@RSohnMD

Interventional cardiology, CTO & CHIP operator. Coronary microvascular dysfunction (CMD), vasospasm angina (VSA) & myocardial bridge (MB) #ANOCA #INOCA #MINOCA

 Portland, OR
Joined November 2019
  • Tweets649
  • Following813
  • Followers1.8K
249Media
Doing solo-operator ROTAPRO (rotational atherectomy) STARTING POSITION (after testing & adjusting burr speed): Dynaglide ON, wire inside clip inside “brake defeat slot” (make sure to insert clip while pressing black button) #RadialFirst
14
102
10
310
70M w/ acute CP ➡️ VF EKG & cath 👇🏼👇🏼👇🏼 What next? 👀
8
7
43
7,791
Intervention = ic NTG 👇🏼 B/c some stenoses persisted, did 3V #IVUS : 1. No sig plaque (or bridge) 2. ++SPASM ➡️ Note remarkably THICK MEDIA layer 👀 #vasospasm #MINOCA #ANOCA @jedicath @AlanHeldman @realarainmd @nadig_cardio @Hragy @mirvatalasnag @jsenior64 @mmamas1973
4
2
8
608
Thick media layer
1
1
3
554
#ANOCA — Best medical therapy ?? See these 👇🏼 fantastic references 1️⃣ Toleva et al, JSCAI 2025 2️⃣ Miner et al, Eur Heart J 2026 * I routinely copy👇🏼 into my reports #vasospasm @Hragy #MicrovascularDysfunction #MyocardialBridge @mirvatalasnag
2
26
1
88
6,180
Do any of you do SuperSaturated O2 (SSO2) for anterior STEMI? ➡️ What are your thoughts on this therapy?
7
8
3,500
Young woman w/ VF arrest This 👇🏼 angiogram after ROSC 👀 Hemos stable, no CP What is the etiology, and what next?
19
33
3
101
18,609
When seeing #SCAD, we’re tempted to minimize & flee. But NTG solves the riddle here 👇🏼 👀 Take-homes: 1. If you think SCAD, try NTG first 2. Coronary #vasospasm can be lethal ! #MINOCA #SCD @CannanCharles
9
15
72
4,786
Richard Sohn MD retweeted
Richard Sohn MD@RSohnMD9 Feb 2025
1/ MYOCARDIAL BRIDGES (MBs) ANOCA mechanisms: - Slow early diast relaxation - Diast vessel restriction +/- neg remodeling - Branch steal (Venturi effect) - Proximal atherosclerosis - Associated vasospasm, CMD (common!) (see next for MINOCA)
2
45
1
172
15,613
Calcium score CAC = ZERO ➡️ But this 👇🏼👇🏼👇🏼 👀 (Class 3 angina on meds) PCI or CABG❓
20
9
1
67
17,875
Just doing elective PCI w/ #Shockwave (red) Then this 👇🏼👇🏼👇🏼 … 👀 #R-on-T #ventricularfibrillation #defibrillation
2
19
2
100
11,024
Simultaneous SCAD + TAKOTSUBO SCAD-subo or tako-SCAD — which came first ?? 👀 60F w/ NSTEMI Echo ➡️ takotsubo Angio ➡️ prob SCAD of ramus note coronary AK + microvasc staining in distribution of #takotsubo (eg AP cranial washout) @rajivxgulati
4
15
1
56
9,801
What an UNDERSIZED STENT looks like by #OCT 👀 👇🏼👇🏼👇🏼
25
8
2
82
10,737
ANSWER: Undersized AND partially undeployed See next 👇🏼 for details @TWilsonMD @doc_ecmo @DrWhyWho @champion_slayer @mlbalbinotti @mmamas1973 @mirvatalasnag
1
6
580
During difficult delivery in crazy RCA (👇🏼), stent got stuck but stent balloon catheter pushed few mms farther downstream ➡️ Most of stent deployed (albeit undersized👇🏼) BUT proximal end un-deployed (👇🏼) Not apparent b/c NO imaging … until recurrent STEMI 3 wks later 👀
3
3
17
2,782
Richard Sohn MD retweeted
Richard Sohn MD@RSohnMD12 Sep 2023
1/ Step-by-step “CORONARY FUNCTION TESTING” for #ANOCA #INOCA PREPARATION: 1. Hold all vasodilators for 48 hours (exceptions = hydralazine, clonidine, doxazosin) 2. Hold caffeine for 24 hours (for adenosine) #CardioTwitter
6
89
5
326
66,598
Intra-plaque hemorrhage (IPH) — involving 12 mm of LAD ostium — another great example showing #OCT’s ability to clarify ACS mechanism
3
9
64
5,579
Always consider #ANOCA 50M w/ debilitating episodes of “atypical” CP at rest. Non-exertional ➡️ normal vasodilator nuclear stress Before & after acetylcholine 👇🏼 👀 #coronaryvasospasm
2
8
1
47
4,553
The LADD OSTIAL Lesion 👀 ➡️ perfect target for #DCB? 60 yo man w/ NSTEMI IVUS = 3.8 mm prox-LADD, bifurcates 6 mm downstream into 2.7 mm limbs 👇🏼👇🏼👇🏼 Cutting balloon + 3.5 mm DCB (75 s)
2
1
9
2,120
60 yo woman w/ acute severe CP EKG & cath below 👇🏼👇🏼👇🏼 How would you approach this? #CardioTwitter #STEMI
1
4
14
1,467
Ok, I’ll end the suspense — ⬇️ ic NTG solves the riddle 👀 Amazing case of severe coronary #vasospasm true #Printzmetal
8
333
Load more