GIS Live – 11/3 2022

Patient History:
81 yrs, F known CAD s/p with prior PCIs and HFrEF. Presented with decompensated HF and +TnI with Type 2 NSTEMI. BNP 3956, managed aggressively for HF & CAG. Known extensive cAD with prior PCIs x3, last one in 2019. H/o prior Mis with LVEF 32% on GDMT for HFrEF & BiV-ICD Recent echo revealed mod-severe MR, mild AS and EF 23%. Cath on October 26, 2022 revealed calcific exytensive 3 V CAD with distal LM trifurcation involving prox LAD, ostial Ramus and proximal LCx with RCA DES ISR and Syntax score 42. Pt was referred to CTS for CABG+MVR but declined due to multiple comorbidities and low EF. After Heart team discussion, high risk Protected PCI was considered a viable option for dLM.

Meds:
Aspirin, Ramipril, Furosemide, Spironolactone, ISMN, Carvedilol, Linagliptin, Insulin, Atorvastatin, Plaquenil.

Plan:
Now planned for imaging guided PCI of dLM trifurcation using Rotational atherectomy and dedicated 2 stent technique with Impella LV assist.

Comments

Leave a Reply

Your email address will not be published.*

Yes, I would like to receive emails from Mount Sinai Hospital. Sign me up!


By submitting this form, you are consenting to receive marketing emails from: Mount Sinai Hospital, One Gustave L. Levy Place, Box, New York, NY, 10029, https://ccclivecases.org. You can revoke your consent to receive emails at any time by using the SafeUnsubscribe® link, found at the bottom of every email. Emails are serviced by Constant Contact