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Cath conference5jan2015

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Two interesting angiography cases, illustrating the maxim that a good angiogram is worth a room full of speculating cardiologists.

Publicado en: Salud y medicina
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Cath conference5jan2015

  1. 1. CATH CONFERENCE 5FEB2015 FRANK MEISSNER, MD, RDMS, RDCS FACP, FACC, FCCP, FASNC, CPHIMS, CCDS 2nd Law of Cardiology: A Good Angiogram Trumps A Room Full of Speculating Cardiologists
  2. 2. XMAS EVE CHEST PAIN ED VISIT SERIAL TROPONIN 24DEC@20:19 0.02 NG/DL; 24DEC@22:01 0.03 NG/DL; 25DEC04:03 0.41 NG/DL 65 y/o Hispanic Female No Previous Hx/o Chest Pain CRF: HTN, Lipids, ex-13 yr smoker , postmenopausal Transient (30 mins) Non-exertional Central Burning Pain, Moderate Intensity, Mild Associated Dyspnea No Hx/o GERD, Mild Bronchitic symptoms X 1wk Mildly Obese, Soft S4, Mild Bronchial Breath Sounds No Diagnostic Chest Xray or EKG Findings No Chest Pain on Ward - Last Pain in ED
  3. 3. ATYPICAL NON-ANGINAL PAIN NUCLEAR MEDICINE IMAGES
  4. 4. CAC SCORE PROXIMAL LAD
  5. 5. MDCT AXIAL IMAGE PROXIMAL LAD
  6. 6. CATH LAB IMAGE 11° RAO / 27° CAUDAL
  7. 7. CATH LAB IMAGE 36° RAO / 31° CRANIAL
  8. 8. CATH LAB IMAGE 35° RAO / 35° CAUDAL
  9. 9. CATH LAB IMAGE 17° RAO / 32° CAUDAL
  10. 10. RECURRENT SYNCOPE 30 Y/O REPAIRING HIS ROOF JULY 2014 FELL 14’ NECK & BACK PAIN POST TRAUMA SEQUELA PREMONITION ABSENT SYNCOPE NOT CLEARLY POSTURAL NO CHEST PAIN, DYSPNEA, POUNDING PALPITATIONS AFTER MULTIPLE SERIAL EVALUATIONS, HE REPORTEED THAT SYNCOPE OR VISUAL BLACK OUT WAS ASSOCIATED APPROX 50% OF THE TIME WITH NECK TURNING (KEPT SYMPTOM DIARY) NEGATIVE ECHO, NUC-TMT, CAROTID DOPPLER U/S, CAROTID CTA, LEFT HEART CATH, TILT TABLE TESTING, NO ARRHYTHMIA BY PROLONGED TELE MONITORING MRI CSPINE => CERVICAL MYELOPATHY & CERVICAL 5-6 INSTABILITY
  11. 11. RIGHT VERTEBRAL HEAD NEUTRAL HARD RIGHT TURN No Symptoms Severe Dizziness Visual Blackout
  12. 12. LEFT VERTEBRAL HEAD NEUTRAL HARD RIGHT TURN No Symptoms Severe Dizziness L Sided Visual Blackout
  13. 13. BOW HUNTER’S SYNCOPE SORENSON BF: BOW HUNTER’S STROKE. NEUROSURGERY 2: 259-261, 1978 - 1ST DESCRIPTION PATIENT DEVELOPED HEMIPARESIS AND CONTRALATERAL SENSORY CHANGES DURING ARCHERY PRACTICE. BOW HUNTER’S SYNCOPE RARE FORM OF VBI PRESENTS AS DIZZINESS, VERTIGO, SYNCOPE, NAUSEA, OR SENSORIMOTOR DISTURBANCE DUE TO STENOSIS OR OCCLUSION OF THE VERTEBRAL ARTERY FOLLOWING HEAD ROTATION ABOUT THE CRANIO-CERVICAL AXIS USUALLY OCCLUSION OCCURS AT THE C1 TO C2 LEVELS, BUT LESIONS AT MULTIPLE LEVELS IN THE CERVICAL SPINE HAVE BEEN REPORTED CONCURRENT HYPOPLASTIC VA OR POOR CIRCLE OF WILLIS COLLATERALIZATION CONTRIBUTING FACTOR TO SYMPTOM PRODUCTION CONCURRENT HYPOPLASTIC VA OR POOR CIRCLE OF WILLIS COLLATERALIZATION CONTRIBUTING FACTOR TO SYMPTOM PRODUCTION
  14. 14. 11/11/2014 - DR VELIMIROVIC C5-6 DECOMPRESSIVE LAMINECTOMY + MEDIAL FACETECTOMY AND PARTIAL BILATERAL FORAMINOTOMY C5-6 POSTEROLATERAL ARTHRODESIS & SCREW FIXATION OF C5-6 OPEN REDUCTION OF CERVICAL 5-6 INSTABILITY AND DISLOCATION OPEN REDUCTION OF CERVICAL 5-6 INSTABILITY AND DISLOCATION 12/26/2014 - DR VELIMIROVIC SPINAL ANGIOGRAM + CEREBRAL ANGIOGRAM WITH DYNAMIC CERVICAL ANGIOGRAPHY — NO EVIDENCE OF VERTEBRAL ARTERY OCCLUSION DURING PROVOCATIVE MANEUVERS TO DATE NO FURTHER SYNCOPE
  15. 15. DON’T TURN YOUR HEAD HELTON, TJ & BAVRY AA. CIRCULATION. 2009, 120:E162. IMAGES IN CARDIOVASCULAR MEDICINE 1st Law of Cardiology: We Are All One Heart Beat From Eternity.

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