I am coding a left heat cath, is right femoral angiogram included in the left heart PROCEDURE: Left heart catheterization, selective coronary angiography,
ventriculography, right femoral angiogram.
INDICATION FOR PROCEDURE: A female with history of tobacco use,
family history of heart disease. She was initially referred for shortness
of breath as well as an abnormal EKG, which showed an intraventricular
conduction defect. She had a stress echocardiogram performed in which she
developed episodes of monomorphic ventricular tachycardia with exercise
together with complaints of shortness of breath. Her stress echo images
were technically difficult. There was a suggestion of an apical wall motion
abnormality. In order to define coronary anatomy given her exercise-induced
ventricular arrhythmias, cardiac catheterization angiography being
performed.
PROCEDURE NOTE: Using sterile technique with local anesthesia, right
femoral arterial access was obtained via the Seldinger technique. Selective
coronary angiography and ventriculography then performed in multiple RAO and
LAO projections using 6-French, JL4, JR4, and angled pigtail catheters.
Right femoral angiogram was performed to evaluate the site of the groin
seal.
Following the procedure, hemostasis was achieved with direct manual
compression. An Angio-Seal device was not used because of superficiality of
the artery to the skin.
Selective coronary angiography:
1. Left main coronary artery is patent and smooth.
2. Left anterior descending coronary artery is mild and nonobstructive
luminal irregularities throughout its course. There are several
diagnoses, which appeared to be patent free of disease.
3. Left circumflex coronary artery small nondominant patent.
4. Right coronary artery is a large vessel with mild diffuse disease and
is otherwise patent with no critical lesions.
Ventriculography: Ejection fraction is estimated at 55%. There is mild
mitral regurgitation. There is evidence for posterior mitral valve leaflet
prolapse.
Right femoral angiogram: This revealed a groin stick suitable for Angio-
Seal deployment above the bifurcation of the common femoral artery.
SUMMARY:
1. Patent coronary arteries.
2. Preserved left ventricular ejection fraction.
3. Exercise-induced ventricular tachycardia, likely catecholamine mediated
ventricular tachycardia such as right ventricle outflow tachycardia.
There is no evidence for an ischemic basis based on her epicardial
coronary anatomy.
4. Ventricular function is normal.
5. Patient will be managed medically.
Preliminary Report - if not signed by author.
cath?
ventriculography, right femoral angiogram.
INDICATION FOR PROCEDURE: A female with history of tobacco use,
family history of heart disease. She was initially referred for shortness
of breath as well as an abnormal EKG, which showed an intraventricular
conduction defect. She had a stress echocardiogram performed in which she
developed episodes of monomorphic ventricular tachycardia with exercise
together with complaints of shortness of breath. Her stress echo images
were technically difficult. There was a suggestion of an apical wall motion
abnormality. In order to define coronary anatomy given her exercise-induced
ventricular arrhythmias, cardiac catheterization angiography being
performed.
PROCEDURE NOTE: Using sterile technique with local anesthesia, right
femoral arterial access was obtained via the Seldinger technique. Selective
coronary angiography and ventriculography then performed in multiple RAO and
LAO projections using 6-French, JL4, JR4, and angled pigtail catheters.
Right femoral angiogram was performed to evaluate the site of the groin
seal.
Following the procedure, hemostasis was achieved with direct manual
compression. An Angio-Seal device was not used because of superficiality of
the artery to the skin.
Selective coronary angiography:
1. Left main coronary artery is patent and smooth.
2. Left anterior descending coronary artery is mild and nonobstructive
luminal irregularities throughout its course. There are several
diagnoses, which appeared to be patent free of disease.
3. Left circumflex coronary artery small nondominant patent.
4. Right coronary artery is a large vessel with mild diffuse disease and
is otherwise patent with no critical lesions.
Ventriculography: Ejection fraction is estimated at 55%. There is mild
mitral regurgitation. There is evidence for posterior mitral valve leaflet
prolapse.
Right femoral angiogram: This revealed a groin stick suitable for Angio-
Seal deployment above the bifurcation of the common femoral artery.
SUMMARY:
1. Patent coronary arteries.
2. Preserved left ventricular ejection fraction.
3. Exercise-induced ventricular tachycardia, likely catecholamine mediated
ventricular tachycardia such as right ventricle outflow tachycardia.
There is no evidence for an ischemic basis based on her epicardial
coronary anatomy.
4. Ventricular function is normal.
5. Patient will be managed medically.
Preliminary Report - if not signed by author.
cath?
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