New-Onset Atrial Fibrillation in a Stable Patient with Remote Percutaneous Coronary Intervention
Gender: female.
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New-Onset Atrial Fibrillation in a Stable Patient with Remote Percutaneous Coronary Intervention Juan M. Ruiz-Nodar, Tatjana S. Potpara, and Francisco Marín
8.1
Case Presentation
8.1.1
Baseline Characteristics
• Gender: female. • Age: 73 years. • Cardiovascular risk factors: type 2 diabetes mellitus, hypertension, hypercholesterolemia. • Previous history: 3 years earlier, anterior ST-elevation myocardial infarction (STEMI) because of which percutaneous coronary intervention (PCI) with implantation of two new-generation drug (zotarolimus)-eluting stents (Resolute, Medtronic, 3 × 22 and 2.5 × 18 mm) (Table 8.1) in the left anterior descending (LAD) was performed, followed after 48 h by another PCI with implantation of two new-generation drug (zotarolimus)-eluting stents (Resolute, Medtronic, 3.5 × 22 and 3.5 × 15 mm) (Table 8.1) in the right coronary artery (RCA) that was performed in two separate sessions
J.M. Ruiz-Nodar Department of Cardiology, Hospital General Universitario de Alicante, Alicante, Spain T.S. Potpara School of Medicine, Belgrade University, and Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia e-mail: [email protected] F. Marín (*) Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca Ctra Madrid-Cartagena s/n 30120 Murcia, Spain e-mail: [email protected] © Springer International Publishing Switzerland 2017 A. Rubboli, G.Y.H. Lip (eds.), Atrial Fibrillation and Percutaneous Coronary Intervention, DOI 10.1007/978-3-319-42400-2_8
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(Figs. 8.1, 8.2, and 8.3). The left circumflex (LCX) was considered chronically occluded, and it was therefore decided to treat the lesion only if symptoms would occur during follow-up. Pre-discharge echocardiography showed a hypertrophic left ventricle with mild anterior hypokinesia and slightly decreased ejection fraction (50 %), together with mild dilatation of left atrium. Therapy at discharge included aspirin 100 mg once daily and prasugrel 10 mg once daily, together with bisoprolol 5 mg once daily, ramipril 10 mg once daily, atorvastatin 80 mg once daily, metformin 850 mg twice daily, and insulin. After 12 months, in the absence of recurrent coronary events and bleeding, prasugrel was withdrawn, and aspirin only continued lifelong. • Current history: the patient referred herself to the emergency department because of tiredness, dizziness, and occasional palpitations over the previous 2 weeks. Indeed, short self-limiting episodes of palpitations first occurred several months earlier, with progressive worsening over the last 2 weeks. Upon physical examination, blood pressure was 165/91 mmHg, and an irregularly irregular and accelerated pulse was detected. An electrocardiogram (ECG) showed atrial fibrillation (AF) with ventricular rate approximately 89 bpm and pathological Q waves in precordial leads V1–V2 (Fig. 8.4). Ongoing therapy included aspirin 100 mg once daily, bisoprolol 5 mg once daily, ramipril 10 mg once daily, amlodipine 10 mg once daily, atorvastatin 80 mg once daily, me
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