Alfaro33
Networker
For below cardiac cath DOE noted as pre and post diagnosis however, stenosis was found. Would you assign DOE or Stenosis? Thanks for your input!
Procedure done:
Left cardiac catheterization.
Coronary angiogram.
LV gram.
Left radial arterial access under sonographic guidance using micropuncture technique.
Moderate Sedation under my supervision for 15 minutes.
Indication of the procedure: Dyspnea on exertion symptoms suggestive of angina pectoris.
Brief history:
76-year-old male with history of hypertension, hyperlipidemia. Patient presented with symptoms of dyspnea on exertion suggestive of angina. Stress test was suggestive of anterior wall defect and reduced ejection fraction. Patient was subsequently referred for cardiac catheterization.
Technique:
Patient was consented for the procedure. Access was established via left radial artery with a 5 French sheath under sonographic guidance using micropuncture technique. Using a JL 3.5 catheter, left main was engaged. Angiogram revealed left main to be patent. The LAD is a moderate to large size vessel with mid 30-40% plaque disease. There is a diagonal branch with 70% calcified plaque disease. There are 2 ramus branches with proximal 60-70% narrowing. The circumflex artery is a moderate-sized codominant vessel with 40-50% narrowing. Following that using a JR4 catheter, RCA was engaged. Angiogram revealed RCA to be a moderate-sized vessel with 40% plaque disease. Using a pigtail catheter LV g was done. LVEDP was 29 with no significant gradient across the aortic valve an EF was estimated visually around 50-55%. Patient received moderate sedation with Versed and fentanyl under my direct supervision for 15 minutes.
Anesthesia: 2% lidocaine.
Post-op diagnosis: Same.
Estimated blood loss: 3 cc.
Complications: No immediate complications.
Conclusion:
Left main: Patent.
Lad: 30-40% midvessel plaque disease.
Diagonal branch: 70% calcified plaque disease.
Two ramus branches: Proximal 60-70% narrowing.
Circumflex artery: 40-50% narrowing.
RCA: 40% plaque disease.
EF: Around 50-55%.
Recommend:
Aggressive medical therapy risk factor modifications.
Procedure done:
Left cardiac catheterization.
Coronary angiogram.
LV gram.
Left radial arterial access under sonographic guidance using micropuncture technique.
Moderate Sedation under my supervision for 15 minutes.
Indication of the procedure: Dyspnea on exertion symptoms suggestive of angina pectoris.
Brief history:
76-year-old male with history of hypertension, hyperlipidemia. Patient presented with symptoms of dyspnea on exertion suggestive of angina. Stress test was suggestive of anterior wall defect and reduced ejection fraction. Patient was subsequently referred for cardiac catheterization.
Technique:
Patient was consented for the procedure. Access was established via left radial artery with a 5 French sheath under sonographic guidance using micropuncture technique. Using a JL 3.5 catheter, left main was engaged. Angiogram revealed left main to be patent. The LAD is a moderate to large size vessel with mid 30-40% plaque disease. There is a diagonal branch with 70% calcified plaque disease. There are 2 ramus branches with proximal 60-70% narrowing. The circumflex artery is a moderate-sized codominant vessel with 40-50% narrowing. Following that using a JR4 catheter, RCA was engaged. Angiogram revealed RCA to be a moderate-sized vessel with 40% plaque disease. Using a pigtail catheter LV g was done. LVEDP was 29 with no significant gradient across the aortic valve an EF was estimated visually around 50-55%. Patient received moderate sedation with Versed and fentanyl under my direct supervision for 15 minutes.
Anesthesia: 2% lidocaine.
Post-op diagnosis: Same.
Estimated blood loss: 3 cc.
Complications: No immediate complications.
Conclusion:
Left main: Patent.
Lad: 30-40% midvessel plaque disease.
Diagonal branch: 70% calcified plaque disease.
Two ramus branches: Proximal 60-70% narrowing.
Circumflex artery: 40-50% narrowing.
RCA: 40% plaque disease.
EF: Around 50-55%.
Recommend:
Aggressive medical therapy risk factor modifications.