
Richard Sohn MD
@RSohnMD
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Interventional cardiology, CTO & CHIP operator. Coronary microvascular dysfunction (CMD), vasospasm angina (VSA) & myocardial bridge (MB) #ANOCA #INOCA #MINOCA
Portland, OR
Joined November 2019
Doing solo-operator ROTAPRO (rotational atherectomy) STARTING POSITION (after testing & adjusting burr speed): Dynaglide ON, wire inside clip inside βbrake defeat slotβ (make sure to insert clip while pressing black button) #RadialFirst
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Calcium score CAC = ZERO β‘οΈ But this ππΌππΌππΌ π (Class 3 angina on meds) PCI or CABGβ
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Just doing elective PCI w/ #Shockwave (red) Then this ππΌππΌππΌ β¦ π #R-on-T #ventricularfibrillation
#defibrillation
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Simultaneous SCAD + TAKOTSUBO SCAD-subo or tako-SCAD β which came first ?? π 60F w/ NSTEMI Echo β‘οΈ takotsubo Angio β‘οΈ prob SCAD of ramus note coronary AK + microvasc staining in distribution of #takotsubo (eg AP cranial washout) @rajivxgulati
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During difficult delivery in crazy RCA (ππΌ), stent got stuck but stent balloon catheter pushed few mms farther downstream β‘οΈ Most of stent deployed (albeit undersizedππΌ) BUT proximal end un-deployed (ππΌ) Not apparent b/c NO imaging β¦ until recurrent STEMI 3 wks later π
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ANSWER: Undersized AND partially undeployed See next ππΌ for details @TWilsonMD @doc_ecmo @DrWhyWho @champion_slayer @mlbalbinotti @mmamas1973 @mirvatalasnag
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1/ Step-by-step βCORONARY FUNCTION TESTINGβ for #ANOCA #INOCA PREPARATION: 1. Hold all vasodilators for 48 hours (exceptions = hydralazine, clonidine, doxazosin) 2. Hold caffeine for 24 hours (for adenosine) #CardioTwitter
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Always consider #ANOCA 50M w/ debilitating episodes of βatypicalβ CP at rest. Non-exertional β‘οΈ normal vasodilator nuclear stress Before & after acetylcholine ππΌ π #coronaryvasospasm
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Ok, Iβll end the suspense β β¬οΈ ic NTG solves the riddle π Amazing case of severe coronary #vasospasm true #Printzmetal
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60 yo woman w/ acute severe CP EKG & cath below ππΌππΌππΌ How would you approach this? #CardioTwitter #STEMI
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Sometimes cutting balloon is enough for CALCIUM NODULE (non-eruptive MLA 1.4 mm2) OCT pre- & post CB π β‘οΈ good expansion MLA 7.8 mm2 See next for DES result ππΌππΌ
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5/ Association of MB w/ spasm & CMD https://t.co/77VJfZWoE7
#CardioTwitter #vasospasm #CMD #microvascular #MyocardialBridge #ANOCA #MINOCA @mirvatalasnag
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3/ IMPORTANTLY ππΌππΌππΌ ** Most MBs cause diastolic restriction and/or neg remodeling (refππΌ) CASE: 50 yo athlete β‘οΈ angina 2 yrs MB w/ βfixedβ narrowing (cathππΌ) CCTA & IVUS (seeππΌ) confirm no plaque / dissection Dobut RFR = 0.72 (nl > 0.76) πͺ unroofing β‘οΈ CP-free
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2/ MYOCARDIAL BRIDGES (MBs) MINOCA mechanisms: - Proximal atherosclerosis β‘οΈ plaque erosion or rupture - Coronary vasospasm - Downstream SCAD (exampleππΌ)
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1/ MYOCARDIAL BRIDGES (MBs) ANOCA mechanisms: - Slow early diast relaxation - Diast vessel restriction +/- neg remodeling - Branch steal (Venturi effect) - Proximal atherosclerosis - Associated vasospasm, CMD (common!) (see next for MINOCA)
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