James Fang, MD

All posts by James Fang, MD

September 26th, 2012

Treading Water During the Post-MI Waiting Period


Does your institution use the LifeVest strategy routinely during the waiting period after an MI?

September 4th, 2012

You Got the Criminal. But What About the Bystander?


A drug-eluting stent is successfully implanted after an acute inferior MI in a fit 70-year-old man. What do you do for the bystander disease detected at the LAD/D1 junction?

August 3rd, 2012

To Repeat — or Not to Repeat — the TEE


Is cardioversion without a repeat transesophageal echocardiogram appropriate when an initial TEE revealed a small thrombus and the patient has already undergone 3 weeks of anticoagulation?

April 11th, 2012

Anticoagulation Conundrum


A 75-year-old woman presents to a general cardiology clinic for the first time. She has a history of atrial fibrillation, sick-sinus syndrome requiring a permanent pacemaker, hypertension, and dyslipidemia. She has no specific complaints other than shortness of breath on exertion. Her medications include aspirin (81 mg daily), carvedilol (25 mg twice daily), lisinopril (5 […]

March 1st, 2012

Is Age Just a Number?


An 89-year-old woman with severe aortic stenosis is referred to a cardiologist at a major academic center that offers transcatheter aortic valve implantation (TAVI). A widow for 20 years, the patient lives alone and does well with the assistance of her daughter, who lives nearby. She has two more children in the same town, as well […]

January 27th, 2012

Plaque Rupture with Thrombosis, After Shooting Hoops


A 22-year-old white man presented to the ER with acute non-ST-segment-elevation MI, after playing basketball. He had experienced chest pain on and off for more than 10 hours before presentation. His initial EKG showed T-wave inversions in leads III and avF (see image), and his troponin T level was 1.2 ng/mL. The patient’s initial pain […]

January 5th, 2012

Coach Wants Me to Play. Will You Let Me, Doc?


A 21-year-old Division I college football player presented with palpitations that had started during athletic practice. He was referred to a cardiologist for further evaluation. Vital signs and physical exam were normal. An EKG showed prominent R waves, inverted T waves in leads V1–V2, along with a biphasic T wave in lead V3. QRS axis and QTc […]

December 1st, 2011

Heart Over Head or Head Over Heart?


A 52-year-old man presented with 3 episodes of transient dysarthria and right-sided facial numbness within a 2-week period. A carotid ultrasound revealed >70% stenosis of the left-internal carotid artery and 50%–69% stenosis of the right coronary artery. At age 40, the man had been diagnosed with non-Hodgkin lymphoma, which was treated with cranial radiation and anthracyclines, […]

October 24th, 2011

Does This Child Have More Than an Arrhythmia?


An 11-year-old boy presents with palpitations. He has no family history of heart disease and is asymptomatic while playing competitive sports. His cardiac physical examination is normal, but his ECG (shown below) shows a Wolff-Parkinson-White pattern with a short PR interval and delta waves. A systematic echocardiogram reveals normal LV function, normal atrioventricular valves, and […]

September 8th, 2011

When Is the Patient “Too Old” for an ICD?


Discuss whether to implant an ICD near the end of a patient’s life.