Clinical Summary Live Cases I - IX
Patient: Male, 66 years Diagnosis: Single vessel CAD with normal LVEF Target lesion: proximal RCA Coronary risk factor: Hypertension, smoke (90py) Clinical course: ECG abnormality: Sinusrhythm, 66/min, bifascicular block (LAH+RBBB). Echocardiography LV concentric hypertrophy and diastolic dysfunction type I. Coronary angiogram: RCA-proximal total occlusion with LCA-collaterals, LAD and RCX with coronary sclerosis. June 19 th, 2017. Laevocardiography: LVEF 65%, inferobasal aneurysm? Stress echocardiography: preserved vitality of the inferior LV-wall. ICD- implantation for secondary prevention of SCD (after nsvt) on June 26 2017 Problem:
Patient: Male, 63 years. Diagnosis: Ischemic cardiomyopathy with reduced LVEF (32%); 2-Vessel CAD (LAD and RCA) Target lesion: proximal LAD Coronary risk factor: Hypertension, smoke (90py) Clinical course: ECG abnormality: Sinus rhythm, 76/min, loss of R-wave and T-wave inversion in V1 V4. cnmr: fibrosis and ischemia of the anteroseptal LV-wall. Coronary angiogram: Successful RCA-PCI, total occlusion of proximal LAD-CTO with collaterals from RCX (?) Laevocardiography: LVEF 32%, anteroseptal hypo-akinesia Problem:
University Medicine Berlin, Campus Benjamin Franklin (CBF) Gender: Male Age: 48 Target vessel: RCA mid Relevant Diagnosis: Coronary 2-vessel disease, LVEF 45% Previous STE-ACS 2017/04 with PCI/Scaffold-Implantation LAD mid (04/2017) Coronary Risk Factor: Hypertension, smoking, family history Symptoms: Angina pectoris (CCS II) Coronary Angiography: 04/2017: LAD mid 100%, RCA mid 100% -> PCI LAD (1xBVS) Imaging: Echocardiography 04/2017: LVEF 45%, inferior and anteroseptal: hypokinetic Stress-Echocardiography 08/2017: Preserved viability inferior Procedure: PCI CTO RCA mid Post PCI
Patient: Male, 58 years. Diagnosis: Ischemic cardiomyopathy with reduced LVEF (45%) and complex multivessel CAD. Target lesion: proximal LAD Coronary risk factor: Hypertension, DM II, HLP, smoking Clinical course: ECG abnormality: Sinusrhythm, 76/min, loss of R-wave and T-wave inversion in V1 V4. Coronary angiogram: LAD-proximal total occlusion, RIVP-collaterals. RCA with 50% ostial stenosis and good result after proximal stenting. OM1 90% stenosis, OM2 with 75% stenosis, RPLS 75% stenosis. PTCA (2x DES) of OM2 and RPLs. 10/10 Laevocardiography: hypokinesia anterolateral apical and inferior Stress echocardiography (appointment on 12.09.17) Problem:
Patient: Male, (GG), 81years Diagnosis: Normal LVEF ; multivessel CAD Target lesion: proximal RCA Coronary risk factor: Hypertension, DM II, HLP Clinical course: Angina CCS?? ECG abnormality: none Coronary angiogram: RCA-proximal total occlusion, LCA-collaterals? RCX-PCI 5/17 Transthoracal echocardiography: 12.09.17? Problem: chronic kidney disease (serum creatinine 1.40mg/dl 2008)
University Medicine Berlin, Campus Benjamin Franklin (CBF) Gender: Male Age: 58 Target vessel: LAD mid Relevant Diagnosis: Coronary 3-vessel disease, LVEF 62% Previous STE-ACS with PCI LCX mid (05/2015) Previous PCI LCX distal (07/2017) Coronary Risk Factor: Hypertension, dyslipidemia, smoking, family history Symptoms: Angina pectoris (CCS III) Coronary Angiography: 04/2017: LAD mid 100%, RCA prox 80% (small vessel) Imaging: Echocardiography: LVEF 62%, lateral and inferolateral: hypokinetic Procedure: PCI CTO LAD
Patient: Female 67 years Diagnosis: LVEF 57%; multivessel CAD Target lesion: total occlusion from the medial LAD segment Coronary risk factor: Hypertension, DM II, HLP, smoke (25py) Clinical course: Clinical presentation: instable angina ECG abnormality: Sinusrhythm, 76/min, LAH,.incomplete RSB Coronary angiogram: 06/17 LAD-CTO of the medial segment, RCA-collaterals Laevocardiography: LVEF 57% No Stressecho or MRI PTCA: 06/17- RCX-PCI
Patient: Male, 63 years Diagnosis: Multivessel CAD with normal LVEF (73%) Target lesion: proximal RCA Coronary risk factor: Hypertension, HLP, DM II, smoking (50py), Clinical course: ECG abnormality: SR, 90bpm, LAH, Q in II, III, avf and preterm. T-neg. in III. Transthoracal echocardiography: LV- concentric hypertrophy (IVSd 17mm), no LVOT Coronary angiogram: obstruction or gradient, LVEF 73%, diastolic dysfunction type I. 07/17, RCA-proximal total occlusion, LCA-collaterals PTCA: RIVA-CTO-PCI and PLA-1-PCI, 07/17 cmri: apical akinesia with late enhancement, vitality of the inferoseptal and septal LV -segments, 06/17. Problem: chronic kidney disease, St. IIIa (GFR 62ml/min*1.73, 7/17)
University Medicine Berlin, Campus Benjamin Franklin (CBF) Gender: Male Age: 79 Target vessel: RCA proximal Relevant Diagnosis: Coronary 2-vessel disease, LVEF 68% Myocardial infarction (03/2007) PCI LCX, obtuse marginal, RCA mid Previous Stroke, Stenosis of internal carotid artery (80-90%) with endarterectomy (07/2017) Chronic kidney disease Coronary Risk Factors: Hypertension Symptoms: Pre-Syncope (due to carotid stenosis) Coronary Angiography: 12/2016: RCA prox 100%, Left posterolateral 100%, Diagonal 80% Imaging: Stress-Echocardiography 01/2017: Preserved viability inferior (hypokinetic under stress) Procedure: PCI CTO RCA (retrograde)