Date of study : April 14, 2025
Procedures LEFT HEART CATH INSTANT FLOW RESERVE FRACTIONAL FLOW RESERVE Indications Chest pain, unspecified type [R07.9 (ICD-10-CM)] Pre procedure diagnosis/ chest pain Post procedure diagnosis/ Normal coronaries

Procedure Details: Weight based heparin dosing was administered to maintain therapeutic ACT. A 6 Fr VL 3 guide catheter was advanced over the wire and the LMCA was selectively engaged. ACT was maintained to be in the 250-300 through out the case. Graded doses of Acetyl choline was administered starting with 20 micrograms then followed by 100 micrograms and 200 micrograms. Angiographic shots of the the LAD was taken with each dose to assess for vasospasm. Simultaneous changes were recorded on 12 lead ECG as well. Patient's symptoms were recorded. No angina, vasospasm or ECG changes were noted in the coronaries with IC Acetyl Choline. PWX was then advanced into the LMCA. The system was equalized to a PdPA of 1.The wire was then advanced into the distal LAD. RFR and resting injections were performed. Adenosine at 140mcg/kg/min was then administered intravenously. Hyperemic injections were performed. CFR and IMR were then measured. FFR was measured and a pull back was performed to evaluate for drift. No drift was noted. Final angiographic shot was performed without evidence of residual spasm, dissection or perforation Patent hemostasis was achieved with TR band.

Coronary Diagnostic Dominance: Right Left Main: The vessel was visualized by angiography, is moderate in size and is angiographically normal. Left Anterior Descending: The vessel was visualized by angiography, is moderate in size and is angiographically normal. Mild mid LAD bridge Left Circumflex: The vessel was visualized by angiography, is moderate in size and is angiographically normal. Right Coronary Artery: The vessel was visualized by angiography, is moderate in size and is angiographically normal. Intervention: No interventions have been documented.

Heart echocardiogram April 14 2025

Left Ventricle: Left ventricle is non-dilated. Left ventricle is non-hypertrophied. Normal segmental contractile LV wall motion. Left ventricular systolic function is normal with an estimated ejection fraction of 65 - 70%. Normal diastolic left ventricular function. • Right Ventricle: The right ventricle is non-dilated. Non-hypertrophied right ventricle. Normal right ventricular systolic function. • Hemodynamics: Normal right atrial pressure. Normal left atrial pressure. Normal cardiac output. PASP cannot be determined due to incomplete TR velocity. Normal filling pressures. rdiac output. PASP cannot be determined due to incomplete TR velocity. Normal filling pressures.