Thread by @Hragy

#CardioTwitter poll in next tweet, 54 year old male, smoker since age 14(Egypt!) DM, HPN.
Burning chest discomfort at 6 am, woke him up, came to ER, Tn HS normal, ECG normal…

Now in CCU about to discharge:

@mmamas1973 @GreggWStone @DocSavageTJU @djc795 @mirvatalasnag @saraceciliamtz @SarahFairley7 @Allison_Dupont @drandrewsharp @ShariqShamimMD @aymanka @jedicath @Drlipid @DavidLBrownMD @AntoniousAttall

Ok ! The Pink Team just finished the case ! Have some surprises for u! Stay tuned !!!

Based on Twitter majority poll and my own assessment, decided to go for immediate coronary angio,patient TnHS was 1.5(normal lab max15) 4 hours after pain, i ordered a second one,but took patient to lab #radialfirst after diagnostic angio showed occluded OM2,Tn Result came 438..

Can you see the occluded OM 2, after taking the diagnostic shots i got the Tn result in Cath lab!

Now the twist! While running the cine angio’s with 5F JL still in LM the patient developed non sustained VTach with hypotension.
Based on earlier rest angina ,Tn rise, and VTach decided to open the acutely occluded small OM2!

Wiring with a BMW was straight forward

PTCA with a 2.5/20 balloon then a long 2.5/35 mm DCB was done as the artery was small and I couldnt see a good stent landing zone

End result was stent like with TIMI2-3 flow, sent to CCU for one night of Tirofiban

Video showing non TIMI 3 flow

Lessons I learnt:
1- should we repeat Tn even if first test was 4 hours after pain?
4-small arteries in ACS are a different animal from CCS: V Tach!!

@mmamas1973 @GreggWStone @DocSavageTJU @djc795 @mirvatalasnag @saraceciliamtz @SarahFairley7 @Allison_Dupont @drandrewsharp @ShariqShamimMD @aymanka @jedicath @DavidLBrownMD @AntoniousAttall @timir_paul @mandeep_mayo
Is the non sustained V tach here something worth considering?