CATH CONFERENCE 5FEB2015

FRANK MEISSNER, MD, RDMS, RDCSFACP, FACC, FCCP, FASNC, CPHIMS, CCDS

2nd Law of Cardiology:

A Good Angiogram

Trumps A Room Full of

Speculating Cardiologists

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

ATYPICAL NON-ANGINAL PAIN

NUCLEAR MEDICINE IMAGES

CAC SCORE

PROXIMAL LAD

MDCT AXIAL IMAGE

PROXIMAL LAD

CATH LAB IMAGE

11° RAO / 27° CAUDAL

CATH LAB IMAGE

36° RAO / 31° CRANIAL

CATH LAB IMAGE

35° RAO / 35° CAUDAL

CATH LAB IMAGE

17° RAO / 32° CAUDAL

RECURRENT SYNCOPE30 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

RIGHT VERTEBRAL

HEAD NEUTRAL HARD RIGHT TURN

No

Symptoms

Severe Dizziness

Visual Blackout

LEFT VERTEBRAL

HEAD NEUTRAL HARD RIGHT TURN

No

Symptoms

Severe Dizziness

L Sided Visual Blackout

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

11/11/2014 - DR VELIMIROVIC C5-6 DECOMPRESSIVE LAMINECTOMY + MEDIAL FACETECTOMY AND PARTIAL BILATERAL FORAMINOTOMY

C5-6 POSTEROLATERAL ARTHRODESIS & SCREW FIXATION OF C5-6OPEN 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

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.