CATH CONFERENCE 5FEB2015 FRANK MEISSNER, MD, RDMS, RDCS FACP, FACC, FCCP, FASNC, CPHIMS, CCDS 2nd Law of Cardiology: A Good Angiogram Trumps A Room Full of Speculating Cardiologists
CATH CONFERENCE 5FEB2015
FRANK MEISSNER, MD, RDMS, RDCSFACP, FACC, FCCP, FASNC, CPHIMS, CCDS
2nd Law of Cardiology:
A Good Angiogram
Trumps A Room Full of
Speculating Cardiologists
XMAS EVE CHEST PAIN ED VISIT
SERIAL TROPONIN 24DEC@20:19 0.02 NG/DL; 24DEC@22:01 0.03 NG/DL; 25DEC04:03 0.41 NG/DL
65 y/o Hispanic Female No Previous Hx/o Chest Pain
CRF: HTN, Lipids, ex-13 yr smoker , postmenopausal
Transient (30 mins) Non-exertional Central Burning Pain,
Moderate Intensity, Mild Associated Dyspnea
No Hx/o GERD, Mild Bronchitic symptoms X 1wk
Mildly Obese, Soft S4, Mild Bronchial Breath Sounds
No Diagnostic Chest Xray or EKG Findings
No Chest Pain on Ward - Last Pain in ED
RECURRENT SYNCOPE30 Y/O REPAIRING HIS ROOF JULY 2014 FELL 14’
NECK & BACK PAIN POST TRAUMA SEQUELA
PREMONITION ABSENT SYNCOPE NOT CLEARLY POSTURAL
NO CHEST PAIN, DYSPNEA, POUNDING PALPITATIONS
AFTER MULTIPLE SERIAL EVALUATIONS, HE REPORTEED THAT SYNCOPE OR VISUAL BLACK OUT WAS ASSOCIATED APPROX 50% OF THE TIME WITH NECK TURNING (KEPT SYMPTOM DIARY)
NEGATIVE ECHO, NUC-TMT, CAROTID DOPPLER U/S, CAROTID CTA, LEFT HEART CATH, TILT TABLE TESTING, NO ARRHYTHMIA BY PROLONGED TELE MONITORING
MRI CSPINE => CERVICAL MYELOPATHY & CERVICAL 5-6 INSTABILITY
BOW HUNTER’S SYNCOPE SORENSON BF: BOW HUNTER’S STROKE. NEUROSURGERY 2: 259-261, 1978 - 1ST DESCRIPTION PATIENT DEVELOPED HEMIPARESIS AND CONTRALATERAL SENSORY CHANGES DURING ARCHERY PRACTICE.
BOW HUNTER’S SYNCOPE RARE FORM OF VBI PRESENTS AS DIZZINESS, VERTIGO, SYNCOPE, NAUSEA, OR SENSORIMOTOR DISTURBANCE DUE TO STENOSIS OR OCCLUSION OF THE VERTEBRAL ARTERY FOLLOWING HEAD ROTATION ABOUT THE CRANIO-CERVICAL AXIS
USUALLY OCCLUSION OCCURS AT THE C1 TO C2 LEVELS, BUT LESIONS AT MULTIPLE LEVELS IN THE CERVICAL SPINE HAVE BEEN REPORTED
CONCURRENT HYPOPLASTIC VA OR POOR CIRCLE OF WILLIS COLLATERALIZATION CONTRIBUTING FACTOR TO SYMPTOM PRODUCTION
CONCURRENT HYPOPLASTIC VA OR POOR CIRCLE OF WILLIS COLLATERALIZATION CONTRIBUTING FACTOR TO SYMPTOM PRODUCTION
11/11/2014 - DR VELIMIROVIC C5-6 DECOMPRESSIVE LAMINECTOMY + MEDIAL FACETECTOMY AND PARTIAL BILATERAL FORAMINOTOMY
C5-6 POSTEROLATERAL ARTHRODESIS & SCREW FIXATION OF C5-6OPEN REDUCTION OF CERVICAL 5-6 INSTABILITY AND DISLOCATION
OPEN REDUCTION OF CERVICAL 5-6 INSTABILITY AND DISLOCATION
12/26/2014 - DR VELIMIROVIC SPINAL ANGIOGRAM + CEREBRAL ANGIOGRAM WITH DYNAMIC CERVICAL ANGIOGRAPHY — NO EVIDENCE OF VERTEBRAL ARTERY OCCLUSION DURING PROVOCATIVE MANEUVERS
TO DATE NO FURTHER SYNCOPE