Richard Sohn MD @RSohnMD X 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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Richard Sohn MD

@RSohnMD

4 years

Doing solo-operator ROTAPRO (rotational atherectomy) STARTING POSITION (after testing & adjusting burr speed): Dynaglide ON, wire inside clip inside “brake defeat slot” (make sure to insert clip while pressing black button) #RadialFirst

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Richard Sohn MD

@RSohnMD

2 months

Calcium score CAC = ZERO ➡️ But this 👇🏼👇🏼👇🏼 👀 (Class 3 angina on meds) PCI or CABG❓

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Richard Sohn MD

@RSohnMD

3 months

Just doing elective PCI w/ #Shockwave (red) Then this 👇🏼👇🏼👇🏼 … 👀 #R-on-T #ventricularfibrillation #defibrillation

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Richard Sohn MD

@RSohnMD

4 months

Simultaneous SCAD + TAKOTSUBO SCAD-subo or tako-SCAD — which came first ?? 👀 60F w/ NSTEMI Echo ➡️ takotsubo Angio ➡️ prob SCAD of ramus note coronary AK + microvasc staining in distribution of #takotsubo (eg AP cranial washout) @rajivxgulati

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Richard Sohn MD

@RSohnMD

4 months

During difficult delivery in crazy RCA (👇🏼), stent got stuck but stent balloon catheter pushed few mms farther downstream ➡️ Most of stent deployed (albeit undersized👇🏼) BUT proximal end un-deployed (👇🏼) Not apparent b/c NO imaging … until recurrent STEMI 3 wks later 👀

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Richard Sohn MD

@RSohnMD

4 months

ANSWER: Undersized AND partially undeployed See next 👇🏼 for details @TWilsonMD @doc_ecmo @DrWhyWho @champion_slayer @mlbalbinotti @mmamas1973 @mirvatalasnag

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Richard Sohn MD

@RSohnMD

2 years

1/ Step-by-step “CORONARY 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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Richard Sohn MD

@RSohnMD

4 months

What an UNDERSIZED STENT looks like by #OCT 👀 👇🏼👇🏼👇🏼

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Richard Sohn MD

@RSohnMD

5 months

Intra-plaque hemorrhage (IPH) — involving 12 mm of LAD ostium — another great example showing #OCT’s ability to clarify ACS mechanism

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Richard Sohn MD

@RSohnMD

5 months

Always consider #ANOCA 50M w/ debilitating episodes of “atypical” CP at rest. Non-exertional ➡️ normal vasodilator nuclear stress Before & after acetylcholine 👇🏼 👀 #coronaryvasospasm

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Richard Sohn MD

@RSohnMD

7 months

The LADD OSTIAL Lesion 👀 ➡️ perfect target for #DCB? 60 yo man w/ NSTEMI IVUS = 3.8 mm prox-LADD, bifurcates 6 mm downstream into 2.7 mm limbs 👇🏼👇🏼👇🏼 Cutting balloon + 3.5 mm DCB (75 s)

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Richard Sohn MD

@RSohnMD

7 months

Ok, I’ll end the suspense — ⬇️ ic NTG solves the riddle 👀 Amazing case of severe coronary #vasospasm true #Printzmetal

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Richard Sohn MD

@RSohnMD

7 months

60 yo woman w/ acute severe CP EKG & cath below 👇🏼👇🏼👇🏼 How would you approach this? #CardioTwitter #STEMI

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Richard Sohn MD

@RSohnMD

7 months

DES ➡️ MSA 8.6 mm2

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Richard Sohn MD

@RSohnMD

7 months

Sometimes cutting balloon is enough for CALCIUM NODULE (non-eruptive MLA 1.4 mm2) OCT pre- & post CB 👀 ➡️ good expansion MLA 7.8 mm2 See next for DES result 👇🏼👇🏼

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Richard Sohn MD

@RSohnMD

8 months

5/ Association of MB w/ spasm & CMD https://t.co/77VJfZWoE7 #CardioTwitter #vasospasm #CMD #microvascular #MyocardialBridge #ANOCA #MINOCA @mirvatalasnag

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Richard Sohn MD

@RSohnMD

8 months

4/ Reference: https://t.co/wcFL4r0B4W

ahajournals.org

Graphical Abstract Background: Despite optimal medical therapy, a myocardial bridge (MB) can cause life-limiting symptoms in a subset of patients. While surgical unroofing has been shown to improve...

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Richard Sohn MD

@RSohnMD

8 months

3/ IMPORTANTLY 👇🏼👇🏼👇🏼 ** Most MBs cause diastolic restriction and/or neg remodeling (ref👇🏼) CASE: 50 yo athlete ➡️ angina 2 yrs MB w/ “fixed” narrowing (cath👇🏼) CCTA & IVUS (see👇🏼) confirm no plaque / dissection Dobut RFR = 0.72 (nl > 0.76) 🔪 unroofing ➡️ CP-free

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Richard Sohn MD

@RSohnMD

8 months

2/ MYOCARDIAL BRIDGES (MBs) MINOCA mechanisms: - Proximal atherosclerosis ➡️ plaque erosion or rupture - Coronary vasospasm - Downstream SCAD (example👇🏼)

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Richard Sohn MD

@RSohnMD

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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Richard Sohn MD

@RSohnMD

11 months

Answer ➡️ 3. Macrophages

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