The Common Vein

• 75M
• PMH HTN, HLD, previous tobacco use COPD (previous exacerbations have required intubations), and chronic bronchiectasis, COVID-19 infection
• witnessed collapse with complaints of SOB,
• became unresponsive o
• found to be in VF arrest 2/2 inferior STEMI.
• 7 rounds epi, shocks; also given amio and lidocaine. Post-arrest ECG w/ STE in inferior leads, RBBB, and LAFB.
• cath lab,
  • complete occlusion of the RCA, and stents were placed to proximal RCA.
  • Right Dominant
    Left Main: Normal
    Left Anterior Descending: Appeared to be flush occluded at takeoff, no visible stump, not filling via collaterals.
    Left Circ: Mild Luminal Irregularities less than 30%
    RCA: Large ectatic vessel, difficult to enagage secondary to anterior and inferior take off. Extremely tortuous mid vessel. 70% proximal lesion. Totally occluded mid vessel.PROCEDURAL COMMENTS:
    Pt had incessant VF in the ER requiring multiple shocks. EKG showed inferior ST elevations with IVCD.
  • TTE showed EF 60% with
    • mild inferolateral wall hypokinesis and
    • moderate inferior wall hypokinesis;
    • RV systolic dysfunction was mildly reduced. T

His LAD appeared to be ostially occluded on angiography; however, the anterior wall appeared to move well on echo. He underwent coronary CT angiogram to further evaluate, revealing “extensive calcified plaque in the LAD, RCA and left circumflex coronary arteries. I

• • • study extremely limited for evaluation of stenosis/luminal narrowing…
      • LAD arises directly from the aortic root just above the sinus of Valsalva and has a sharp acute course at the origin between the aorta and main pulmonary artery.”
      • Lcx arises separately from the left coronary cusp
      • EF 50%

 

 

DB136