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OPERATIVE PROCEDURES: Cardiac catheterization, coronary angiogram, left ventriculogram, and aortic arch angiogram INDICATIONS: Young man with no previous history of coronary artery disease but a strong family history with exertional chest pain. He had an abnormal exercise treadmill test but good exercise tolerance. He subsequently underwent exercise stress echocardiography. The ECG portion of the test was positive with 2 mm of ST depression diffusely. The echocardiographic portion of the test was normal. Because of the recurrent chest pain, it was elected to proceed with coronary angiography. The low likelihood of coronary artery disease and the risks of cardiac catheterization were discussed in detail, including the risks of stroke, bleeding, myocardial infarction, and even death. The patient wished to proceed. DESCRIPTION OF PROCEDURE: After informed consent was obtained, the patient was brought to the catheterization laboratory in a fasting state. The right groin was prepped and draped in the usual sterile fashion and infiltrated with 1% Xylocaine. With use of the Seldinger technique, a #6 French sheath was placed in the right femoral artery. Next, selective coronary angiography of the left and right coronary systems was undertaken with Judkins L4 and Judkins R4 catheters. Next, a pigtail catheter was advanced into the left ventricle, and a left ventriculogram was performed. The pigtail catheter was pulled back into the aorta. Pressures were measured in the left ventricle and aorta. A digital aortogram was performed in the LAO 40 view. The R4 catheter was reintroduced to obtain digital views of the right coronary artery. This was done. The R4 catheter was removed, and the case was terminated. Sheaths were removed in the cardiac catheterization laboratory. Hemostasis was achieved with use of manual pressure. There were no complications. All catheter exchanges were done over the wire. For light conscious sedation, the patient received 100 mg of IV Fentanyl and 2 mg of IV Versed. Total contrast used was 165 cc. FINDINGS: Pressures: Left ventricular end-diastolic pressure was 5 mm Hg. Left ventricular systolic pressure was 98. Aortic pressure was 98/63. Left ventriculogram: No wall motion abnormalities. Left ventricular ejection fraction estimated at 60%; no mitral regurgitation. Coronary arteries: Left main coronary artery: The left main coronary artery was a short vessel with no stenosis; it gave rise to left anterior descending and circumflex arteries. Left anterior descending artery: The left anterior descending and diagonal branches were free of disease throughout their course. Circumflex artery: The circumflex artery was a large dominant vessel, was free of disease throughout its course, and gave rise to posterior descending and posterolateral arteries. These were also free of disease, as were the obtuse marginal branches. Right coronary: The right coronary artery was a small nondominant vessel with no significant stenosis. IMPRESSION: Normal left ventricular filling pressure. Normal left ventricular systolic function. No evidence of abnormalities of the ascending, transverse, or proximal portion of the descending aorta. No epicardial coronary artery stenosis, left dominant system. Code the procedure(s) and diagnosis(es).
SCIENCE
HEALTH SCIENCE
NURSING

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