• 45year old male presented to the emergency department  with sharp epigastric pain.
• RUQ US showed cholelithiasis without evidence for cholecystitis. EKG in ED revealed TWI in AVL and troponin was elevated at 0.6.
• CT cardiac angiogram showed presence of premature and significant atherosclerotic disease.
• male with history of chest pain, anginal equivalent with abnormal initial EKG and troponins, presents for coronary CTA.The dominant finding is the presence of premature and significant calcific atherosclerotic disease which is in the 99th percentile for age-matched and sex matched, which is most prominent in the distal left main and proximal LAD.

  The presence of calcium limits optimal evaluation. A left main and proximal LAD lesions cannot be definitely excluded
  Left ventricular ejection fraction is calculated at 61% and LV mass of 197.6 g.

Cardiac cath revealed the following: LM lesion 50-60% and proximal LCx lesion 70%, FFR resting 0.94 and after adenosine 0.72 which was consistent with a significant lesion of the LM.

Hospital Course:  Underwent a CABG x 2 (LIMA-LAD, RIMA-OM1). Pt became asystolic during opening of the chest with ROSC after 2 minutes of internal cardiac massage. Pt was started on Dopamine for bradycardia and Phenylephrine for blood pressure support. Hemodynamics remained stable for the remainder of the operation and pt was successfully extubated in the OR.

 

DB 135