant use.
Coronary thrombosis is a serious condition when one or more blood clots form in the blood vessels that supply the heart. Treatment includes medication and revascularization interventions to improve myocardial perfusion. If the size of the thrombus is small, the doctor just needs to place a stent directly. In case of large and numerous thrombi, it is mandatory to evacuate them before stent placement to avoid occlusion of distant vessels and to prevent thrombus from drifting to other blood vessels.
To reduce the risk of coronary thrombosis, Dr. Long recommends quitting smoking, not drinking too much alcohol, having a heart-healthy diet, exercising regularly, and maintaining control of risk factors. such as hypertension, diabetes, and lipid disorders. People who are being treated for cardiovascular disease using anticoagulants need to take the medicine regularly as directed by their doctor.