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NUCLEAR CONFERENCE 8/30/02

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NUCLEAR CONFERENCE 8/30/02

  1. 1. NUCLEAR CONFERENCE 8/30/02
  2. 2. JC <ul><li>81 YO WM </li></ul><ul><li>CP W/ EXERTION-TYPICAL SXS </li></ul><ul><li>PMHX: OA, GERD, ANGINA NOS </li></ul><ul><li>SHX: NO TOB </li></ul><ul><li>FHX: NC </li></ul>
  3. 3. Jc 7/29
  4. 4. jcbw
  5. 5. NUCLEAR SCAN <ul><li>REDISTRIBUTION AND PARTIAL REDISTRIBUTION BASO-INFERIOR WALL </li></ul><ul><li>NORMAL SYSTOLIC FNC </li></ul>
  6. 6. NUCLEAR SCAN <ul><li>MAZZ INTERPRETATION: MAINLY FIXED BASAL INFERIOR DEFECT </li></ul>
  7. 7. CATH RESULTS <ul><li>LM: NORMAL </li></ul><ul><li>LAD: LUMINAL IRREGULARITIES </li></ul><ul><li>CX: OM1 20% MID </li></ul><ul><li>RCA: DOMINANT 100% MID VESSEL </li></ul><ul><li>LVG: EF 55% INF/BASAL HK TO AK MILD ANT HK </li></ul>
  8. 8. INTERVENTION <ul><li>NONE </li></ul><ul><li>COLLATERAL FLOW NOTED FROM LEFT SYSTEM </li></ul><ul><li>AGGRESSIVE MEDICAL TREATMENT </li></ul>
  9. 9. GS <ul><li>64 YO WM </li></ul><ul><li>PRE-OP EVAL FOR COLON RESECTION </li></ul><ul><li>PMHX: DM, INC CHOL, HTN, COLON CA, CRI AND ANEMIA </li></ul><ul><li>SHX: + TOB </li></ul><ul><li>FHX: NC </li></ul>
  10. 10. Gs 6/27
  11. 11. gsbw
  12. 12. NUCLEAR SCAN <ul><li>ISCHEMIA IN APICAL WALL </li></ul><ul><li>FIXED HYPOPERFUSION ANTEROSEPTAL WALL </li></ul><ul><li>MOD TO SEVERE LV DYSFUNCTION </li></ul>
  13. 13. CATH RESULTS <ul><li>LM: NORMAL </li></ul><ul><li>LAD: D1 70% PROX </li></ul><ul><li>CX: NORMAL </li></ul><ul><li>RCA: DOMINANT NO DISEASE </li></ul><ul><li>LVG: NOT DONE </li></ul>
  14. 14. INTERVENTION <ul><li>NONE </li></ul><ul><li>SINGLE VESSEL CAD W/ SYST DYSFXN OUT OF PROPORTION TO CAD </li></ul><ul><li>CONT MEDICAL THERAPY </li></ul>
  15. 15. GA <ul><li>68 YO WM </li></ul><ul><li>CRESCENDO ANGINA </li></ul><ul><li>PMHX: CAD, HTN,GERD, BPH AND ANEMIA </li></ul><ul><li>SHX: REMOTE TOB/ETOH </li></ul><ul><li>FHX: NO PREMATURE CAD </li></ul>
  16. 16. Ga 8/2
  17. 17. gabw
  18. 18. NUCLEAR SCAN <ul><li>MOD TO SEVERE LV ENLARGEMENT </li></ul><ul><li>FIXED APICAL HYPOPERFUSION </li></ul><ul><li>REDISTRIBUTION IN SMALL AREA OF ANTERIOR WALL </li></ul>
  19. 19. CATH RESULTS <ul><li>LM: NORMAL </li></ul><ul><li>LAD: D1 50-60% OSTIAL </li></ul><ul><li>CX: TORTUOUS BUT NORMAL </li></ul><ul><li>RCA: DOMINANT NO DISEASE </li></ul><ul><li>LVG: NOT DONE </li></ul>
  20. 20. INTERVENTION <ul><li>NONE </li></ul><ul><li>AGGRESSIVE MEDICAL THERAPY AND RISK FACTOR MODIFICATION </li></ul>
  21. 21. MR <ul><li>67 YO WM </li></ul><ul><li>PRE-OP EVAL FOR CEA </li></ul><ul><li>PMHX: CAD CABG ‘97, HTN,COPD, OA, INC LIPIDS,HH AND ANEMIA </li></ul><ul><li>SHX: NO TOB/ETOH </li></ul><ul><li>FHX: NC </li></ul>
  22. 22. Mr 7/1
  23. 23. mrbw
  24. 24. NUCLEAR SCAN <ul><li>MILD LV ENLARGEMENT </li></ul><ul><li>ISCHEMIA INVOLVING INFERIOR WALL </li></ul><ul><li>MILD LV DYSFUNCTION </li></ul>
  25. 25. NUCLEAR SCAN <ul><li>MAZZ INTERPRETATION: PARTIALLY REVERSIBLE INFERIOR DEFECT </li></ul>
  26. 26. CATH RESULTS <ul><li>LIMA TO LAD OCCLUDED </li></ul><ul><li>GE TO RCA OCCLUDED </li></ul><ul><li>SVG TO OM2 WIDELY PATENT </li></ul><ul><li>LM: DISTAL 30-40% </li></ul><ul><li>LAD: DIFFUSE PROX IRREGS UP TO 50% FOCAL 80% LESION AT BEND </li></ul><ul><li>CX: DIFFUSE PROX IRREGS UP TO 50% AFTER OM1 100% OCCLUDED </li></ul><ul><li>RCA: DOMINANT 80% PROX LESION </li></ul><ul><li>LVG: NOT DONE </li></ul>
  27. 27. INTERVENTION <ul><li>STENTING </li></ul><ul><ul><li>PROX RCA </li></ul></ul><ul><ul><li>PROX LAD </li></ul></ul><ul><ul><li>MID LAD </li></ul></ul>
  28. 28. KM <ul><li>50 YO WM </li></ul><ul><li>CP AND INCREASING SOB X 3 WKS </li></ul><ul><li>PMHX: 4V- CABG ‘96, </li></ul><ul><li>SHX: NO TOB/ETOH </li></ul><ul><li>FHX: NC </li></ul>
  29. 29. Km 8/16
  30. 30. kmbw
  31. 31. NUCLEAR SCAN <ul><li>REVERSIBLE REDISTRIBUTION OF MID ANTERIOR, </li></ul><ul><li>MID ANTEROSEPTAL, </li></ul><ul><li>MID INFEROLATERAL AND BASOINFERLATERAL WALLS </li></ul>
  32. 32. CATH RESULTS <ul><li>LIMA TO LAD OCCLUDED </li></ul><ul><li>SVG TO OM1 AND PDA OCCLUDED </li></ul><ul><li>SVG TO D1 WIDELY PATENT </li></ul><ul><li>LM: 30% PRIOR TO TAKE OFF OF LAD/CX </li></ul><ul><li>LAD: 100% PROXIMALLY OCCLUDED </li></ul><ul><li>CX: 100% OCCLUDED </li></ul><ul><li>RCA:100% OCCLUDED PROXIMALLY </li></ul><ul><li>LVG: EF 55% </li></ul>
  33. 33. INTERVENTION <ul><li>NONE </li></ul><ul><li>OPTIMIZE MEDICAL THERAPY </li></ul>
  34. 34. CB <ul><li>58YO WM </li></ul><ul><li>CP WHILE MOWING THE LAWN X 1 </li></ul><ul><li>PMHX: NONE </li></ul><ul><li>SHX: + TOB </li></ul><ul><li>FHX: NC </li></ul>
  35. 35. Cb 8/15
  36. 36. cbbw
  37. 37. NUCLEAR SCAN <ul><li>ABSENT MYOCARDIAL PERFUSION BASAL INFERIOR, BASAL INFEROLATERAL, MID INFERIOR AND MID INFEROLATERAL WALLS </li></ul><ul><li>AND SMALL AREA OF MID ANTEROSEPTAL WALL </li></ul><ul><li>AREAS SIGNIFICANTLY REDISTRIBUTED ON REST </li></ul>
  38. 38. NUCLEAR SCAN <ul><li>MAZZ INTERPRETATION: REVERSIBLE INFERIOR AND APICAL DEFECT </li></ul>
  39. 39. CATH RESULTS <ul><li>LM: NORMAL </li></ul><ul><li>LAD: 75% MID VESSEL </li></ul><ul><li>CX: 90% STENOSIS PRIOR TO OM1 </li></ul><ul><li>RCA:100% OCCLUDED MID VESSEL WITH COLLATERAL FLOW </li></ul><ul><li>LVG: NORMAL EF AK TO HK INF WALL </li></ul>
  40. 40. INTERVENTION <ul><li>CT SURGERY CONSULT </li></ul>
  41. 41. JW <ul><li>73YO WM </li></ul><ul><li>4 MINUTES OF CP WHILE AT REST </li></ul><ul><li>PMHX: HTN, OA AND PROSTATE CA </li></ul><ul><li>SHX: NO TOB </li></ul><ul><li>FHX: HTN </li></ul>
  42. 42. Jw 8/26
  43. 43. jwbw
  44. 44. NUCLEAR SCAN <ul><li>SMALL AREA OF REDISTRIBUTION IN INFEROLATERAL WALL </li></ul>
  45. 45. CATH RESULTS <ul><li>LM: NORMAL </li></ul><ul><li>LAD: NORMAL </li></ul><ul><li>CX: NORMAL </li></ul><ul><li>RCA:NORMAL </li></ul><ul><li>LVG: NOT DONE </li></ul>
  46. 46. INTERVENTION <ul><li>NONE </li></ul><ul><li>CONTINUE RISK FACTOR MODIFICATION </li></ul>
  47. 47. CS <ul><li>66YO WM </li></ul><ul><li>H/O CAD AND SSCP </li></ul><ul><li>PMHX: PVD, DM, CVA, HTN, INC CHOL </li></ul><ul><li>SHX: NO TOB </li></ul><ul><li>FHX: PVD </li></ul>
  48. 48. Cs 8/16
  49. 49. csbw
  50. 50. NUCLEAR SCAN <ul><li>REVERSIBLE APICAL AND INFEROAPICAL PERFUSION CHANGES </li></ul>
  51. 51. CATH RESULTS <ul><li>LM: DIFFUSE DX 60-70% STENOSIS </li></ul><ul><li>LAD: PROX 60-70% STENOSIS W/ LU IRRS </li></ul><ul><li>CX: OM1 70-80% OSTIAL STENOSIS </li></ul><ul><li>RCA:DOMINANT 100% PROX OCCLUDED WITH L TO R COLLATERALS </li></ul><ul><li>LVG: EF 55% </li></ul>
  52. 52. INTERVENTION <ul><li>CT SURGERY CONSULT </li></ul>
  53. 53. RF <ul><li>69YO WM </li></ul><ul><li>H/O RUL MASS AND SPINE PAIN PRE-OP SPINAL BX </li></ul><ul><li>PMHX: PANCYTOPENIA, HTN, CAD (H/O MI 17 YRS AGO), COPD AND HYPOTHYROIDISM </li></ul><ul><li>SHX: PRIOR HEAVY TOB USE </li></ul><ul><li>FHX: NC </li></ul>
  54. 54. Rf 7/31
  55. 55. rfbw
  56. 56. NUCLEAR SCAN <ul><li>SMALL AREA OF INFEROLATERAL REDISTRIBUTION </li></ul><ul><li>FIXED HYPOPERFUSION INFERIOR WALL </li></ul><ul><li>SPLENOMEGALY </li></ul>
  57. 57. NUCLEAR SCAN <ul><li>MAZZ INTERPRETATION: SMALL FIXED BASAL INFERIOR DEFECT </li></ul>
  58. 58. CATH RESULTS <ul><li>LM: 30% OSTIAL LESION </li></ul><ul><li>LAD: PROX 30% STENOSIS </li></ul><ul><li>CX:DOMINANT MID VESSEL 40% STENOSIS </li></ul><ul><li>RCA:SMALL VESSEL NO DISEASE </li></ul><ul><li>LVG: EF >55% INF BASAL HK TO AK </li></ul>
  59. 59. INTERVENTION <ul><li>NONE </li></ul><ul><li>MID CX LESION MAY BE CULPRIT FOR OLD MI AND WALL MOTION ABNORMALITY </li></ul>
  60. 60. HS <ul><li>49YO WM </li></ul><ul><li>EPISODIC CP AND POOR ECHO IMAGES </li></ul><ul><li>PMHX:HTN, PTSD, INC LIPIDS, OBESITY AND CAD </li></ul><ul><li>SHX: + TOB USE </li></ul><ul><li>FHX: NO PREMATURE CAD </li></ul>
  61. 61. Hs 8/21
  62. 62. hsbw
  63. 63. NUCLEAR SCAN <ul><li>ISCHEMIA INVOLVING APICAL INFERIOR, APICAL LATERAL, MID INFERIOR MID INFEROLATERAL AND BASAL INFERIOR WALLS AT REST </li></ul><ul><li>EF 50% </li></ul>
  64. 64. NUCLEAR SCAN <ul><li>MAZZ INTERPRETATION: PARTLY REVERSIBLE APICAL AND INFERIOR DEFECT </li></ul>
  65. 65. CATH RESULTS <ul><li>LM: NORMAL </li></ul><ul><li>LAD: 80% STENOSIS OSTIUM D1, D2 60% PROX </li></ul><ul><li>CX: 20-30% DIFFUSE DISEASE </li></ul><ul><li>RCA:DOMINANT 90% STENOSIS AT TAKEOFF OF PDA </li></ul><ul><li>LVG: EF >55% APICAL AND INFEROBASAL HK TO AK </li></ul>
  66. 66. INTERVENTION <ul><li>CT SURGERY CONSULT </li></ul>

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