Patient is a 67-year-old male with a past medical history of hypertension and hyperlipidemia who presents for diagnostic coronary artery catheterization with possible intervention due to unstable angina.
Summary:
- In summary, a 90% stenosis was found in the proximal left anterior descending artery. A PTCA balloon was used, followed by the placement of a 3.0 x 18 mm DES stent. No balloon pump or impella placement was required.
- LVEDP: 18 mm Hg
- LV EF: 55%
Right Heart Catheterization:
- RA Pressure: 5 mm Hg
- RV Pressure: 25/5 mm Hg
- PA Pressure: 25/10 mm Hg
- PCWP: 12 mm Hg
- PA Saturation: 98%
- RA Saturation: 75%
- CO: 5.0 L/min
- CI: 2.5 L/min/m^2
Procedures Performed:
- Coronary Angiography (Judkins Left 4)
- PTCA (Emerge 2.5 x 15 mm balloon)
- DES Placement (Xience 3.0 x 18 mm)
Interventions:
- Lesion Location: Proximal left anterior descending artery, 90% stenosis
- Guide: EBU 3.5
- Wire: BMW Universal
- Imaging: IVUS used, MLA 4.5 mm², MSA 5.0 mm², fibrous plaque morphology
- PTCA Pre: Emerge 2.5 x 15 mm balloon
- DES: Xience 3.0 x 18 mm
- PTCA Post: NC Trek 3.5 x 15 mm balloon
- Stenosis: Pre: 90% Post: 0%
- TIMI grade: Pre: 1 Post: 3
Recommendations:
- ASA + Brilinta for 12 months; high-intensity statin, beta blocker
- IV fluids post-catheterization per Poseidon protocol
- Monitor access site above per protocol
- Monitor vitals, telemetry, labs with renal function & CBC
- Risk factor management with lifestyle modifications - diet, exercise, weight loss, medical compliance
- Follow-up in cardiology outpatient clinic in 1 week after discharge with primary cardiologist.
Coronary Anatomy:
Dominance: Right dominant
Left Main Coronary Artery: Normal
Left Anterior Descending Coronary Artery: Proximal 90% stenosis
Ramus Intermedius: Not present
Left Circumflex Coronary Artery: Minor irregularities
Right Coronary Artery: Normal
Dr. Thomas Kelly
MD, FACC
