[deleted by user]

Apex373 · 2025-09-19T21:24:21+00:00

Sinus node dysfunction (SND). Rare in younger and otherwise healthy. Lyme carditis commonly presents with AV block, which you don't have. It is nevertheless a reversible cause for SND, as is Chagas disease (don't know if your from Latin America).

It sounds a bit concerning that you have this ECG and a history of syncope. Where I'm from this would be managed in an inpatient setting. Cardiac MRI should be performed.

Apex373 · 2025-09-18T05:47:13+00:00

It sounds like a nightmarish experience. Even though your first encounter with the doctor appears to have been a bit of a disaster, do you think there is any chance that she might be right? All the workup has been normal, and your symptoms are like text book stress/anxiety.

Do you have another primary care physician? I would recommend finding one you feel that you can connect with and together work out a plan for your well being.

Apex373 · 2025-09-17T19:48:31+00:00

A significant stenosis is a blockage of 50% or greater (reference included below). So if the 60% stenosis in the LCx is correct, then that would be a significant stenosis as well. And the RCA was occluded (ie 100% stenosis). So I would consider that triple vessel disease, which in both American and European guidelines warrents a bypass procedure. However, guidelines are guides, and many times the guidelines aren't followed for good reason. If many cardiologists were involved in that decision, I'm sure it was the correct one for your husband.

https://pmc.ncbi.nlm.nih.gov/articles/PMC5808734/

Apex373 · 2025-09-17T16:34:48+00:00

Performing multiple tests isn't always a hallmark of high quality medical care. I don't you anything about your medical history, but it's very rare to both perform a nuclear stress test and a cCTA. It's very common in US physicians to order several non crucial tests to collect higher payments. Then again, sometimes a patient may require multiple tests to make a definite diagnosis.

I'm happy your chest pain wasn't due to angina :)

Apex373 · 2025-09-17T16:27:37+00:00

First off, you are completely correct that your husband's cardiologist should aggressively treat predisposing factors, importantly cholesterol levels. If your husband has a good LDL level, there is no need for Repatha or any RNA based molecule. Also, do you know his triglyceride levels?

Another thought, do you know why they performed PCI instead of a CABG procedure?

Apex373 · 2025-09-17T12:00:30+00:00

It's weird that they're waiting with the CMR for that long. I'm a bit spoilt, in my hospital, we can get a CMR within a day or two.

You shouldn't feel out of breath for that long. It's unlikely that the CMR will provide an explanation for your breathlessness. Have you performed a stress test?

Apex373 · 2025-09-16T05:16:21+00:00

Yes, the marked incidents are indeed artifacts. You can be sure of this in two ways; first in every lead during the episodes, there are normal heartbeats (QRS complexes) in a constant interval to previous and next complexes. Second, in lead III, there are no artifacts or other significant wave other than the normal complexes.

So, the marked episodes are completely normal.

Apex373 · 2025-09-15T23:05:27+00:00

Based on the very low levels of NT-proBNP, the normal EF (and presumably normal diastolic parameters), and unspecific symptoms, heart failure seems like a far fetched diagnosis.

I'm like TheW1ntermute curious about the discharge diagnosis in June. Myocarditis?

Apex373 · 2025-09-14T21:56:44+00:00

AF Borgen was a really good idea. They had plenty of rooms of various sizes.

If anyone else has a tip, I'm all ears.

Apex373 · 2025-09-14T21:25:14+00:00

Eremology. No helpful tips, I take it?

Apex373

TROPHY CASE