0:01

This is a 60 something patient

0:03

and they had symptoms of progressive dyspnea, exertion,

0:07

and as you know, there's a differential for dyspnea,

0:09

could have lung disease, could have, uh, heart disease,

0:12

and eventually made their way to a cardiologist.

0:15

And, uh, this test is requested, so let's just look.

0:19

This is not known disease, but just some that I could think

0:22

'cause their, their age and their risk factor

0:23

has made it a higher risk.

0:25

So definitely they have their share of calcium,

0:27

so it's not gonna be a negative, but it's kind

0:29

of scattered throughout though.

0:30

Dents and, um, good scan,

0:33

no artifacts, really beautiful scan.

0:36

Actually, let's look through the

0:38

right coronary artery, lumpy and bumpy.

0:41

I don't think there'll be anything severe there, though.

0:43

Um, probably mild in the mid RCA left main.

0:48

I like what I see, but I'm gonna, just gonna confirm

0:50

and yeah, it looks fine there.

0:51

So it's kind of ectatic, uh,

0:53

a normal left main's about three to five millimeters.

0:56

Um, and at the distal part it flares here.

0:59

So I would definitely make a comment about ectasia

1:01

throughout all the vessels here.

1:03

And, um, LED, some scattered disease

1:07

and, well, that's a, it is kind

1:09

of got a little focal narrowing.

1:11

Those tend to be more treatable

1:12

and cause the kind of things, especially if they develop,

1:15

uh, with any acute component, they can give you symptoms.

1:19

Um, so let's just look here

1:21

and just, this is a nice orientation, beautiful study.

1:25

PLED. There's the, where it becomes mid

1:28

and right at the mid segment there's this kind of,

1:31

at the osteum of the mid, uh, a focal probably moderate,

1:35

potentially severe stenosis.

1:37

And, um, I think with the pretest risk, the symptoms

1:41

and the lesion, uh, the next step was, uh, deemed

1:46

to do an invasive angiogram.

1:48

I am gonna just do one thing more before I move over there,

1:52

and that's just give ourselves a volume rendered.

1:55

This, this software happens to do it very quickly.

1:58

It's nice to just be very clear where we're gonna send the,

2:02

uh, interventionalist to look.

2:03

And so, um, wouldn't be wrong to stick an arrow

2:06

and just say, Hey, that's what I'm worried about.

2:08

And, uh, right

2:09

after that, uh, branch there, the diagonal branch.

2:12

So let's look at our cath.

2:15

As much as I, um, certainly hope that

2:20

our interventional colleagues look at the CT exam images.

2:25

The, the report still is the most important thing.

2:26

And so here comes that cath.

2:28

So big-ish vessels, a little sluggish flow in

2:33

that LED here,

2:35

it is projected now right at the front.

2:38

And I, I do think I see an abnormality there.

2:42

The pretest risk must have been high enough

2:44

where they just knew that the treatment was, uh,

2:46

on the table here, there's a wire down.

2:49

Uh, it does look like it's significant,

2:51

looks like a stenting procedure was undertaken.

2:54

And, um, pretty nice angiographic result.

2:57

So, uh, a moderate stenosis, it was really in the mid LED,

3:02

strictly speaking, uh, which weren't a treatment.

3:06

And looks like the patient did pretty well.