Hany Ragy Profile picture
Aug 23 13 tweets 11 min read
#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… Image
Now in CCU about to discharge:
Ok ! The Pink Team just finished the case ! Have some surprises for u! Stay tuned !!! Image
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.. ImageImage
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! ImageImage
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 ImageImage
End result was stent like with TIMI2-3 flow, sent to CCU for one night of Tirofiban ImageImage
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!!

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More from @Hragy

Aug 26
The father of syncope in Europe #ESCCongress ImageImageImage
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Read 10 tweets
Aug 26
Women present with more/worse HF with same risk factors #ESCCongress #Gender ImageImageImage
Swedeheart women vs men Image
Female patients with HFpEF older, live longer #ESCCongress on gender differences in HF Image
Read 38 tweets
Aug 24
By the way, a few years ago I was attacked in Barcelona and beaten for my watch! No machete was used! I was saved by 2 kind Spanish young men, my watch bracelet was broken , but i kept it.
Please all #ESCCongress attendees be careful with petty crime in this lovely city 🧵
Read 4 tweets
May 16, 2021
important to know that many in Egypt do not like or trust Hamas due to relationship with the MB,yet we almost all condemn Israel’s bombing of Gaza unconditionally, it’s not like an ideological support of Hamas-actually quite the opposite!Most would love to see it go,like hezbolla
We also condemn the unlawful evictions at Jerusalem , those are citizens under occupation who should be protected by international law,we believe the USA has a major role in making its position clear to Israel,just like Biden said it has right to defend itself, evictions?
In Egypt we have a peace treaty with Israel, it’s obvious from both Camp David and Oslo that the ONLY way for peace to really happen is self autonomy in the West Bank and Gaza return of the arab part of Jerusalem, and we know that’s going to happen,Better sooner than later
Read 7 tweets
May 15, 2021
Football boots , something a football player is very proud of! Any of those boots would sell to collectors for a lot of money
Mo Salah shoes now among the British museum’s Egyptian collection ..
Read 4 tweets

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