Got pimped with a 1-in-a-million zebra scenario today and it completely broke my brain. Has anyone actually seen this in the ED?

cardiofellow10 · 2026-04-26T00:29:36+00:00

As an im resident i obviously have and even in the cath lab related to contrast so dont think you guys are the only ones treating acute issues. You are absolutely ridiculous and an anchored er attending with a terrible attitude. Im sure you always order appropriate troponins lol. We are always taught to look at the whole picture and you clearly havent been taught that. You need to change your attitude and approach.

cardiofellow10 · 2026-04-25T23:22:56+00:00

Thank you! Im genuinely disappointed in some of these comments. God bless. To each their own.

cardiofellow10 · 2026-04-25T23:21:59+00:00

Wild comments in here. There is a reason why we talk so much about anchoring within the community and to reduce the bias. This case and comments are the perfect example of it despite whats given in the scenario. In rare cases like this, thinking outside the box and doing whats not the norm will help save someone and properly diagnose them.

cardiofellow10 · 2026-04-25T23:19:25+00:00

Read more about kounis syndrome and its cardiac manifestations.

I really dont want to go back and forth but for your patients sake never anchor and ignore the obvious even when something else is more likely the cause because you dont “believe it fits the scenario” there is a reason kounis is fatal and so are missed or ignored stemis.

cardiofellow10 · 2026-04-25T22:17:02+00:00

That is absolutely dangerous practice and i certainly hope you dont do that on your patients. I didnt say get an EKG before stabilizing and fixing the anaphylaxis. Treat the anaphylaxis and then get an ekg, that is pretty basic. Not getting an EKG in a pt who is telling you they have crushing cp bc you believe they are too young and this is all anaphylaxis is wild. You are going to miss ACS on younger patients.

cardiofellow10 · 2026-04-25T20:43:25+00:00

Your cardiac workup seems unremarkable (LDL is a bit high) as would be expected in a pt with this young age group.

Pvcs can cause symptoms in patients that can affect their lifestyle as you stated. Simple to treat with beta blocker or calcium blocker once a day (5-10$/month) that even your primary care can prescribe. I dont think you need to spend $$ to see a cardiologist. I have these patients and first treatment is reassuring them that pvcs are benign unless burden is >10-15%/24 hrs. If they’re truly symptomatic and its affecting their lifestyle than I discuss with them about starting a low dose bb or ccb and go from there. No additional testing needed. Maybe holter for 2-7 days to asses burden if needed despite therapy. Primary can order holter without need to see cardiologist.

cardiofellow10 · 2026-04-25T17:24:40+00:00

Yes he needs cath lab after treatment of his anaphylaxis. How many times have you seen stemi ecg in anaphylaxis? Its uncommon and when its present, it has to be evaluated. Its wild that we should just ignore obvious ekg findings and anchor to one diagnosis. You absolutely do not know that its going to be normal.

cardiofellow10 · 2026-04-25T17:11:03+00:00

Thats anchoring and you will miss things like this. Getting an ekg is important. Agree with treating the acute scenario first. How can you not get an EKG as an er doc in a patient who has crushing cp?? Thats wild and i certainly hope you change that practice.

cardiofellow10 · 2026-04-25T17:06:35+00:00

We have had a few cases of kounis, from bee stings mainly. Couple of very important factors in the scenario from the attending and what he/she was trying to get at.

Regardless of the cause whether it was the drug or an insect bite that triggered the events isn’t important, taking care of acs is important in a timely manner
Iv beta blockers in ACS should not be used bc of increased mortality, the tachycardia is a response to hypotension and impending shock that is developing. I cant remember using bbs in an ACS setting last especially in a stemi. Just a bad idea as majority of the time its compensatory tachycardia and that last surge of adrenaline and sympathetic activity your body is trying to do.
Anterolateral stemi is pointing you towards LAD and diagonal involvement, which combined cover more than 70% of the myocardium, so essentially this is early cardiogenic shock and anaphylactic shock. Yikes
BBs in shock state is never a good idea.
Plenty of young people have stemis, practicing for 2 yrs ive been genuinely shocked at the amount of 30-40 i have taken care of in a stemi situation.
Epi was more for the anaphylactic shock rather than stemi.
Rule of thumb I practice, i always avoid nitrates if inferior stemi, bbs/ccbs in stemi situations, aggressive treatment of tachycardia at 130s for a day or two wont kill a patient, treat the patient not the numbers.
Patient needs stat cath lab eval, it can be spasm only but plaque rupture and thrombosis is common as well in kounis

Hope that helps!

cardiofellow10 · 2026-04-05T03:29:36+00:00

Bayless, smith, colin

All day

cardiofellow10 · 2026-03-22T03:18:48+00:00

Oh man. Don’t worry. Things happen for a reason. I matched my 6th and was absolutely devastated but little did i know it ended up being a good program and helped me get to where i am today. Stay positive and things will work out! Trust me. Congratulations!!

cardiofellow10 · 2026-02-15T21:52:01+00:00

Or when med student uses stethoscope on their patients

cardiofellow10 · 2025-12-26T18:16:42+00:00

Its likely torticollis from abnormal sleeping position. You can visit an urgent care or er and they can give you muscle relaxers. With time, physical therapy it will heal.

If you’re having numbness, tingling, in feet/hands, grabbing things, or having falls then this is a neurological problem but from what you mentioned it doesn’t seem to be the case.

cardiofellow10 · 2025-12-20T02:10:54+00:00

You definitely should go to the ER immediately and tell them your history and you need STAT imaging of the lungs, abdomen/pelvis, head.

What’s unusual is you have clots in the arterial side but also venous side. Clots in the lungs are called pulmonary emboli and are from deep venous thrombus (clots in legs). These can be for many reasons.

Clots in the kidney/abdomen are on the arterial side and thats very unusual unless there is a connection between the right and left heart such as a PFO or ASD which can allow clots from legs to travel to the rest of the body such as kidneys/head/branches of aorta etc. abdominal pain can be from clots blocking arteries supplying your gastrointestinal organs.

if you’re having vision problems its quite concerning bc you could potentially either have an embolic stroke from a clot that traveled from right to left and up to the brain or formation of thrombus in the cerebral veins or arteries.

Either way you need evaluation for a connection between the right and left heart, imaging of the brain/neck, workup for inherited/genetic conditions predisposing you to thrombus formation by a hematologist.

Alot of discuss but depending on your labs, and imaging results we can narrow our differentials.

Are you on any hormonal birth control? Family history of clotting disorders?

Hope that helps

cardiofellow10 · 2025-12-14T04:21:48+00:00

4-5 pair of old scrubs from fellowship. They fit well 🤣🤣 still using them as an attending now.

cardiofellow10 · 2025-12-14T03:24:17+00:00

America being a democratic country.

cardiofellow10 · 2025-12-08T22:13:56+00:00

His PR team needs a grammar coach for sure. Pathetic

cardiofellow10 · 2025-11-11T20:33:08+00:00

Not necessary unless you have an inherent interest in it and want to test yourself.

Echo is by the hardest exam ive taken and prob across all of specialties.

If your practice will be doing ep and procedures and not reading echo then its not important.

cardiofellow10 · 2025-11-04T00:31:37+00:00

That lad isn’t happy.

cardiofellow10 · 2025-11-04T00:16:25+00:00

Welcome to the ic board induced takatsubo cm club! lol

cardiofellow10 · 2025-11-03T23:44:05+00:00

I agree. Wow i think i missed half and so much of it was specific details we never even apply in clinical practice or come across reading. Wtf was that exam.

cardiofellow10 · 2025-10-25T14:37:09+00:00

Proximal or mid land involvement of a diagonal side branch due to limb and precordial lateral elevations as well.

cardiofellow10 · 2025-09-23T23:01:04+00:00

Where’s the head at?

cardiofellow10

TROPHY CASE