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Physician: Maureen J. Smith, MD EKG No.: 43021

Room No.: 422 Hospital No.: 560213

Hemodynamic Measurements

Aortic pressure 110/75 mean 95. Left ventricular pressure 110/0-20. Left ventricular enddiastolic pressure preatrial systole eight and postatrial systole 18 mmHg. These parameters are indicative of impairment in left ventricular function.

Ventriculogram

Left ventricular function is impaired to a severe degree with an ejection fraction .15. There is akineses anteriorly with dyskinesia apically and infero-apical anurysm as well as the akinesis extending up the inferior surface to the mid-portion. There are filling defects in the inferior apical aneurysm consistent with thrombi. The ventricular chamber is dilated, and there is a grade 1 mitral insufficiency.

(Now continue with this coronary arteriographic analysis).

LEFT MAIN AND ANTERIOR DESCENDING

The anterior descending is totally occluded at its origin. The distal vessel is seen on the left coronary injection, thready and most likely a diagonal branch rather than the main anterior descending.

Circumflex

Circumflex vessel proximally as well as a branch in the atrio-ventricular groove and circumflex intermediate are normal.

Right Coronary

There is a small plaque in this dominant vessel, proximally. The distal anatomy is normal.

DIAGNOSES

1. Arteriosclerotic heart disease with severe impairment in left ventricular function, EF.15.

2. Ventricular aneurysm and thrombi.

3. Mitral insufficiency, mild.

4. Total occlusion of the anterior descending coronary.

The vessel obstructing distal diameter values are as follows: LMC: 0; AD: 100-0; DG: 100-0.3; CX: 0; CX PL: 0; CX INT: 0; RC: 0; PD: 0.

William B. Waxman, MD

student’s initials

D: 11/25/2013

T: 11/25/2013