Patient: Male, 54 years old, second heart attack. He was admitted to the First Affiliated Hospital of Shanxi Medical University mainly because of “intermittent precordial suffocating pain for 3 years, aggravated for 5 days. 3 years ago, he was diagnosed with acute anterior and inferior wall myocardial infarction when he had chest pain and pain radiating to the back during activity, accompanied by dizziness, blurred vision and dry cough. He was treated conservatively and discharged after remission. In the afternoon of January 22, 2012, he felt chest tightness and shortness of breath on his way to work, not accompanied by nausea and vomiting, which was relieved after taking a quick-acting heart pill for 20 minutes; on January 26, he had such symptoms again, which could not be relieved by taking a heart pill, so he was admitted to the hospital for treatment. At the time of this admission, troponin 21.4/L, CK-MB 103u/L. Smoking age 40 years, 1 pack/day. 1, Three years ago, conservative treatment was taken, with drug maintenance as the mainstay. 2.This time, a cardiac ultrasound suggested: segmental ventricular wall motion abnormalities (consistent with post-infarction changes), left ventricular enlargement, and reduced left ventricular systolic function (LVEF about 25%). Ultrasound description: left ventricular enlargement, thinning of the left ventricular anterior wall and apical segments, no motion, and outward expansion of the apical segments. 3.Electrocardiographic analysis: inferior and anterior wall myocardial infarction. 4.Diagnostic opinion of resting myocardial imaging: myocardial infarction and/or severe ischemic changes in the left ventricular apical, inferior posterior, interstitial and lateral walls, markedly reduced to no motion of the corresponding ventricular walls, mild enlargement of the left ventricular chambers, and overall reduced systolic function of the left ventricle.EF: 36%. 5. PET/CT diagnostic opinion: no significant metabolism was seen in the left ventricular apical and anterior interventricular walls, and the metabolism of the lateral walls was significantly reduced, with matching changes in perfusion, suggesting no cardiomyocyte survival or little cardiomyocyte survival. FDG uptake in the inferior posterior and posterior interventricular walls of the left ventricle showed mismatched changes with perfusion, suggesting that most of the myocardium survived. Can you give some treatment suggestions in the context of poor family economy? Yangming Ke: If we don’t consider the economic factors, first of all, we should open the coronary artery that indicates the surviving myocardium on PET, and we can consider stenting or bypass, and hope that this part of ischemic myocardium can slowly return to normal. ——– The cost of angiography and stenting is about 30,000-50,000, and the cost of bypass surgery is about 50,000-60,000. Secondly, if the LVEF is still less than 35% on recheck 6 weeks after the second heart attack, ICD implantation should be considered. —— about 100,000. This is an insurance, because such a heart can occur at any time ventricular fibrillation ventricular tachycardia, resulting in sudden death, this ICD can save lives (can save 50 times) in critical moments (need to be replaced after 6-8 years). Finally, long-term medication: secondary prevention drugs for coronary heart disease + anti-heart failure drugs (beta-blockers + AECI). You can only combine your family’s financial situation to see which option you can choose to treat.