HFrEF Medical Treatment

Heart Failure with Reduced Ejection Fraction (also known as systolic heart failure) is broken up into two phases of treatment:  the acute (on presentation to the hospital) and chronic (long-term to prevent re-hospitalization). Acute Exacerbation Treatment DIURETIC (urinate off all the excess fluid in a volume-overloaded patient) ACE inhibitor or Angiotensin Receptor Blocker (ARB) contraindicated if symptomatic hypotension (SBP<90 or MAP<65) After symptoms have improved/resolved, initiate … Continue reading HFrEF Medical Treatment

Heart Failure Pathophysiology and Diagnosis

Pathophysiology In an average healthy person, normal LV ejection fraction (LVEF):  >50% Roughly 50% of those with heart failure have reduced left ventricular (LV) function (HFrEF) Heart cannot squeeze/contract properly, and then progressively dilates. The other 50% have preserved (normal contraction) LV function (HFpEF) Cannot relax properly, leading to high diastolic (filling) pressures. New heart failure – work patient up for ischemic disease (CAD) and ACS … Continue reading Heart Failure Pathophysiology and Diagnosis

Atrial Flutter

More organized, saw-tooth type pattern seen on standard 12-lead EKG. Negative flutter waves in inferior leads Positive flutter waves in V1 Typical Flutter = counterclockwise reentry around tricuspid annulus. Rate is ~250/min; noted as 2:1 or 4:1 for its atrial rate and the ratio of electrical conduction down the AV node. Atrial Flutter is often seen in patients diagnosed with concomitant Atrial Fibrillation (Fib-Flutter). Management Similar to … Continue reading Atrial Flutter

Atrial Fibrillation

As of the time of this writing, I am a second-year internal medicine resident physician, and have been involved in the care of at least fifty patients (averaging nearly one patient per work week, a very conservative estimate) with Atrial Fibrillation (AFib), an abnormal heart rhythm.  According to MKSAP 17 Cardiovascular Medicine, it is the #1 most common sustained cardiac arrhythmia, or abnormal electrical activity of the … Continue reading Atrial Fibrillation

PGY-2 Life And Decisions

It’ll take some time to shake the feeling of being the “Intern” after twelve months with that role.  One of my primary goals for intern year (first year) was to learn the fundamentals of real-world medical practice.  If I had to choose a few from a long-list, some fundamentals would include:  recognize life-threatening and other urgent but common conditions, treatment, and speaking to patients and families about their … Continue reading PGY-2 Life And Decisions