Clinical Case Database / Category: Patient Management
An approach to the unwell patient post-PCI
Peregrine Green, Andrew Jordan
Foundation Years Journal, volume 8, issue 2, p.12 (123Doc Education, London, February 2014)
As percutaneous coronary intervention (PCI) becomes more prevalent, it is increasingly likely that Foundation doctors will be required to review those patients who have undergone this procedure when they become unwell, and carry out appropriate initial investigation and management. We present a fictional case of hypotension in a patient who has recently undergone PCI. This is a not uncommon scenario, and one for which there is a broad differential. We discuss these key differential diagnoses, and show how a structured approach to history and examination can allow them to be narrowed down
to a final diagnosis, allowing prompt and appropriate management.
Access the Clinical Cases Database
A subscription is required to read the full article. Please subscribe using one of the options below.
|Foundation Years Clinical Cases Database||£29.00||6 months|
|Foundation Years Clinical Cases Database||£39.00||12 months|
CMT 2, Royal Bournemouth Hospital
Cardiology ST5, Southampton General Hospital
1. Valle JA, Smith DE, Booher AM, Menees DS, Gurm HS. Cause and circumstance of in-hospital mortality among patients undergoing contemporary percutaneous coronary intervention: a root-cause analysis. Circ. Cardiovasc Qual Outcomes 2012, 5(2):229-35
2. DâAscenzo F, Bollati M, Clementi F, et al. Incidence and predictors of coronary stent thrombosis: Evidence from an international collaborative meta-analysis including 30 studies, 221,066 patients, and 4276 thromboses. Int J Cardiol 2012. Epub ahead of print.
5. Harrison RW, Aggarwal A, Ou FS, et al. Incidence and Outcomes of No-reflow Phenomenon During Percutaneous Coronary Intervention Among Patients With Acute Myocardial Infarction. Am J Cardiol 2013, 111(2):178-84
10. Biancari F, DâAndrea V, Di Marco C, Savino G, Tiozzo V, Catania A. Meta-analysis of randomized trials on the efficacy of vascular closure devices after diagnostic angiography and angioplasty. Am Heart J 2010, 159(4):518-31
12. Trimarchi S, Smith DE, Share D et al. Retroperitoneal hematoma after percutaneous coronary intervention: prevalence, risk factors, management, outcomes, and predictors of mortality: a report from the BMC2 (Blue Cross Blue Shield of Michigan Cardiovascular Consortium) registry. JACC Cardiovasc Interv 2010, 3(8):845-50
Conflict Of Interest
The Journal requires that authors disclose any potential conflict of interest that they may have. This is clearly stated in the Journal’s published “Guidelines for Authors”. The Journal follows the Guidelines against Conflict of Interest published in the Uniform Requirements for Manuscripts Submitted to Biomedical Journals (http://www.icmje.org/urm_full.pdf).
The authors of this article have not been paid. The Journal is financed by subscriptions and advertising. The Journal does not receive money from any other sources. The decision to accept or refuse this article for publication was free from financial considerations and was solely the responsibility of the Editorial Panel and Editor-in-Chief.
Patient Consent statement
All pictures and investigations shown in this article are shown with the patients’ consent. We require Authors to maintain patients’ anonymity and to obtain consent to report investigations and pictures involving human subjects when anonymity may be compromised. The Journal follows the Guidelines of the Uniform Requirements for Manuscripts (http://www.icmje.org/urm_full.pdf). The Journal requires in its Guidelines for Authors a statement from Authors that “the subject gave informed consent”.
Animal & Human Rights
When reporting experiments on human subjects, the Journal requires authors to indicate whether the procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the HelsinkiDeclaration of 1975, as revised in 2008.
About the Clinical Cases Database
The Foundation Years Clinical Cases Database is a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.
The database is fully searchable, or can be browsed by medical specialty. Abstracts can be read free of charge, however a subscription is required in order to read the complete cases.