Happy Study Time

  Simulated case: A 36-year-old male, called Joe, comes to the ER with sudden palpitations lasting 15 minutes. He was at rest and denies chest pain. No family history of similar issues. Physical examination is normal The physician ordered metoprolol for the next episode and sent him home 💀. Three days later, the patient came back (he was at the same time, expecting to find -or avoid- the physician), and said that he had palpitations and dizziness. He was experiencing tachycardia. He mentioned that he had taken the medication. Re-check The first EKG - short PR, delta wave: WPW (Wolff-Parkinson-White syndrome) - AV node blockers are not the best option. Maybe the physician was looking for the "Wolf" and "White" rather than the unusual WPW . Bibliography:  https://www.ncbi.nlm.nih.gov/books/NBK554437/

  I read an interesting article about the traits of great physicians. All the advice seemed recurrent: Be a detective  (👮 This is a detective...right?) Get healthy and relax 💆 Be a listener 👂 Find your passion 💓 Treat the whole patient 👴 Have empathy 👱 Pay attention to detail 👀 Develop resilience 💃 Take responsibility 👷 ... But the last piece of advice was different: Count your stars . Here, the author explains why it is so important to give value to the things that we currently don’t. He says that our stars are the ways we improve, save, and change the lives of our patients and their families for the better. So, I started to think about my stars. I’ve given something to my patients: respect, care, attention, knowledge, and love. And they have given me back these things, with even more rewards. I don’t know why we have nights  in our lives, but I know that those periods remind us that we have stars . 😌  Higgins JP. Ten Traits of Great Physicians! And Tips t...

  During medical school, I used to think that we were building a tall tower, starting with a solid foundation and then adding the next floors. After reading this article, I thought: what if it's more like a cake? I mean, each year we gain more knowledge (of course), but we also acquire experience in patient interactions, physical examinations, resilience, and communication skills. We also get better at understanding the healthcare system and how to search for information in databases. Then, the mission wouldn’t be just to become a great doctor; it would be to become a complete one. 😃 Ann Eye Sci. 2017 Jul; 2: 36.

After reading the latest Heart Failure (HF) guidelines, I had to acknowledge the massive difference from those of just five years ago. Here are a few key points I want to highlight before diving into vericiguat: HF is a syndrome. Mix everything HF results from an impairment in the function AND/OR structure of the heart, leading to elevated intracardiac pressure AND/OR inadequate cardiac output at rest AND/OR during exercise.  The number of times the guideline says "AND/OR" is truly impressive. HF can have preserved cardiac output (>50% EF), mildly reduced (40–49%), or reduced (The classic <40%). Then, of course, there are the stages: Stage A: Just risk factors—nothing too dramatic. Stage B (Pre-HF): Structural changes show up on echocardiography, but no symptoms yet. Stage C: Et voilà —breathlessness, ankle swelling, fatigue, JVP elevation, pulmonary crackles, peripheral edema. Maybe you’ll even catch the point of maximal impulse shift or, for the experts, the elusive S...

  Since 1997, we’ve known that heart failure is a syndrome, and the positive predictive value increases when multiple findings are present. But is semiology the key? I wouldn’t say it gives us the best diagnostic accuracy. However, it does give us something far more valuable—the ability to think like real doctors again .   ☝ Davie AP, Francis CM, Caruana L, Sutherland GR, McMurray JJ. Assessing diagnosis in heart failure: which features are any use? QJM. 1997 May;90(5):335-9. doi: 10.1093/qjmed/90.5.335. PMID: 9205668.

Hey everyone, Welcome to this blog! Here, I'll be sharing medical insights, practical tips, and thought-provoking discussions. Medicine is a journey of continuous learning, and I look forward exploring it together with all of you.