STRETCH Trial: stretches can improve pain during interventional procedures. Improve your ergonomic health by doing 15 mins of daily stretches. Our research published in MyJSCAI Brenden Ingraham, M.D. Rajiv Gulati Dr.Patricia Pellikka jscai.org/article/S2772-…

Five “G”eneral principles of successful PCI:
1. Good guide support
2. Good view(2 lumens (A), lower is false (B), aimed for upper.
3. Good angulations @ wire tip ( primary & secondary bends) & with MC (Twin pass or angled MC: used)
4: Good friend⁦Benjamin Hibbert⁩
5: God

What are the 5 essentials to do a successful PCI of this LAD?

Answers to yesterday’s trivia
1. Giant “V” waves in TR. look at pressure data.
2. Papillary fibroelastoma at AV in a young lady causing multiple strokes.
3. Spike & dome in obstructive HCM.
4. Multivessel dx in a diabetic patient with severe LV dysfunction.

Today’s menu:
Four cases and four different indications for surgery.
Identify the diseases and reasons for surgery.

Asbestosis thoracic disease
1. Pleural plaques (after 20y of exposure, holly-leaf, asx, Ca2+)
2. Diaphragmatic pleural plaques are pathognomonic.
3. Pleural effusion
4. Diffuse pleural thickening
5. Malignant mesothelioma

Once you see it, you will never forget it. What is your diagnosis?

mandeep singh presents our findings from the CHAMP Trial. #Genotype -guided P2Y12 inhibitor monotherapy within a week of #PCI is feasible and likely safe in patients with #HBR . Rajiv Gulati Chet Rihal Amir Lerman Naveen Pereira Linnea Baudhuin, PhD 🧬 Ann Moyer #ACC2024 🫀🩸

To Interventional Cardiology Program Directors and Education Coordinators:
 
We have an unexpected opening for our Mayo Clinic Interventional Cardiology Fellowship in Structural Heart Disease for 2024-25 in Rochester, Minnesota.

What is wrong with this LV angiogram?

What is wrong here? Please pledge not to repeat it!

BER vs. Acute Pericarditis: Remember the setting (ASx vs. Sx) and T wave height in precordial leads (higher in BER) with resultant smaller ST/T wave ratio.

STEMI call was activated on this young smoker presenting with chest pain. What would you do next?

Second, type 2 MI should be diagnosed only
1. In the right clinical context
2. Absence of ischemic symptoms
3. (Very important) less troponin elevation with lower delta.

There are 2 concepts that I would like to share. First, difference between myocardial injury and infarction rests on patient’s symptoms.

Age & stress of surgery points to Takotsubo cardiomyopathy. The spike-and-dome pattern and dagger shaped Doppler gradient points to its dynamic& not fixed nature. Key point is not to give inotropes. Optimize preload, beta blockers, & alpha agonists. She became better with this.

What is your diagnosis?
64YF underwent abdominal surgery and went into cardiogenic shock. she was started on inotropes with further deterioration in hemodynamics seen. Referred for angio; ascending aortic pressure is shown and a 126mm gradient was detected on echocardiogram.

Innovative ways to delineate left coronaries. What would you do next, if the lesion in the LAD is significant?

Ventricularization (V) vs. Damping (D)
1.V: Recognize a wave, before systole due to motion of aorta during atrial systole
2.D more severe than V & occurs when outer cath dia> ostial coronary dia
3.Pulse pressure ⬇️ in D; ⬆️in V; delayed upstroke& downstroke in D
4.D/V: DON’T 🩼

Diagnosis in a post TAVR patient with BMI of 65. Tracing obtained during PCI of LAD.