بسم الله الرحمن الرحيم
السادة القائمين الافاضل على موقع المستشار .. السلام عليكم ورحمة الله وبركاته .. نشكر لكم هذا الموقع وجعله الله في ميزان حسناتكم وأجزل لكم المثوبة..
جائني قبل حوالي عام من هذا التاريخ نوع من التنميل يبدأ من البطن ثم يرتفع الى الاعلى مثل انسكاب الماء الدافيءمارا بكلتا يداي مع شعور بالغيبوبة وليس بالالم الحادوتأتي في اوقات اكون فيه مرتاح
بدأت بعمل فحوصات كاملة للقلب تخطيط سليم بالجهد سليم الايكو سليم ثم القسطرة للاكتشاف سليم ماعدا تضيق في آخر الشريان الايسر ثم التنظيرالهظمي علوي وسفلي سليم وسبق ان عملت قبل الاثنى عشرة سنة قسطرة واستئصال الظفيرة المسارعة لنبضات القلب حيث كنت اعاني منها واليكم التقارير السابقة واللاحقة ..
السؤال لدي شعور دائما بعودة هذه الاعراض وبعد السطرة واستخدام العلاج اصبت بوهن وآلام غير الاعراض السابقة مثل الم دائم في القفص الصدري والظهر وشعور بالتنميل في الاكتاف حتي في الارجل علما ان تحاليل الشحوم ممتازة والسكر منتظم وهل هذا الشريان سوف يتطور وهل احتاج الى كشف آخر ام ان الدلزيم غير مناسب لي ارجو النصيحة ولكم جزيل الشكر
This gentleman has a 20 year history suggestive of tachycardia. lie was recently seen by
Professor A J Camm who referred him for radiofrequency ablation 01 a left sided anomalous pathway presumed to be responsible for his symptoms. The procedure was as follows:-
DA VID E WARD MD
ST GEORGE'S HOSPITAL LONDON S\V17 OQT
CORRESPONIDENCE TO: 97HARLEY STREF'T' LONDON WIN IDF
TEL: 0181 682 0418
'TEI,: 0171 93537.t7 FAX: 0171 22-1 3.t51
24 August 1995
Radiofrcquencv Ablation Procedure
The right femoral artery and femoral vein were punctured. A Josephson was positioned into
the right heart and a standard Polaris into the left ventricle. At the start of the procedure the
ECG showed pre-excitation With positive Delta waves VI-V6, negative in 3 and AVl:
suggesting a left posterior pathway. The pathway was indeed mapped to a left posterior site at around 5 o' cluck on the mitral annulus looking from below. At the ninth site energy
delivery resulted in block in 6.8 seconds. After half an hour there was complete A V block
"lid no evidence of ventricular pre-excitation.
The procedural details :!!'e as follows '¬
1 hr +30 minutes waiting
- )() ms
Time to Block
1 : 3
This gentleman presented with a left sided accessory pathway presumed to be responsible for his symptoms. Ablation has been successful. Hopefully pre excitation has been permanently abolished.
Or. D. E. Ward
97 Harley Street
Tel.0171 9353747 Fax. 0171 2243451
ee Protesso Camm
وهذا التقرير الاخير
MEDICAL & CATH REPORT
Mr. Mansour is a 50-year-old Saudi gentleman seen in the clinic on the 24th of May 2006 with recurrent history of severe epigastric and retrostemal chest discomfort radiating to the left and right precordium occurring at rest. Over the last few months he had 5 episodes unrelated to exertion. He was thoroughly investigated with an ECG, Echocardiogram, and exercise treadmill test which were negative. He had upper G.I endoscopy which showed only mild reflux with gastric erosions. His symptoms did not improve on Pentazol treatment.
CAD RISK FACTORS:
Include age and gender, in addition to smoking 1-2ppd. He is diabetic for the last 8 years managed with OHG. His lipid profile is unknown. He is not hypertensive. He had family history of IHO in his father in his 70's.
PAST MEDICAL AND SURGICAL HISTORY:
Include radio-frequency ablation for supraventricular arrhythmias and history of
MEDICATIONS AND ALLERGIES:
Include Glucophage OD, Avandia 00, Pentazol 00, Lipitor 20mg at HS OD,
Juspirin 81mg OD, and Motilium 10mg TID.
He was in no apparent distress. His Ht is 165cm and his B. Wt is 96Kgs. His HR is 80/minute regular, of good volume, no special character. His B/P right arm supine and sitting is 130/80mmHg.
His head and neck, chest, cardiovascular, abdominal, and extremity examination showed no significant abnormality except for mild tenderness in the epigastrium which does not reproduce his pain.
The patient had recurrent symptoms despite treatment with Pentazol. He was advised to undergo either nuclear perfusion scan (thallium or sestamibi) which gives the sensitivity of 80% for detection of CAD or undergo coronary angiography which gives the sensitivity of 100% for detection of CAD with quoted risk of 1 in a 1000.
The patient elected to undergo coronary angiography since he lives in a area remote from medical services. He was admitted to SFH after loading dose of Plavix, in addition to ASA for coronary angiography. That was done on the 25th of May 2006 using right femoral approach with 6F sheath and catheters. The left main
coronary artery is normal. The LAD had multiple mild plaques in its mid portion of about 15-20% severity. The circumflex artery is non-dominant and had very small 2nd and 3rd obtuse marginal. He had 50-60% plaque at its distal circumflex artery before the 3rd obtuse marginal branch. The right coronary artery is large and dominant and again had mild plaques in the origin of the PDA branch.
There were no complications. The sheaths were removed and the patient will be
discharged in the evening of the 25th of May.
He was advised to abstain smoking and have a tight control of his BIP and lipid profile. His Lipitor was increased to 40mg OD and he was prescribed Dilzem 60mg BID. His symptoms will be reassessed in one-week time.
50-year-old Saudi gentleman with recurrent episodes of epigastric and C/P,
hyperlipidemia, mild coronary artery disease, will be managed as discussed.