Here's the full report.
Procedure: Left Cardiac Catheterization, Left Ventriculography,
Coronary Angiography and Arch Aortography
Indications: Recurring chest pain with negative stress testing.
Shortness of breath.
Providers:
Referring MD:
Procedure Medications:
Isovue 409 mL.
Total IV Fluids Administered
- IV Fluids: 0.9NaCl IV started @ kvo ml/hr IV Fluids
Oxygen: Started @ 2 L/min via nasal cannula
Midazolam (Versed) 2 mg IV.
Fentanyl (Sublimaze) 50 mcg IV.
Local Anesthetic to right groin 19 ml Lidocaine 2% >Initial mL, local
infiltration.
Oxygen: Increased to 4 L/min via nasal cannula
Oxygen: Increased to 6 L/min via nasal cannula
Total Diag Contrast: Isovue 409 ml's
Total Proc Contrast: Isovue 409 ml
Complications: No immediate complications.
Patient History:
PROCEDURE 2 Aortic Root
Pt Status: Admission Status: Outpatient Referral
Pt Status: Patient Admission Type >> Outpatient
Pt Status: Cath Status: Elective
Pt Status: PCI Status: Elective
Pt Status: Insurance Payor: Commercial
Hx/Risk Factors: BP Problems: Hypertension
Hx/Risk Factors: R/O CAD - Stress Test: Yes Positive
Hx/Risk Factors: Chest Pain/Angina
Previous Procedures: NONE
ALLERGIES: NKDA
Beta Blocker-Beta Blocker > Yes
Description of Procedure:
Approach:
- Right femoral artery. Access method: Percutaneous puncture.
Fluoroscopy
- Fluoroscopy time: 13.6 minutes.
Devices Used
- Boston Scientific Fixed Core 3mm J .035" 145 cm
- Boston Scientific 5 Fr. FL 4.0 cm
- Boston Scientific 5 Fr.Fr 4.0 cm
- Boston Scientific 5 Fr. Pigtail Straight
- Terumo Standard 5 Fr.
- Boston Scientific 5 Fr. IMA Regular
- Boston Scientific 5 Fr. AL 1.0
- Boston Scientific 5 Fr. AR 1
- Boston Scientific 5 Fr. MP A2 - 100 cm
- Cordis Standard 6 Fr.
- Mynx
- 6Fr CLS 3.0 Boston Scientific RunWay
- 6Fr Hockey stick Boston Scientific RunWay
- 6Fr IMA Boston Scientific RunWay
- Namic 12 cc Control
Closure
- At the conclusion of the procedure, the right femoral artery sheath
was removed.
- Hemostasis was obtained with the Mynx.
Findings/Interventions:
Left Ventriculography
- The overall left ventricular systolic function was normal. Left
ventricular ejection fraction was 55-60%.
Left Main Coronary Artery
- There were no obstructing lesions in the left main coronary artery.
Blood flow appeared normal.
Left Anterior Descending Artery
- There was a 30 to 40% discrete stenosis in the proximal left anterior
descending artery. The proximal LAD had vasospasm during injection
relieved with nitroglycerin.
Left Circumflex Artery
- There was a 30% discrete stenosis in the proximal left circumflex
artery.
Right Coronary Artery
- Anomalous origin off the left coronary cusp. The right coronary artery
was dominant to the posterior circulation. There was a 30% discrete
stenosis in the mid right coronary artery. There was a 30% discrete
stenosis in the distal right coronary artery.
Aortography Injections
- The pigtail catheter was advanced into the aortic arch and an
injection of contrast was performed.
Aorta and Major Vessels
- There was mild atherosclerotic plaque of the aortic arch.
Impression:
Minimal atherosclerotic coronary artery disease.
Anomalous origin of the RCA off the left coronary cusp.
Vasospasm of the proximal LAD during angriography.
The left ventricular ejection fraction was 55-60%.
The overall left ventricular systolic function was normal.
Measurements:
VITALS
Arm Cuff Blood Pressure: 102 / 66 mmHg
O2 Sats: 98 %
Respiratory Rate: 8 r/min
Heart Rate: 57 /min
HEMODYNAMIC DATA
Left Ventricular Ejection Fraction: 55-60%
OXYGEN SATURATION
O2 Estimated: 263.34 % 02
ARTERIAL PRESSURE DATA
Aorta Pressure: 93 / 46 mmHg
Left Ventricle Systolic Pressure: 96 mm(hg)
Left Ventricle Diastolic Pressure: 18 mm(hg)
Left Ventricle End Diastolic Pressure: 28 mm(hg)
Aorta Mean Pressure: 66 mm(hg)
VENOUS DATA
Systemic Venous Hemoglobin: 14
LABS
Hemoglobin: 14
Recommendation:
Optimal medical therapy of the patient's disease, including
anti-vasospastic therapy.
Aggressive risk factor modification.
