Barbara4198
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PROCEDURES PERFORMED:
1. Left Heart Catheterization
2. Selective Coronary Angiography
3. Proximal Aortogram
4. Left Ventriculogram
5. Graft Angiogram
6. LIMA to LAD angiogram
7. SVG to Ramus angiogram
8. SVG to OM angiogram
9. SVG to RCA angiogram
INDICATIONS:
Evaluation of CAD
Chest Pain
ACS: Non ST-segment elevation myocardial infarction
Angina Class III
Graft Study
HISTORY:
Brief History:
The patient came in through the ER with severe chest pain. There were deep ST
segment depressions in the inferior leads as well as the precordial leads. There
was an elevation in lead aVR about 2 mm and a1 mm elevation in lead aVL.
Lead 1 showed an isoelectric ST segment. The patient had known stenting to
1
the saphenous vein graft to the ramus intermedius in June 2018.. The patient
was on Effient. The EKG findings did not make the diagnosis of a STEMI.
The patient was having global ischemic changes in the EKG and was felt to be
having an acute coronary syndrome/non-STEMI. Initially an attempt at managing
the pain and the ST segment depressions with medical management was done.
The patient was given Dilaudid for analgesia and was also given nitroglycerin
and was given full dose Lovenox SQ. there was minimal improvement in the pain
and this was only transient. There was likewise minimal improvement in the EKG
ST segment changes and this was also only transient. Because of this the
decision was made to take the patient to the cardiac catheterization laboratory.
PROCEDURE TECHNIQUE:
3:33 AM Procedure site was clipped. Patient prepped with chloraprep and
draped in the usual fashion in the cardiac catheterization laboratory. Barbeau
test performed on left wrist. The Barbeau was a A. Lidocaine 2% was used
for local anesthesia. The right femoral approach was used. The artery was
obtained using the Seldinger method. 3:40 AM A 6 Fr 11cm sheath was
inserted in the right femoral artery. 3:41 AM A 4 Fr. 11 cm Sheath Avanti+
was inserted in the right femoral vein. A 6 Fr. LCB 100 cm Guide Catheter was
inserted over a .035" 145cm PTFE J-tip Fixed Core GW. Bypass Graft
angiography performed in multiple views. The 6 Fr. 100cm JL 4 Catheter was
exchanged over the wire for a 4 Fr. 100cm Mod AR Catheter. Bypass Graft
angiography performed in multiple views. The 4 Fr. 100cm Mod AR Catheter
was exchanged over the wire for a 6 Fr. 100cm JL 4 Catheter. Bypass Graft
angiography performed in multiple views. LCA angiography performed in
multiple views. A 6 Fr 110cm Pig 145 was inserted over a .035" 145cm PTFE
J-tip Fixed Core GW. Aortic Root angiography performed. right femoral artery
angiography done for sheath placement. Sheath removed and a Mynx device
deployed successfully. Site without swelling, oozing or hematoma A 2 x 2 cm
and air occlusive dressing was applied. right femoral vein angiography done
for sheath placement. Sheath removed and a Starclose device deployed
successfully. Site without swelling, oozing or hematoma A 2 x 2 cm and air
occlusive dressing was applied.
1. Left Heart Catheterization
2. Selective Coronary Angiography
3. Proximal Aortogram
4. Left Ventriculogram
5. Graft Angiogram
6. LIMA to LAD angiogram
7. SVG to Ramus angiogram
8. SVG to OM angiogram
9. SVG to RCA angiogram
INDICATIONS:
Evaluation of CAD
Chest Pain
ACS: Non ST-segment elevation myocardial infarction
Angina Class III
Graft Study
HISTORY:
Brief History:
The patient came in through the ER with severe chest pain. There were deep ST
segment depressions in the inferior leads as well as the precordial leads. There
was an elevation in lead aVR about 2 mm and a1 mm elevation in lead aVL.
Lead 1 showed an isoelectric ST segment. The patient had known stenting to
1
the saphenous vein graft to the ramus intermedius in June 2018.. The patient
was on Effient. The EKG findings did not make the diagnosis of a STEMI.
The patient was having global ischemic changes in the EKG and was felt to be
having an acute coronary syndrome/non-STEMI. Initially an attempt at managing
the pain and the ST segment depressions with medical management was done.
The patient was given Dilaudid for analgesia and was also given nitroglycerin
and was given full dose Lovenox SQ. there was minimal improvement in the pain
and this was only transient. There was likewise minimal improvement in the EKG
ST segment changes and this was also only transient. Because of this the
decision was made to take the patient to the cardiac catheterization laboratory.
PROCEDURE TECHNIQUE:
3:33 AM Procedure site was clipped. Patient prepped with chloraprep and
draped in the usual fashion in the cardiac catheterization laboratory. Barbeau
test performed on left wrist. The Barbeau was a A. Lidocaine 2% was used
for local anesthesia. The right femoral approach was used. The artery was
obtained using the Seldinger method. 3:40 AM A 6 Fr 11cm sheath was
inserted in the right femoral artery. 3:41 AM A 4 Fr. 11 cm Sheath Avanti+
was inserted in the right femoral vein. A 6 Fr. LCB 100 cm Guide Catheter was
inserted over a .035" 145cm PTFE J-tip Fixed Core GW. Bypass Graft
angiography performed in multiple views. The 6 Fr. 100cm JL 4 Catheter was
exchanged over the wire for a 4 Fr. 100cm Mod AR Catheter. Bypass Graft
angiography performed in multiple views. The 4 Fr. 100cm Mod AR Catheter
was exchanged over the wire for a 6 Fr. 100cm JL 4 Catheter. Bypass Graft
angiography performed in multiple views. LCA angiography performed in
multiple views. A 6 Fr 110cm Pig 145 was inserted over a .035" 145cm PTFE
J-tip Fixed Core GW. Aortic Root angiography performed. right femoral artery
angiography done for sheath placement. Sheath removed and a Mynx device
deployed successfully. Site without swelling, oozing or hematoma A 2 x 2 cm
and air occlusive dressing was applied. right femoral vein angiography done
for sheath placement. Sheath removed and a Starclose device deployed
successfully. Site without swelling, oozing or hematoma A 2 x 2 cm and air
occlusive dressing was applied.