In the Blog Section, we would be presenting interesting cases where Clinical Acumen and Technology helped to clinch the Diagnoses and Change in Treatment often Life-saving.
NEARLY MISSED Left Main Coronary Artery Significant Stenosis.
62 years housewife had presented with backache, shoulder, jaw pain for 2-3 months. She had taken treatment from a family physician, orthopedic surgeon even dentist. She is also Diabetic & has Hypertension
ECG showed an Inferior wall Myocardial infarction (Heart Attack). The patient kept insisting she never had chest pain. 4D Echo has shown damage to Posterior- Inferior wall of Left ventricle of the Heart. Injury profile was Abnormal. Family was ready for Coronary Angiography.
Angiography showed Triple Vessel Blockages. The patient was advised was Bypass Surgery, which she and her family refused but wanted the second choice of Coronary Angioplasty.
ANGIOPLASTY to Right Coronary Artery a Stent was done successfully, however on cannulating the Left Main Coronary Artery, with Guide Catheter the pressures dropped. The pressure trace showed an ominous pattern of Ventricularization suggestive of additional Left-Main disease which was not seen in routine diagnostic views.
We had more sophisticated Gadgets such as FFR which could not be used because of the economic constraints of patient. Hence Heart-Sweep with Multiple views picked up a Critical Tight Left Main blockage. This was first dilated the blockages in LAD & Cx (two main branches of the left main coronary artery) were stented and then the left main coronary artery was stented successfully. Her backache, shoulder & Jaw pain disappeared.
So here Clinical Acumen and watch on Pressures and Heart-Sweep present in High-End Cath lab in Vijan Hospital made the difference which was life-saving and very Cost Saving..
The patient is stable with two years of follow-up.