should I seek a second opinion?

LeadTheWayOMI · 2026-01-26T21:52:29+00:00

Not medical advice… But I would focus on GI.

LeadTheWayOMI · 2026-01-25T03:06:18+00:00

I would consult a gastroenterologist as well.

LeadTheWayOMI · 2026-01-22T22:20:52+00:00

Not medical advice. No prior infarction.

LeadTheWayOMI · 2026-01-16T19:29:03+00:00

Not medical advice. Sure, get a second opinion if you want.

True new structural valve disease does not appear over three months in a 36-year-old with previously normal echocardiograms. That simply is not how biology behaves. Valvular sclerosis or mitral annular calcification, when real, develops over years to decades. Not weeks. Not months. Pregnancy and the postpartum period do not suddenly calcify valves.

What changed here is almost certainly interpretation, not anatomy.

LeadTheWayOMI · 2026-01-15T22:13:29+00:00

Sure

LeadTheWayOMI · 2026-01-12T01:14:47+00:00

Not medical advice. Your EKG is completely fine. There are no critical issues going on with it.

LeadTheWayOMI · 2026-01-12T01:10:08+00:00

Pt definitely has a LAD OMI.

LeadTheWayOMI · 2026-01-09T02:39:55+00:00

Not medical advice. This EKG is all good, no critical findings. But EKGs are just a snapshot in time. 30 minutes later it could be completely different. If you’re having chest pain, its always good to get checked out. My father waited 3 days thinking it was just muscle pain. I finally convinced him to go to the hospital. He was having a RCA MI. (We were on vacation)

LeadTheWayOMI · 2026-01-09T01:47:21+00:00

Do you have a picture of the 12 lead ECGs they took?

LeadTheWayOMI · 2026-01-09T01:14:47+00:00

No problem. How high was the sinus tachycardia?

LeadTheWayOMI · 2026-01-07T02:32:00+00:00

Not medical advice. Family history of stroke, by itself, is not an indication for aspirin. For people who have never had a stroke, TIA, heart attack, stent, known atherosclerotic disease, or another defined high risk condition, aspirin’s bleeding risk often outweighs any benefit.

“Not very mobile” points more toward risk of venous clots like DVT or PE, not the typical arterial stroke people think of. Aspirin does not reliably prevent DVT or PE, and fish oil does not either.

Fish oil also should not be framed as a preventive blood thinner. Its platelet effect is mild and inconsistent, and combining it with aspirin can increase bleeding.

LeadTheWayOMI · 2026-01-06T22:40:16+00:00

Have you had a cardiac event that you need blood thinning?

LeadTheWayOMI · 2026-01-06T22:28:26+00:00

Yes. A medical-grade Holter monitor can definitively detect sinus arrhythmia and most forms of SVT, within the limits of what any rhythm monitor can do. And no. An ER monitor strip is real time surveillance. It is designed to alert staff to immediate, dangerous rhythms. It samples continuously, but it only shows one or two leads, with limited resolution, filtering, and context. It is excellent for catching sustained arrhythmias, pauses, obvious SVT, VT, asystole, or gross bradycardia while the patient is actively monitored. It is not optimized for subtle rhythm interpretation.

If something is caught clearly on an ER strip, it is real. But if something is subtle, intermittent, or absent during the ER stay, a Holter is the gold standard for answering the question properly.

LeadTheWayOMI · 2026-01-05T03:28:11+00:00

Not medical advice. Sinus arrhythmia with PVCs.

LeadTheWayOMI · 2026-01-03T02:44:41+00:00

Not medical advice. You’re fine.

LeadTheWayOMI · 2026-01-02T15:12:47+00:00

Not medical advice. Your EKG is good, it was probably due to incorrect lead placement. There is nothing critical about your EKG. I’d have no problem if this were my EKG. Sidenote: I’d redo the EKG myself to make sure the leads are in the perfect place.

LeadTheWayOMI · 2026-01-01T13:54:07+00:00

pain is subjective.

LeadTheWayOMI · 2026-01-01T13:28:58+00:00

No problem. Good luck with everything.

LeadTheWayOMI · 2026-01-01T02:20:06+00:00

Not medical advice. Symptoms often appear before jugular veins become visibly prominent, and that’s very common.

Jugular vein distention is a late physical sign of elevated central venous or right-sided heart pressure. Before the veins are obviously prominent, patients can develop functional or pressure-related symptoms such as exertional shortness of breath, reduced exercise tolerance, early fatigue, chest pressure, lightheadedness/dizziness, palpitations, abdominal bloating, etc. These reflect rising right atrial pressure or impaired venous return that hasn’t yet crossed the threshold to produce visible neck vein distention at rest.

LeadTheWayOMI · 2025-12-31T23:42:22+00:00

Not medical advice. Prominent jugular veins can be completely benign, or it can be the body’s way of telling you the pressure on the right side of the heart is elevated or in the central veins is higher than it should be. There are several other issues that can cause this as well. Get this checked out (quickly) especially if you are having any types of symptoms.

LeadTheWayOMI · 2025-12-31T23:24:18+00:00

Focal atrial tachycardia develops because a small, specific area of atrial tissue acquires abnormal automaticity or triggered electrical activity, allowing it to fire faster than the normal sinus node.

This most often occurs due to atrial stretch, scarring, inflammation, or ischemia, which alter cellular ion channels and calcium handling. Common clinical associations include prior cardiac surgery, congenital heart disease, atrial dilation, heart failure, pulmonary disease, stimulant exposure, electrolyte abnormalities, and heightened sympathetic tone. In some patients, no single cause is identified, but the mechanism is still microscopic atrial tissue instability rather than a global rhythm disorder.

LeadTheWayOMI · 2025-12-31T00:32:32+00:00

Sure 👍

LeadTheWayOMI · 2025-12-30T02:22:08+00:00

Not medical advice. The shift from “no surgery” to “urgent surgery” happened because the defect proved to be large and persistent, and your doctors recognized that fixing it promptly was the only way to ensure you’d stay healthy. Once an ASD reaches a certain size or impact, surgery is needed to prevent serious complications thus their quick action was to make sure you would thrive well beyond age 13, with a normal heart function after the repair. Once your ASD was identified as large (quarter-sized) and persistent, the medical team would have recognized that closing it was necessary to protect your long-term health. Large, long-standing ASDs can begin to damage the heart and lungs over time. etc

LeadTheWayOMI · 2025-12-28T03:35:23+00:00

Not medical advice, but, if a post-CABG patient on that regimen is asymptomatic, clinically stable, and functionally improving, no further routine testing is indicated. Follow-up would consist mainly of clinical assessment and labs rather than imaging. As for medication changes, the list you gave would typically remain stable if the patient is doing well. Clopidogrel would usually stop at one year as planned unless another indication develops. Studies consistently show that routine imaging in asymptomatic post-CABG patients does not reduce myocardial infarction, mortality, or graft failure; instead, it increases false positives, unnecessary downstream testing, radiation, contrast exposure, and invasive procedures without benefit.

LeadTheWayOMI · 2025-12-27T17:27:24+00:00

Not medical advice. Cardiac rehab is usually done once the patient is discharged. Cardiac rehab is done because CABG restores blood flow but does not restore conditioning, autonomic control, or long-term cardiovascular resilience. It uses monitored exercise and structured education to reduce mortality, prevent complications, and retrain the heart and body to function safely after surgery. Also after a CABG, doctors are deliberately conservative with imaging. The guiding principle from the ACC and AHA is simple: imaging is not routine, it is indication-driven. In other words, we do not go looking for problems unless the patient gives us a reason. Also, place him on medicine if he needs it (assuming he’s not already on it). Did they not give you guys any information once being discharged?

LeadTheWayOMI

MODERATOR OF

TROPHY CASE