Clinical Summary Live Cases I - IX
Case #1 2017/09/16 Age: 66 Target Vessel: RCA proximal Relevant Diagnosis: Single vessel CAD with normal LVEF Coronary Risk Factors: Hypertension, smoke (90py) ECG abnormality: Sinusrhythm, 66/min, bifascicular block (LAH+RBBB), angina CCS II Coronary Angiography: RCA-proximal total occlusion with LCA-collaterals, LAD and RCX with coronary sclerosis. June 19th, 2017 Echocardiography: LV concentric hypertrophy and diastolic dysfunction type I 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
Case #2 2017/09/16 Age: 63 Target Vessel: LAD proximal Relevant Diagnosis: Ischemic cardiomyopathy with reduced LVEF (32%); 2-Vessel CAD (LAD and RCA) Coronary Risk Factors: Hypertension, smoke (90py) ECG abnormality: Sinus rhythm, 76/min, loss of R-wave and T-wave inversion in V1 V4, dyspnea NYHA III Coronary Angiography: Successful RCA-PCI, total occlusion of proximal LAD-CTO with collaterals from RCX (?) cnmr: fibrosis and ischemia of the anteroseptal LV-wall Laevocardiography: LVEF 32%, anteroseptal hypoakinesia
Case #3 (ZA), 2017/09/16 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 Angina pectoris (CCS II) Coronary Angiography: 04/2017: LAD mid 100%, RCA mid 100% -> PCI LAD (1xBVS) Echocardiography 04/2017: LVEF 45%, inferior and anteroseptal: hypokinetic Stress-Echocardiography 08/2017: Preserved viability inferior Procedure: PCI CTO RCA mid
Post PCI
Case #4 2017/09/16 Age: 58 Target Vessel: LAD proximal Relevant Diagnosis: Ischemic cardiomyopathy with reduced LVEF (45%) and complex multivessel CAD Coronary Risk Factors: Hypertension, DM II, HLP, smoking ECG abnormality: Sinusrhythm, 76/min, loss of R-wave and T-wave inversion in V1 V4, angina CCS III Coronary Angiography: 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)
Case #5 2017/09/16 (GG) Age: 81 Target Vessel: RCA proximal Relevant Diagnosis: Normal LVEF; multivessel CAD Coronary Risk Factors: Hypertension, DM II, HLP Angina CCS II; ECG abnormality: none Coronary Angiography: 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)
Case #6 (WL), 2017/09/16 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 Factors: Hypertension, dyslipidemia, smoking, family history Angina pectoris (CCS III) Coronary Angiography: 04/2017: LAD mid 100%, RCA prox 80% (small vessel) Procedure: Echocardiography: LVEF 62%, lateral and inferolateral: hypokinetic PCI CTO LAD
Case #7 2017/09/16 Female Age: 67 Target Lesion: Total occlusion from the medial LAD segment Relevant Diagnosis: LVEF 57%; multivessel CAD Coronary Risk Factors: Hypertension, DM II, HLP, smoke (25py) Instable angina ECG abnormality: Sinusrhythm, 76/min, LAH, incomplete RSB Coronary Angiography: 06/17 LAD-CTO of the medial segment, RCA-collaterals PTCA: 06/17- RCX-PCI Laevocardiography: LVEF 57% No Stressecho or MRI
Case #8 2017/09/16 Age: 63 Target Vessel: RCA proximal Relevant Diagnosis: Multivessel CAD with normal LVEF (73%) Coronary Risk Factors: Hypertension, HLP, DM II, smoking (50py) ECG abnormality: SR, 90bpm, LAH, Q in II, III, avf and preterm. T-neg. in III, angina CCS II Coronary Angiography: 07/17, RCA-proximal total occlusion, LCA-collaterals PTCA: RIVA-CTO-PCI and PLA-1-PCI, 07/17 Transthoracal echocardiography: LV- concentric hypertrophy (IVSd 17mm), no LVOT obstruction or gradient, LVEF 73%, diastolic dysfunction type 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)
Case #9 2017/09/16 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) Coronary Risk Factors: Hypertension Dyspnea NYHA II, angina CCS II, pre-syncope (due to carotid stenosis) Coronary Angiography: 12/2016: RCA prox 100%, Left posterolateral 100%, Diagonal Procedure: Problem: 80% Stress-Echocardiography 01/2017: Preserved viability inferior (hypokinetic under stress) PCI CTO RCA (retrograde) Chronic kidney disease