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Abstract 4140682: Clinical Case: Flipping the Script: Tackling CAD in Dextrocardia During Cardiac Catheterization

Circulation

Although he had a normal echocardiogram and stress test a year ago at a different hospital, due to his symptoms and intermediate-high risk probability of coronary artery disease (CAD), the decision was made to proceed with a cardiac catheterization using a trans-radial approach with a horizontal sweep technique.

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Cath Lab occupied. Which patient should go now (or does only one need it? Or neither?)

Dr. Smith's ECG Blog

A prehospital “STEMI” activation was called on a 75 year old male ( Patient 1 ) with a history of hyperlipidemia and LAD and Cx OMI with stent placement. Additionally, a bedside echocardiogram showed no wall motion abnormality and normal LV function. Angiography revealed a 30% nonobstructive stenosis of the mid LAD.

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Right Heart Catheterization in Tetralogy of Fallot

All About Cardiovascular System and Disorders

Another important role is for detection of coronary anomalies, which can also be seen on echocardiogram sometimes. Stenting of the patent ductus arteriosus can be considered in neonatal period for improving oxygen saturation till corrective surgery. Magnetic resonance imaging is another way of documenting coronary anomalies.

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See how bad the outcome can be if you don't know OMI findings on the ECG, and don't use the Queen of Hearts

Dr. Smith's ECG Blog

An echocardiogram showed severely reduced global systolic function with an EF of 20-25% and an LV apical thrombus. The red arrow shows a roughly 80% stenosis of the proximal LAD. The blue arrow shows another stenosis of the LAD distal to the first diagonal branch of about 99%. All three lesions had TIMI 2 flow prior to stenting.

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"The dye don't lie".except when it does. Angiogram Negative, or is it?

Dr. Smith's ECG Blog

The patient was thought to have low likelihood of ACS, and cardiology recommended repeat troponin, urine drug testing, and echocardiogram. Bedside echocardiogram showed hypokinesis of the mid to distal anterior wall and apex. The cardiologist called this 20% stenosis. Initial hscTnI was 10 ng/L (ref. <14).

Plaque 66
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"Non-STEMI" is a worthless term.

Dr. Smith's ECG Blog

A 60 yo with 2 previous inferior (RCA) STEMIs, stented, called 911 for one hour of chest pain. The first hs troponin I returned at 1100 ng/L Angiogram Lesion on 1st Obtuse Marginal : Proximal subsection = 90% stenosis Stented. He had no h/o heart failure. Pre procedure TIMI III flow was noted.

STEMI 112
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What if your system adopted the recommendation that a computer "normal" ECG need not be shown to the doctor?

Dr. Smith's ECG Blog

Angiogram findings included: 95% mid RCA stenosis with occluded distal right PDA secondary to thrombus (peristent OMI). Successful drug-eluting stent placement opening up 95% mid RCA stenosis to 0% residual Nonobstructive left system disease. Formal echocardiogram: Systolic function is at the lower limits of normal.