Reading File
Finding Sources
Finding Sources
Here is a full transcription and clinical interpretation of the catheterization report:
Coronary Angiography Report - Transcription & Interpretation
Institution: Department of Cardiology, AIMSS Chamiana, Shimla, H.P.
Date: 15/06/26 | Cath No: 591/26
Patient: Sahil, Age: 65, Male | BMI: noted
Lab Values
| Parameter | Value |
|---|---|
| HbA1c | noted |
| eGFR | 1.35 |
| Troponin I | >20 |
| LDL | 81 |
Note: Troponin I >20 indicates significant myocardial injury. eGFR of 1.35 is critically low (likely mL/min/1.73m² - severe CKD or AKI).
Procedure
CAG/P Angio - Coronary Angiography + Peripheral Angio
Access: Coronary (4) | RA + AORTA + LCA/RCA | FA + AORTA + LCA/RCA
Indication
- CTE (likely Chronic Total Occlusion evaluation)
- LCu + LTw + LW (left coronary territory)
- PTMR (?), TMPl (?), KGlp1 (??)
- YR-Collin S/T, T D2, PYF VSG, 8TJ + TZ y-y → ST changes noted
- ECG: 4C Rollin S/T, TD2/PYF VSG, 8TL+TZ 4-9 (ST changes in multiple leads)
Hemodynamics
- Opening BP: 126/60 mmHg | HR: 80/min
- Closing BP: 140/66 mmHg
- SpO2: 99% on RA
Coronary Angiography Findings
LCA (Left Coronary Artery)
- LAD to LMC: LAD-Ostium (W = within normal limits)
- LCx-Ostium: Diseased (noted as "dowured"/diseased)
- RCA-Reflux/Ostium: (W)
LAD (Left Anterior Descending)
| Segment | Finding |
|---|---|
| Proximal | Tubular eccentric lesion in 60% stenosis - TIMI flow (S) |
| Biflesion c 0.1 (Grade 1,1,1) | |
| Shaft | (Normal) |
| Mid | Tubular autoclear lesion 50% stenosis (S) |
| Distal | Within normal (W) |
| Ramus | Within normal (W) |
| Diagonal | Diffuse calcified lesion |
| Septal | Plaque |
LCx (Left Circumflex)
| Segment | Finding |
|---|---|
| Proximal | Plaque |
| OM (Obtuse Marginal) | Major OM: Ostial 90% stenosis (S) - significant! |
| Mid | Plaque |
| Distal | Plaque |
| PD | (W - normal) |
| PLV | (W - normal) |
RCA (Right Coronary Artery)
| Segment | Finding |
|---|---|
| Proximal | Plaque |
| Mid | Plaque |
| RV Branch | Within normal (W) |
| Distal | Plaque |
| PD | (W - normal) |
| PLV | (W - normal) |
Dominance: Right dominant system
Summary Diagnosis
DVD (Double Vessel Disease)
- LAD: Proximal 60% stenosis (S) + Biflesion Grade 0.1 (1,1,1) + Mid 50% stenosis (S)
- LCx: OM major ostial 90% stenosis (S) - the critical lesion
Plan
PCI to LCx - OM major
The plan is to perform percutaneous coronary intervention (PCI/stenting) to the Obtuse Marginal branch of the LCx, targeting the 90% ostial lesion which is the most hemodynamically significant finding.
Clinical Summary
This is a 65-year-old male with elevated Troponin I (>20, consistent with NSTEMI or recent MI), presenting with double vessel coronary artery disease:
- Critical lesion: LCx-OM ostial 90% stenosis - the culprit vessel
- Significant lesion: LAD proximal 60% + mid 50% with bifurcation involvement (Grade 1,1,1 Medina classification)
- Background: Diffuse calcification, widespread plaque burden
- Decision: PCI to LCx-OM major (the critical 90% ostial lesion is the primary target)
The LAD lesions (60% proximal, 50% mid) are significant but below the typical intervention threshold of 70%; FFR/iFR guidance would be ideal to determine if they are functionally significant.
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