CardioExchange Archive

July 14th, 2011

Recurrent Arterial Thrombosis plus GI Bleeding in an Elderly Woman

Faiza Hashmi, MD and James Fang, MD

An 85-year-old woman with a history of hypertension and Crohn’s disease presented with severe pain in the left hand and was admitted to the hospital. Examination revealed a diminished left-radial pulse; arterial Doppler imaging showed a thrombus in the radial artery. The patient underwent surgical thrombectomy. The workup, including a hypercoagulability profile, was negative. Transthoracic […]

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June 16th, 2011

Case Study: Advanced Heart Failure in a Prison Inmate

Tariq Ahmad, MD, MPH and James Fang, MD

A 37-year-old prisoner with end-stage nonischemic cardiomyopathy was transferred from a local county hospital to a tertiary care center for heart failure therapy. Soon after his arrival, he developed ventricular tachycardia and cardiogenic shock. He was sent urgently to the cardiac catheterization laboratory, where he underwent placement of an intra-aortic balloon pump (IABP). Right-heart catheterization, on dobutamine […]

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May 13th, 2011

Simultaneous TIA and ACS After Aspirin Cessation for Palpebral Surgery

Jean-Pierre Usdin, MD and James Fang, MD

A 77-year-old man with metformin-treated type 2 diabetes, high blood pressure, moderate renal insufficiency, stable angina, and a history of phlebitis stopped taking aspirin in preparation for palpebral surgery. A day after the surgery, he presented to the ER with two transient ischemic attacks (TIAs) affecting the left arm. The patient complained to the examining neurologist of […]

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April 21st, 2011

Will a STICH in Time Save Nine?

Anju Nohria, MD and James Fang, MD

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 apex most […]

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February 18th, 2011

A Case of Clopidogrel Nonresponsiveness?

Tariq Ahmad, MD, MPH and James Fang, MD

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. She […]

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January 28th, 2011

She Doesn’t Mind that Her Heart Races … Do You?

Alfonso E. Sierra, MD and James Fang, MD

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 history […]

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September 6th, 2010

What’s at the Heart of This Patient’s Problem?

Anju Nohria, MD and James Fang, MD

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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June 18th, 2010

Is Optimal Medical Therapy Really Optimal?

Nihar Desai, MD, MPH and James Fang, MD

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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May 27th, 2010

The Tests Say Intervene, but the Patient Feels Fine

Anju Nohria, MD and James Fang, MD

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 increased […]

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March 31st, 2010

Her Cancer Treatment Is Working, but Her Heart Is Failing

Anju Nohria, MD and James Fang, MD

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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