SMOKING AND MULTIARTERIAL CORONARY DISEASE: A CASE REPORT

Abstract

THE CONSUMPTION OF TOBACCO PRODUCTS CAUSES ALMOST 50 DIFFERENT DISEASES, MAINLY CARDIOVASCULAR DISEASES. CARDIOVASCULAR DISEASES ARE THE MAIN CAUSES OF DEATH DUE TO ILLNESS IN BRAZIL. CORONARY DISEASE IS THE RESULT OF THE FORMATION OF ATHEROSCLEROSIS PLAQUES, WHICH ARE FIBROUS TISSUE PLAQUES AND CHOLESTEROL. THE GROWTH OF THIS LESION CAN BE ACCELERATED BY SMOKING. TYPICALLY IN THE CORONARY CIRCULATION, WHEN CHRONIC OCCLUSION REACHES 70%, THE FLOW IS COMPROMISED AND DEMAND EXCEEDS SUPPLY. CORONARY ARTERY DISEASE (CAD) IS CHARACTERIZED BY INSUFFICIENT BLOOD SUPPLY TO THE HEART THROUGH THE CORONARY ARTERIES. GIVEN THE ABOVE, THIS PAPER AIMS TO REPORT A CASE OF MULTIARTERIAL CORONARY ARTERY DISEASE. PATIENT OF 57 YEARS, MALE, BROWN, CHRONIC SMOKER AND ALCOHOLIC WITH AN ULCERATED LESION OF 60% IN THE DISTAL THIRD OF THE TRUNK, WITH A LESION OF 90 % IN THE ORIGIN OF THE SECOND DIAGONAL BRANCH OF FINE CALIBER AND 70% LESION IN THE PROXIMAL THIRD OF THE FIRST LEFT MARGINAL BRANCH OF FINE CALIBER. AN OBSTRUCTIVE CORONARY ARTERY DISEASE WAS DIAGNOSED, BEING A MULTIARTERIAL CORONARY DISEASE. THE MEDICAL TEAM EVALUATED THE CASE AND DETERMINED SURGICAL INTERVENTION, AND TWO MYOCARDIAL REVASCULARIZATIONS WERE PERFORMED. THE SURGICAL APPROACH USED WAS MINIMALLY INVASIVE, PERFORMING A LEFT ANTERIOR THORACOTOMY IN THE FOURTH INTERCOSTAL SPACE OF APPROXIMATELY 6 CENTIMETERS. SURGERY WITHOUT COMPLICATIONS. PATIENT WAS DISCHARGED FROM THE FIFTH OP. PATIENT RETURNED AFTER 5 DAYS AND NO INTERCURRENCE WAS DETECTED. CABG WAS SUPERIOR TO TM (MEDICATION THERAPY) AND PCI (PERCUTANEOUS CORONARY INTERVENTION) FOR THE COMBINED OUTCOMES OF AMI (ACUTE MYOCARDIAL INFARCTION), ADDITIONAL REVASCULARIZATION, AND MORTALITY. THEREFORE IT IS POSSIBLE THAT SURGICAL PATIENTS HAVE A BETTER PROGNOSIS. THEREFORE, CRM, IN ADDITION TO BEING MORE POSITIVE, ALSO HAS A VERY EFFECTIVE REPERCUSSION IN THE CESSATION OF SMOKING, A PRECORDIAL FACTOR IN THE DEVELOPMENT OF CAD. THUS, THE CONDUCT AND PROCEDURES PERFORMED BY THE TEAM WERE ADEQUATE AND RECOMMENDED ACCORDING TO THE LITERATURE.