Download Eli Vasculopath DOB: 11/25/1952 ADM: 05/29/2012 HARRISBURG

Eli Vasculopath
DOB: 11/25/1952
ADM: 05/29/2012
HARRISBURG HOSPITAL CARDIAC CATH
DATE OF SERVICE: 05/29/2012
CATH LAB PROCEDURE NOTE
CLINICAL HISTORY: This is a 59-year-old gentleman with a history of prior LAD stenting, now
presents in the emergency room with an acute posteriorlateral ST elevation MI.
PROCEDURES PERFORMED:
1. Selective coronary angiography.
2. Left heart catheterization, left ventriculography.
3. Thrombectomy and direct stenting of an occluded circumflex marginal branch stenosis.
CONSENT: The risks and benefits of the heart catheterization procedure were discussed with the
patient. The patient was told that he was having a heart attack and that he needed to go to the cath
lab to remove the clot. A clot had formed in his heart vessels that needed to be removed surgically.
After sedation, the doctor would thread a catheter (tube) through his femoral artery (blood vessel in
his leg) up into his heart and then remove the blood clot. If the doctor does not remove the clot
quickly, then the patient’s heart would die from lack of oxygen.
The risks include:
• Infection, bleeding, swelling, or scarring at the site of catheter insertion.
• Discomfort, nausea, and vomiting.
• Temporary changes in heart rhythms and blood pressures. Serious changes may require treatment with
emergency defibrillation (application of electrical shock to the heart).
• Allergic reaction to, or uncomfortable feeling from the dye used in angiography, including headache,
sneezing, chills, fever, hives, itching, or shock.
• Nerve injury causing temporary or permanent localized weakness or numbness in the affected area.
• Damage, bruising or rupture of the artery or heart wall. Any of these problems may require open heart or
vascular surgery to repair damage.
• Severe bleeding, stroke, and emboli.
• Slight risk of harm to your body due to radioactive exposure.
• Death from complications during the procedure.
• Risks associated with anesthesia such as delayed awakening, allergic reactions, or death.
• Infection.
• Kidney damage.
The benefits include:
• Removal of the clot with return of lifesaving blood and oxygen to the deprived heart muscle tissue.
• Correcting clots or stenotic heart vessels.
• Saving your life from a heart attack.
Informed consent was obtained from the patient, who read and signed the consent form himself.
After informed consent was obtained, the patient was taken to the catheterization lab.
PROCEDURE: Patient was sedated with IV Versed and fentanyl. O2 saturation and hemodynamics
were monitored throughout the procedure. The patient was placed into a supine position with his
arms at his side. The patient was prepped and draped in the sterile fashion. The right groin was
prepped with Betadine. A 7-French sheath was placed in the right common femoral artery. Using
the modified Seldinger technique after administration of 1% lidocaine over the right groin, selective
coronary angiography was performed using a 5-French JL4 catheter, 5-French JR4 catheter. We
then proceeded to perform intervention, which will be discussed later. Finally, left
ventriculography was performed using a 5-French angled pigtail catheter.
FINDINGS ON SELECTIVE CORONARY ANGIOGRAPHY:
1. Left main was angiographically normal.
2. Left anterior descending artery had a previously deployed stent along its proximal and mid
segment that was patent. Just beyond the stent, there was a 50% narrowing along the
midportion of the LAD.
3. The circumflex artery was a large dominant vessel with a completely occluded second
obtuse marginal branch along its proximal segment.
4. There was a very small intermediate ramus artery that was otherwise patent.
5. The right coronary artery had mild luminal irregularities at most and again this is a codominant
circulation.
Given the above findings, the patient was administered IV Angiomax and a 7-French EBU guide
catheter was then used for the intervention. A short BMW wire was advanced across the OM
occlusion and thrombectomy was performed using an Xpress-Way catheter. There was reperfusion
noted after one pass and we then deployed a 3.5 x 18mm Vision non-drug eluting stent in the
circumflex marginal at the point to a maximum of 12 atmospheres leaving a 0% residual stenosis.
With this, the patient’s ST segment elevation and chest pain resolved.
Left ventriculography was then performed. The left ventricular end-diastolic pressure was
measured at 22mmHg. There appeared to be hypokinesis of the mid diaphragmatic wall as well as
the inferoapical wall. The overall estimated ejection fraction was approximately 40%. There was
no mitral regurgitation. There was no gradient across the aortic valve upon pullback.
IMPRESSIONS:
1. Occluded second obtuse marginal branch in a patient presenting with a posteriorlateral ST
segment elevation MI. Status post successful thrombectomy and stenting with a non-drug
eluting stent.
2. Patent previously deployed LAD stent, but otherwise moderate nonocclusive disease.
3. Moderate LV systolic dysfunction.
PLAN:
1. The patient will remain in the hospital for several days for observation of potential
complications.
2. Plavix 75 mg daily
3. Aspirin 81 mg daily
4. Metoprolol 50 mg PO bid daily
5. Lisinopril 5 mg PO daily
6. Lipitor 40mg PO daily
7. Patient scheduled for follow-up visit June 8, 2012 at 10:00 am.
Signed: Rachel Harten PA-S
Rachel Harten PA-S