Category: Cardiology

To shock or not to shock that is the question?

  A 60 yo male came into Midtown a few days ago for generalized weakness.  He was hemodynamically stable and the EKG above was obtained.   With an irregularly irregular wide complex tachycardia like this our differential is fairly short… 1) A-fib or MAT with aberrant conduction (aka a bundle branch block) 2) A-fib or …

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CHF and Atrial Fibrillation

A lesson I learned caring for a recent patient:  CHF exacerbation in Afib with RVR Clinical Question:  What is the best way to rate control in decompensated heart failure? Our first instinct when we see patients with A-fib with RVR is to reach for diltiazem or our beta blocker of choice, however, these are not …

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Can I use the age adjusted D-dimer in clinical practice? If so, how?

The ADJUST PE trial is hot off the JAMA presses in March 2014. The takehome: of 1141 patients excluded from scanning by clinical assessment plus age adjusted d-dimer, there were only 2 cases of non-fatal PE (0.2%). Of these 1141 patients, 331 had an age adjusted d-dimer greater than the standard cutoff of 500mg/mL. Of these …

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CHF or PE? PE is a known and common complication of CHF

challenging case: an obese 60yo patient never seen by a doctor as an adult presents marked peripheral edema, hypertension, and 2 months of worsening DOE, PND, orthopnea. BNP 400, EKG Unremarkable, trop 0.1, stating well. It feels like CHF. But the cardiologist wants a CTPE. We oblige – big saddle embolus with RV strain. This …

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How to give thrombolytics

[notice]PHARMACOLOGY[/notice] A great question came up in the zones. We see and likely should be comfortable with the dosing of Alteplase for CVA. Grady is a renowned Stroke Center and I would certainly have any of my family members come to the Marcus Stroke and Neuroscience Center if they were having a stroke. The fact …

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Finger Thoracostomies

From teaching round–Courtesy of Mene Demestihas: In a patient in cardiopulmonary arrest, going through the H’s and T’s can lead us to suspect a tamponade or compressive physiology as the culprit of the arrest. In these patients placing a formal chest tube is generally frowned upon as it can be a labor-intensive process for a …

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EKG of the Day?

Anyone want to guess this rhythm and the treatment of choice?

Case of the Month #5

EMory Files Case #5:  Massive PE Hx:  40 yo F hx of Lupus presents with CP SOB  PE:   VS:  BP 90/50, HR 125, RR 30, O2 88%, afebrile.  Awake and alert, mild distress improved with nonrebreather.   Case Discussion Massive PE: ***Case Discussion Wissam Jaber, Dir. PE Response Team***   Teaching Point #1:  Negative …

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