NUCLEAR CONFERENCE

1
NUCLEAR CONFERENCE

• 8/30/02

2
JC

• 81 YO WM
• CP W/ EXERTION-TYPICAL SXS
• PMHX OA, GERD, ANGINA NOS
• SHX NO TOB
• FHX NC

3
Jc 7/29
4
jcbw
5
NUCLEAR SCAN

• REDISTRIBUTION AND PARTIAL REDISTRIBUTION
  BASO-INFERIOR WALL
• NORMAL SYSTOLIC FNC

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NUCLEAR SCAN

• MAZZ INTERPRETATION MAINLY FIXED BASAL INFERIOR
  DEFECT

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CATH RESULTS

• LM NORMAL
• LAD LUMINAL IRREGULARITIES
• CX OM1 20 MID
• RCA DOMINANT 100 MID VESSEL
• LVG EF 55 INF/BASAL HK TO AK MILD ANT HK

8
INTERVENTION

• NONE
• COLLATERAL FLOW NOTED FROM LEFT SYSTEM
• AGGRESSIVE MEDICAL TREATMENT

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GS

• 64 YO WM
• PRE-OP EVAL FOR COLON RESECTION
• PMHX DM, INC CHOL, HTN, COLON CA, CRI AND ANEMIA
• SHX TOB
• FHX NC

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Gs 6/27
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gsbw
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NUCLEAR SCAN

• ISCHEMIA IN APICAL WALL
• FIXED HYPOPERFUSION ANTEROSEPTAL WALL
• MOD TO SEVERE LV DYSFUNCTION

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CATH RESULTS

• LM NORMAL
• LAD D1 70 PROX
• CX NORMAL
• RCA DOMINANT NO DISEASE
• LVG NOT DONE

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INTERVENTION

• NONE
• SINGLE VESSEL CAD W/ SYST DYSFXN OUT OF
  PROPORTION TO CAD
• CONT MEDICAL THERAPY

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GA

• 68 YO WM
• CRESCENDO ANGINA
• PMHX CAD, HTN,GERD, BPH AND ANEMIA
• SHX REMOTE TOB/ETOH
• FHX NO PREMATURE CAD

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Ga 8/2
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gabw
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NUCLEAR SCAN

• MOD TO SEVERE LV ENLARGEMENT
• FIXED APICAL HYPOPERFUSION
• REDISTRIBUTION IN SMALL AREA OF ANTERIOR WALL

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CATH RESULTS

• LM NORMAL
• LAD D1 50-60 OSTIAL
• CX TORTUOUS BUT NORMAL
• RCA DOMINANT NO DISEASE
• LVG NOT DONE

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INTERVENTION

• NONE
• AGGRESSIVE MEDICAL THERAPY AND RISK FACTOR
  MODIFICATION

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MR

• 67 YO WM
• PRE-OP EVAL FOR CEA
• PMHX CAD CABG 97, HTN,COPD, OA, INC LIPIDS,HH
  AND ANEMIA
• SHX NO TOB/ETOH
• FHX NC

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Mr 7/1
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mrbw
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NUCLEAR SCAN

• MILD LV ENLARGEMENT
• ISCHEMIA INVOLVING INFERIOR WALL
• MILD LV DYSFUNCTION

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NUCLEAR SCAN

• MAZZ INTERPRETATION PARTIALLY REVERSIBLE
  INFERIOR DEFECT

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CATH RESULTS

• LIMA TO LAD OCCLUDED
• GE TO RCA OCCLUDED
• SVG TO OM2 WIDELY PATENT
• LM DISTAL 30-40
• LAD DIFFUSE PROX IRREGS UP TO 50 FOCAL 80
  LESION AT BEND
• CX DIFFUSE PROX IRREGS UP TO 50 AFTER OM1 100
  OCCLUDED
• RCA DOMINANT 80 PROX LESION
• LVG NOT DONE

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INTERVENTION

• STENTING
• PROX RCA
• PROX LAD
• MID LAD

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KM

• 50 YO WM
• CP AND INCREASING SOB X 3 WKS
• PMHX 4V- CABG 96,
• SHX NO TOB/ETOH
• FHX NC

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Km 8/16
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kmbw
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NUCLEAR SCAN

• REVERSIBLE REDISTRIBUTION OF MID ANTERIOR,
• MID ANTEROSEPTAL,
• MID INFEROLATERAL AND BASOINFERLATERAL WALLS

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CATH RESULTS

• LIMA TO LAD OCCLUDED
• SVG TO OM1 AND PDA OCCLUDED
• SVG TO D1 WIDELY PATENT
• LM 30 PRIOR TO TAKE OFF OF LAD/CX
• LAD 100 PROXIMALLY OCCLUDED
• CX 100 OCCLUDED
• RCA100 OCCLUDED PROXIMALLY
• LVG EF 55

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INTERVENTION

• NONE
• OPTIMIZE MEDICAL THERAPY

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CB

• 58YO WM
• CP WHILE MOWING THE LAWN X 1
• PMHX NONE
• SHX TOB
• FHX NC

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Cb 8/15
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cbbw
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NUCLEAR SCAN

• ABSENT MYOCARDIAL PERFUSION BASAL INFERIOR, BASAL
  INFEROLATERAL, MID INFERIOR AND MID INFEROLATERAL
  WALLS
• AND SMALL AREA OF MID ANTEROSEPTAL WALL
• AREAS SIGNIFICANTLY REDISTRIBUTED ON REST

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NUCLEAR SCAN

• MAZZ INTERPRETATION REVERSIBLE INFERIOR AND
  APICAL DEFECT

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CATH RESULTS

• LM NORMAL
• LAD 75 MID VESSEL
• CX 90 STENOSIS PRIOR TO OM1
• RCA100 OCCLUDED MID VESSEL WITH COLLATERAL FLOW
• LVG NORMAL EF AK TO HK INF WALL

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INTERVENTION

• CT SURGERY CONSULT

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JW

• 73YO WM
• 4 MINUTES OF CP WHILE AT REST
• PMHX HTN, OA AND PROSTATE CA
• SHX NO TOB
• FHX HTN

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Jw 8/26
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jwbw
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NUCLEAR SCAN

• SMALL AREA OF REDISTRIBUTION IN INFEROLATERAL WALL

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CATH RESULTS

• LM NORMAL
• LAD NORMAL
• CX NORMAL
• RCANORMAL
• LVG NOT DONE

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INTERVENTION

• NONE
• CONTINUE RISK FACTOR MODIFICATION

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CS

• 66YO WM
• H/O CAD AND SSCP
• PMHX PVD, DM, CVA, HTN, INC CHOL
• SHX NO TOB
• FHX PVD

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Cs 8/16
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csbw
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NUCLEAR SCAN

• REVERSIBLE APICAL AND INFEROAPICAL PERFUSION
  CHANGES

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CATH RESULTS

• LM DIFFUSE DX 60-70 STENOSIS
• LAD PROX 60-70 STENOSIS W/ LU IRRS
• CX OM1 70-80 OSTIAL STENOSIS
• RCADOMINANT 100 PROX OCCLUDED WITH L TO R
  COLLATERALS
• LVG EF 55

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INTERVENTION

• CT SURGERY CONSULT

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RF

• 69YO WM
• H/O RUL MASS AND SPINE PAIN PRE-OP SPINAL BX
• PMHX PANCYTOPENIA, HTN, CAD (H/O MI 17 YRS AGO),
  COPD AND HYPOTHYROIDISM
• SHX PRIOR HEAVY TOB USE
• FHX NC

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Rf 7/31
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rfbw
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NUCLEAR SCAN

• SMALL AREA OF INFEROLATERAL REDISTRIBUTION
• FIXED HYPOPERFUSION INFERIOR WALL
• SPLENOMEGALY

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NUCLEAR SCAN

• MAZZ INTERPRETATION SMALL FIXED BASAL INFERIOR
  DEFECT

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CATH RESULTS

• LM 30 OSTIAL LESION
• LAD PROX 30 STENOSIS
• CXDOMINANT MID VESSEL 40 STENOSIS
• RCASMALL VESSEL NO DISEASE
• LVG EF gt55 INF BASAL HK TO AK

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INTERVENTION

• NONE
• MID CX LESION MAY BE CULPRIT FOR OLD MI AND WALL
  MOTION ABNORMALITY

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HS

• 49YO WM
• EPISODIC CP AND POOR ECHO IMAGES
• PMHXHTN, PTSD, INC LIPIDS, OBESITY AND CAD
• SHX TOB USE
• FHX NO PREMATURE CAD

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Hs 8/21
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hsbw
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NUCLEAR SCAN

• ISCHEMIA INVOLVING APICAL INFERIOR, APICAL
  LATERAL, MID INFERIOR MID INFEROLATERAL AND BASAL
  INFERIOR WALLS AT REST
• EF 50

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NUCLEAR SCAN

• MAZZ INTERPRETATION PARTLY REVERSIBLE APICAL
  AND INFERIOR DEFECT

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CATH RESULTS

• LM NORMAL
• LAD 80 STENOSIS OSTIUM D1, D2 60 PROX
• CX 20-30 DIFFUSE DISEASE
• RCADOMINANT 90 STENOSIS AT TAKEOFF OF PDA
• LVG EF gt55 APICAL AND INFEROBASAL HK TO AK

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INTERVENTION

• CT SURGERY CONSULT