An 80 y/o male with past medical history of paroxysmal atrial fibrillation, hypertensive heart disease, hypercholesterolemia, and benign prostatic hypertrophy was intervened on today. Cardiac catheterization performed on 09/23/2009 revealed small but normal coronary arteries.
The patient has recurrent chest pain that occurs at minimal exertion and at rest. He has been experiencing this symptom for the past 1 month and has been progressively worsening. It is described as midsternal pressure, that lasts for 30 minutes and resolves spontaneously. It is moderate in intensity and rates 7/10 on a pain scale. He states that he has been more fatigued of late and tires easily. The patient underwent Coronary CT angiogram on 11/05/14 which revealed 2 vessel coronary artery disease in the right dominant system with 25-49% proximal right coronary artery, and diaphragmatic right coronary artery calcified plaquing, significant plaque 50-60% soft, and calcified mid LAD plaque possibly greater than 70%, soft non-calcified 25-49% proximal first diagonal branch plaque.
Today, the patient underwent cardiac catheterization at a nearby hospital for angiography and possible angioplasty. He was put under conscious sedation with a local anesthetic at the left femoral artery. The right mid-femoral head was targeted under fluoroscopic guidance and access was gained with both a catheter then a sheath. A JL4 catheter was then placed at the left main coronary artery and contrast dye was injected which revealed no major occlusion in the LAD. Guidelines show that for the LAD, CABG is indicated for any occlusion greater than 50% and so no intervention was initiated. The right main coronary artery revealed no major occlusions. All instrumentation was removed and the femoral artery wound was closed with a sealant device. The patient was to be monitored for 10-12 hours and discharged if clinically stable on Plavix 75mg QD and Ecotrin 325mg QD.