Abstract
Alcohol Septal Ablation (ASA) is an interventional procedure that involves injecting ethanol into a targeted septal artery, inducing localized tissue necrosis, and subsequently reducing septal thickness. Our experience highlights this method as an effective therapeutic intervention for symptomatic HOCM patients, providing relief from symptoms and enhancing cardiac function, reducing Left Ventricular Outflow Tract (LVOT) gradient. However, potential complications such as arrhythmia, Left Anterior Descending (LAD) dissection, cardiac tamponade, and coronary artery spasm are rare but necessitate careful patient selection and vigilant post-procedural monitoring. It is a reasonable therapeutic option especially in older patients with favourable coronary anatomy in the absence of mitral valve disease and if it is performed by an experienced operator. We present a case of a 68-year-old man with Hypertrophic Obstructive Cardiomyopathy (HOCM), elevated LVOT gradient, and symptoms despite optimal medical therapy. He underwent alcohol septal ablation which was complicated by alcohol leakage likely via collateral circulation into the distal left anterior descending artery and obliteration of the vessel.
Highlights
One of the first lessons you are taught during clinical rotations in medical school is that a negative test doesn’t necessarily help you
The CAC test, which is scored based upon the detection of calcium using essentially the same approach as the bone density exam – is derived from a semi-quantitative value called the Agatston score
We present a clinical example of one such patient seeking further treatment recommendations following CAC testing, after modifying treatment for elevated total cholesterol levels
Summary
One of the first lessons you are taught during clinical rotations in medical school is that a negative test doesn’t necessarily help you. It either means what you are looking for isn’t there, or the test missed it. Following routine blood work revealing a total cholesterol level of 146mg/dl (3.77mmol/l), a 56-year-old Caucasian male elected to modify his dietary habits in an effort to lower his blood cholesterol. Six months later he developed chest discomfort.
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