A 57-year-old man with a history of hypertension, hyperlipidemia, and smoking presented with increasing dyspnea on exertion, mild chest discomfort, and lower-extremity edema. Physical exam results were consistent with decompensated heart failure. Echocardiographic findings: left-ventricular ejection fraction (LVEF), 20% LV end-diastolic dimension, 6.3 cm global hypokinesis (with regional variation affecting the septum, inferior wall, and…

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This latest installment in our case discussion series is submitted by Tariq Ahmad, MD, MPH. We encourage members to submit cases that they believe warrant discussion. Selected cases will be presented to the community, and case authors will receive a $100 Amazon gift card. A 70-year-old woman presents to the ED with an anterior STEMI….

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This latest installment in our case discussion series is submitted by Alfonso E. Sierra, MD. We encourage members to submit cases that they believe warrant discussion. Selected cases will be presented to the community, and case authors will receive a $100 Amazon gift card. A 62-year-old woman comes in for a routine exam, with a…

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No matter how evidence-based we strive to be in our decision making, we all know that the patient in front of us is never exactly like those enrolled in large clinical trials. Thus at CardioExchange, we have highlighted cases where the application of evidence-based medicine and treatment guidelines is not straight-forward. And often, to our…

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These four patients are receiving chronic anticoagulation therapy. Read the descriptions of their cases and decide which, if any, of them you would switch to dabigatran. Case 1 A 69-year-old man with a history of hypertension and colon cancer was found to be in atrial fibrillation during a preoperative assessment for colon resection. Metoprolol was…

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The patient is a 53-year-old lawyer with no cardiac risk factors other than a 70 pack-year history of smoking. He has a known history of diverticulitis with prior gastrointestinal bleeding and presented with lightheadedness and bright red blood per rectum. Initial evaluation revealed a drop in his hematocrit from 43% to 39%. He underwent a…

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A 61-year-old man with a past medical history significant for hypertension, hyperlipidemia (LDL-C, 145 mg/dL; HDL-C, 38 mg/dL), and type 2 diabetes (HbA1c, 8.2) presents to his primary care physician after several months of exertional chest tightness that is associated with dyspnea and relieved by rest. His current medications include lisinopril at 20 mg/day, metoprolol succinate…

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A 58-year-old asymptomatic man with hypertension and hyperlipidemia was noted to have an abnormal electrocardiogram during his routine annual physical examination. His primary care physician ordered a treadmill stress test. The patient exercised for 6 minutes and 39 seconds of a standard Bruce protocol, achieving 8.1 METs. He stopped because of dyspnea. His heart rate…

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The patient is a 57-year-old woman with a history of Hodgkin disease of the anterior mediastinum. Upon being diagnosed at age 26, she was treated with a staging laparotomy, splenectomy, and 36 Gy of radiation to the mantle and para-aortic areas. She did well until September 2009, when she developed increasing dyspnea on exertion, weight…

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The patient is a 72-year-old man with a history of ischemic cardiomyopathy (LV ejection fraction, 30%–35%) and NYHA class II/III heart-failure symptoms at baseline. Over the previous month, he had experienced recurrent episodes of volume overload and sustained ventricular tachycardia (VT) requiring intravenous diuretics and up-titration of his amiodarone therapy. He then presented in VT…

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