78 y/o female presenting with "heartburn" and nausea/vomitin | Figure 1

Patient Case Summary

Age: 78 y/o female
Symptoms: Presenting with "heartburn" and nausea/vomiting x6 hours with mild SOB.
History: Patient has a history of CHF and HTN.
Upon Arrival:

• Troponin: 0.044
• CXR showed extensive pulmonary edema.

Additional Case Details

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Detailed Cath Lab Results

Patient Profile:

• Age: Approximately 60’s F
• Symptoms: Chest ache x20 minutes radiating down left arm and into back, constant, 5/10, diaphoretic
• History: COPD, hypertension
• Medications: Losartan, albuterol, spiriva, HCTZ
• Allergies: Sulfa, PCN
• Heart Rate: 80 - 110 bpm
• Blood Pressure: 110/70
• SPO2: 99 RA

Troponin Levels:

• Trop 1: 81
• Trop 2: 188
• Trop 3: 240

Angiographic Details:

1. Left Main: Bifurcates into LAD and LCX; no significant disease.
2. LAD: Normal anatomic course, no angiographic significant disease.
3. LCX: Normal anatomic course, no significant disease.
4. RCA: Acute total occlusion proximal RCA; normal anatomic course.
   • Dominance: Right

Procedure Details:

• Lesion #1: Proximal to mid RCA
• Anticoagulation with heparin, antiplatelet therapy (loaded with ASA and Ticagrelor).
• Catheter deployed under fluoroscopy; lesions documented with angiography.
• Balloon 2.5 x 12 mm advanced to lesion site; inflated at 18 ATM.
• Stent deployed (overlapping stents: Synergy 2.75 x 12, Onyx 3.0 x 38, Xience 3.0 x 8, Onyx 3.0 x 8).
• Post-stent balloon dilation done with 3.25 NC Balloon at 18 ATM.
• IVUS confirmed stent fully expanded.
• Closure achieved with radial compression band; no complications.

Conclusion:

Successful PCI to acute total RCA occlusion with multiple overlapping drug-eluting stents.