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Richard Sohn MD Profile
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
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@RSohnMD
Richard Sohn MD
4 years
Doing solo-operator ROTAPRO (rotational atherectomy) STARTING POSITION (after testing & adjusting burr speed): Dynaglide ON, wire inside clip inside β€œbrake defeat slot” (make sure to insert clip while pressing black button) #RadialFirst
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@RSohnMD
Richard Sohn MD
2 months
Calcium score CAC = ZERO ➑️ But this πŸ‘‡πŸΌπŸ‘‡πŸΌπŸ‘‡πŸΌ πŸ‘€ (Class 3 angina on meds) PCI or CABG❓
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@RSohnMD
Richard Sohn MD
3 months
Just doing elective PCI w/ #Shockwave (red) Then this πŸ‘‡πŸΌπŸ‘‡πŸΌπŸ‘‡πŸΌ … πŸ‘€ #R-on-T #ventricularfibrillation #defibrillation
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@RSohnMD
Richard Sohn MD
4 months
Simultaneous SCAD + TAKOTSUBO SCAD-subo or tako-SCAD β€” which came first ?? πŸ‘€ 60F w/ NSTEMI Echo ➑️ takotsubo Angio ➑️ prob SCAD of ramus note coronary AK + microvasc staining in distribution of #takotsubo (eg AP cranial washout) @rajivxgulati
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@RSohnMD
Richard Sohn MD
4 months
During difficult delivery in crazy RCA (πŸ‘‡πŸΌ), stent got stuck but stent balloon catheter pushed few mms farther downstream ➑️ Most of stent deployed (albeit undersizedπŸ‘‡πŸΌ) BUT proximal end un-deployed (πŸ‘‡πŸΌ) Not apparent b/c NO imaging … until recurrent STEMI 3 wks later πŸ‘€
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@RSohnMD
Richard Sohn MD
4 months
ANSWER: Undersized AND partially undeployed See next πŸ‘‡πŸΌ for details @TWilsonMD @doc_ecmo @DrWhyWho @champion_slayer @mlbalbinotti @mmamas1973 @mirvatalasnag
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@RSohnMD
Richard Sohn MD
2 years
1/ Step-by-step β€œCORONARY FUNCTION TESTING” 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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@RSohnMD
Richard Sohn MD
4 months
What an UNDERSIZED STENT looks like by #OCT πŸ‘€ πŸ‘‡πŸΌπŸ‘‡πŸΌπŸ‘‡πŸΌ
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@RSohnMD
Richard Sohn MD
5 months
Intra-plaque hemorrhage (IPH) β€” involving 12 mm of LAD ostium β€” another great example showing #OCT’s ability to clarify ACS mechanism
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@RSohnMD
Richard Sohn MD
5 months
Always consider #ANOCA 50M w/ debilitating episodes of β€œatypical” CP at rest. Non-exertional ➑️ normal vasodilator nuclear stress Before & after acetylcholine πŸ‘‡πŸΌ πŸ‘€ #coronaryvasospasm
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@RSohnMD
Richard Sohn MD
7 months
The LADD OSTIAL Lesion πŸ‘€ ➑️ perfect target for #DCB? 60 yo man w/ NSTEMI IVUS = 3.8 mm prox-LADD, bifurcates 6 mm downstream into 2.7 mm limbs πŸ‘‡πŸΌπŸ‘‡πŸΌπŸ‘‡πŸΌ Cutting balloon + 3.5 mm DCB (75 s)
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@RSohnMD
Richard Sohn MD
7 months
Ok, I’ll end the suspense β€” ⬇️ ic NTG solves the riddle πŸ‘€ Amazing case of severe coronary #vasospasm true #Printzmetal
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@RSohnMD
Richard Sohn MD
7 months
60 yo woman w/ acute severe CP EKG & cath below πŸ‘‡πŸΌπŸ‘‡πŸΌπŸ‘‡πŸΌ How would you approach this? #CardioTwitter #STEMI
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@RSohnMD
Richard Sohn MD
7 months
DES ➑️ MSA 8.6 mm2
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@RSohnMD
Richard Sohn MD
7 months
Sometimes cutting balloon is enough for CALCIUM NODULE (non-eruptive MLA 1.4 mm2) OCT pre- & post CB πŸ‘€ ➑️ good expansion MLA 7.8 mm2 See next for DES result πŸ‘‡πŸΌπŸ‘‡πŸΌ
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@RSohnMD
Richard Sohn MD
8 months
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@RSohnMD
Richard Sohn MD
8 months
3/ IMPORTANTLY πŸ‘‡πŸΌπŸ‘‡πŸΌπŸ‘‡πŸΌ ** Most MBs cause diastolic restriction and/or neg remodeling (refπŸ‘‡πŸΌ) CASE: 50 yo athlete ➑️ angina 2 yrs MB w/ β€œfixed” narrowing (cathπŸ‘‡πŸΌ) CCTA & IVUS (seeπŸ‘‡πŸΌ) confirm no plaque / dissection Dobut RFR = 0.72 (nl > 0.76) πŸ”ͺ unroofing ➑️ CP-free
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@RSohnMD
Richard Sohn MD
8 months
2/ MYOCARDIAL BRIDGES (MBs) MINOCA mechanisms: - Proximal atherosclerosis ➑️ plaque erosion or rupture - Coronary vasospasm - Downstream SCAD (exampleπŸ‘‡πŸΌ)
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@RSohnMD
Richard Sohn MD
8 months
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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@RSohnMD
Richard Sohn MD
11 months
Answer ➑️ 3. Macrophages
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