Test bank for critical care nursing a holistic approach 11th edition morton f...
dilemma in hocm ].pptx
1. Dilemma in case of HOCM
Dr. Vivek mandurke
Interventional cardiologist
2. • 52 yr female
• Hypertensive
• k/c/o HOCM
• Exertional angina CCS class III
• Presented with acute LVF
• ECG : LBBB with QRS – 140 ms
• ECHO
3.
4.
5.
6. • Pt shifted from periphery hospital with acute LVF
• Managed with Oxygen, Lasix infusion
• Pt improved over 72 hours
• Shifted to ward
• After every meal she use to have tachycardia, dyspnoea and fall in
saturation
• Pt twice shifted to ICU twice as saturation fall below 90
• Pt was on optimised doses of betablockers CCB diuretics
• Pt added on SGLT2 inhibitor
• Still no relief … medical management failed to relieve her symptoms
7.
8. • We planned to do CAG to rule out any obstructive lesion
15. What next….
• We decided to do left main stenting with imaging as confused even
after FFR
• Default strategy was IVUS but machine not working
• Difficult to visualise ostial segment of LM with OCT
• We decided to use TELESCOPE
16.
17. Ostium of left main looks fairly good with
eccentric plaque
18. • After looking OCT we abandoned plan of left main stenting
• Limited Literature - FFR in HOCM
32. All izz still not well…
• Pt went into CHB post operative
• Decided to go for permanent pacemaker
33.
34. Date of admission 10/11/21
Cag 13/11/21
FFR 16/11/21
OCT 19/11/21
Surgical myectomy 25/11/21
Discharged on 1/12/21
Re-admission and Detection of VSR with acute LVF 9/12/21
Dacron Patch closure of VSD 11/12/21
PPMI 18/12/21
Asymptomatic till date …..
35. Learning points
• Management of HCM is very challenging
• Every ventriculisation is not significant lesion
• Limited literature about FFR in HOCM
• Surgery though better than alcohol septal ablation for long run … still
it is last resort
