洗腎患者心跳突然下降，心導管檢查結果如何？-心臟血管專科

洗腎掉血壓時連帶心跳數也掉？

醫師您好本身是洗腎一年多的病患 三高都有 也有冠心病 輕度心律不整 去年做過一次心導管結果是2條血管各塞40%跟50% 醫師說不到70%一般不處理 吃藥就好最近半個月洗腎時掉過2次血壓 症狀都是冒冷汗 嘔吐 暈到幾乎昏過去 連帶心跳也掉 第一次掉到41下 第二次甚至掉到28下 但在停止洗腎休息號就恢復正常(平常因為有吃康肯所以心跳本就不快 休息時約5X到6X) 這一年來也掉過幾次血壓 但也沒掉過心跳 這半個月的2次才這樣上週做心肌灌注後醫生建議再做心導管 說心肌缺血12%(第一次) 16%(第二次)現在是擔心要是心導管還是說不到70%不處理 那掉心跳的問題該怎麼解決?附上報告去年做的心導管Indication : (Stress Test)TL-201(SPECT)Pre-Cath Diagnosis :Chronic CADPost-Cath Diagnosis :1VD-CADIntervention :NoComplication:NoStent :NOProcedure Time : ( Start 17:02 Close 17:14 Mins 12 )Contrast：Visipaque： 35 ml Vascular Access :Artery, Trans-radial ( R’t )Intervention Methods :Additional Procedure :None Hemodynamic: AsAo 130-/70 mmHgCoronary Angiography: - Dominant(R’t) - LM -normal - LAD -50％ stenosis, mid-LAD - LCX -40％ stenosis - RCA -Insignificant stenosis - Ramus - - Collateral - - SYNTAX score- Others(Selective Angiography): Intervention Procedure: Recommendation: Medical treatment including risk factors modification去年9月做的24小時攜帶式心電圖1. Normal sinus rhythm at baseline ( 51-99 bpm, ave= 67 bpm )2. Transient T inversion at mid-night, cause undetermined3. 164 isolated VPCs, 13 VPC couplets4. No significant tachyarrhythmia and long pause去年9月做的心臟超音波1. Dilated LA ( 42mm) and LV ( 55 , 29mm) chamber sizes ; concentric LVH with normal LV systolic wall motion ; LVEF: 79%2. Mild to moderate aortic regurgitation3. Mild mitral regurgitation ; reversed MV E/A ratio , suggested diastolic dysfunction4. Minimal pulmonic regurgitation5. Mild tricuspid regurgitation with peak pressure gradient 24 mmHg今年10月做的24小時攜帶式心電圖1. Normal sinus rhythm at baseline ( 47-90 bpm, ave= 62 bpm )2. 2 isolated APCs3. 19 isolated VPCs4. No significant tachyarrhythmia and long pause今年10月做的心臟超音波Poor echo window Concentric LVH , dilated LA(41mm) Impaired LV and RV relaxation Mild PR, trivial TR (PG=21.2 mmHg), mild MR and mild AR Adequate LV and RV systolic function (LVEF=72%) Normal LV and RV wall motion另外想請問 去年左心室射出還有79% 今年就只剩72% 請問是否會逐年降低到心衰呢?抱歉問題有點多 因為真的很擔心 心跳掉到28下讓我極度恐懼!