A 64-year-old gentleman admitted with CHF. Diabetic, without any previous cardiac history. He is a former smoker. An echocardiogram demonstrated findings consistent with cardiomyopathy, and with injection fraction of 20-30%, and mild mitral insufficiency. Because he developed new T-wave inversions and had risk factors, it was appropriate, though he was without anginal symptoms, to recommend catheterization.
Catheterization was undertaken today, demonstrating the following:
Right ostial-dominant coronary disease of 30%, and no more than 40%.
The left main demonstrated a distal 40%.
The left anterior descending artery demonstrated a long area of disease in its proximal portion from the 1st septal, on through to the mid LAD. However, …show more content…
The flow ratios with adenosine challenge were 0.6 and, prior to that, in the range of 0.7. With the above noted, a 2.75 Penta stent was deployed, 13 mm in length. The lesion was hard; there was calcium. I had to take the stent up to 12 atmospheres in order to fully expand the balloon, and ensure good deployment. The stent was deployed without complication, and there was good flow established. The distal left main was assessed closely in view of passing a stent by the left main lesion, and there was no disruption of this area.
Integrilin was initiated prior to the intervention, as was the use of heparin in usual doses to maintain ACT at 250 or less.
The patient's past history is positive for diabetes, negative for CHF, though he was told many years ago that he had some enlargement of his heart.
The patient has been on the following medications: K-Dur 40 mEq p.o. day, Capoten 12.5 t.i.d., Mag-Ox 400 mg p.o. b.i.d., Lasix 40 mg p.o. day, Novolin 70/30, now down to 15 units subcu twice a day, Lanoxin 0.25 a day, Ecotrin 81 mg a day, nitro paste 1 inch q.
Catheterization was undertaken today, demonstrating the following:
Right ostial-dominant coronary disease of 30%, and no more than 40%.
The left main demonstrated a distal 40%.
The left anterior descending artery demonstrated a long area of disease in its proximal portion from the 1st septal, on through to the mid LAD. However, …show more content…
The flow ratios with adenosine challenge were 0.6 and, prior to that, in the range of 0.7. With the above noted, a 2.75 Penta stent was deployed, 13 mm in length. The lesion was hard; there was calcium. I had to take the stent up to 12 atmospheres in order to fully expand the balloon, and ensure good deployment. The stent was deployed without complication, and there was good flow established. The distal left main was assessed closely in view of passing a stent by the left main lesion, and there was no disruption of this area.
Integrilin was initiated prior to the intervention, as was the use of heparin in usual doses to maintain ACT at 250 or less.
The patient's past history is positive for diabetes, negative for CHF, though he was told many years ago that he had some enlargement of his heart.
The patient has been on the following medications: K-Dur 40 mEq p.o. day, Capoten 12.5 t.i.d., Mag-Ox 400 mg p.o. b.i.d., Lasix 40 mg p.o. day, Novolin 70/30, now down to 15 units subcu twice a day, Lanoxin 0.25 a day, Ecotrin 81 mg a day, nitro paste 1 inch q.