Cardiology Notes: Clinical Cases including ECG, Echocardiography, Cath, and MOCK Exams to sharpen your cardiology data interpretation skills. Healthcare is stressful!!! Learning cardiology shouldn't be !!!
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MCQ 8
A 67-year-old woman with a history of hypertension and insulin-dependent type 2 diabetes is found on the floor of her room 15 minutes after having dinner with her family. She is immediately brought to the hospital. Per family, she was on the normal state of health until 3 days ago, when she began to complain of malaise and night sweats. She had molar tooth extraction 1 week ago. She appears confused, and vital signs show temperature 102 F, blood pressure 80/40 mmHg, pulse 123/min, and SpO2 90% on room air. Bedside glucose is measured to be 180 mg/dL. Initial labs show WBC count 22000/microL, raised ESR, and lactic acid 5.2 mg/dL. She is given vancomycin/cefepime and metronidazole. Lumbar puncture is unremarkable. Her mental status improves on the 2nd day. Blood cultures grow Streptococcus viridans. A transthoracic echocardiogram shows no vegetations but is notable for a mobile solid left atrial mass attached to the anterior mitral leaflet. What is the next best step in the management of this patient?
A. Continue current antibiotics and plan for 6 weeks B. IV alteplase C. Surgical resection of the mass D. Add on micafungin Click the button below to view answer:
Brugada ECG vs Incomplete Right Bundle Branch Block (iRBBB) Why this differentiation matters Brugada pattern is a malignant channelopathy associated with sudden cardiac death, while incomplete RBBB is usually a benign conduction variant. Mislabeling Brugada as iRBBB can be fatal; overcalling iRBBB as Brugada can lead to unnecessary anxiety and ICD implantation. --- 1. Basic Definitions Brugada ECG Pattern Primary repolarization abnormality Genetic sodium-channel disorder Characteristic ST-segment elevation in V1–V3 Risk of ventricular fibrillation and sudden death Incomplete RBBB (iRBBB) Depolarization abnormality Delay in right ventricular conduction Common in healthy individuals Usually asymptomatic and benign --- 2. ECG Morphology: Side-by-Side Comparison QRS Duration Brugada: QRS usually <120 ms iRBBB: QRS <120 ms, but with RBBB morphology --- V1–V2 Pattern (Key Differentiator) Brugada Pseudo-RBBB appearance ST elevation ≥2 mm ST segment is coved or saddleback Terminal QRS bl...
Acute Treatment of Hyperkalemia – A Practical, Bedside-Oriented Guide Hyperkalemia is a potentially life-threatening electrolyte abnormality that demands prompt recognition and decisive management. The danger lies not only in the absolute potassium value but in its effects on cardiac conduction, which can rapidly progress to fatal arrhythmias. Acute treatment focuses on three parallel goals: stabilizing the cardiac membrane, shifting potassium into cells, and removing excess potassium from the body. Understanding this stepwise approach helps clinicians act quickly and rationally in emergency settings. Why Hyperkalemia Is Dangerous Potassium plays a key role in maintaining the resting membrane potential of cardiac myocytes. Elevated serum potassium reduces the transmembrane gradient, leading to slowed conduction, ECG changes, ventricular arrhythmias, and asystole. Importantly, ECG changes do not always correlate with potassium levels, so treatment decisions should be based on clinical c...
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