Where medicinethinks together.

STEMI patient in a hospital without PCI facility. Door-to-balloon time will exceed 120 min. Patient has no prior stroke, no active bleeding, no recent surgery. Is thrombolysis appr…

75-year-old presents with syncope. ECG: HR 38 bpm, P waves dissociated from QRS. BP 80/50. No reversible cause found. What are the immediate and definitive management steps?

Post-cardiac surgery patient develops hypotension, raised JVP, muffled heart sounds, and pulsus paradoxus. Echo shows pericardial effusion with RV diastolic collapse. What is the i…

Patient with fever, new murmur, and positive blood cultures for Streptococcus viridans x2. How do I apply the Duke Criteria to confirm or rule out infective endocarditis?

60-year-old with exertional chest pain, positive stress test, on aspirin, statin, and long-acting nitrates. Symptoms persist. Should I proceed with coronary angiography? What are t…

Patient with new-onset AF, HR 130 bpm, mildly symptomatic. No structural heart disease. Should I use beta-blocker, CCB, or digoxin for rate control? When would I consider rhythm co…

BP 210/120 mmHg with papilledema and mild confusion. No prior history. Is this a hypertensive emergency or urgency? What is the target BP reduction and timeline?

Patient with HFrEF (EF 28%) has been on optimal medical therapy for 6 months. When is ICD indicated vs CRT-D? What EF cutoff and NYHA class criteria apply?

A patient presents with chest pain. ECG shows changes in multiple leads. How do I distinguish STEMI requiring immediate cath lab activation from NSTEMI that can be managed medicall…

A 68-year-old patient presents with severe breathlessness, SpO2 88%, bilateral crackles, and elevated JVP. CXR shows pulmonary congestion. What is the immediate management priority…

60M with ischemic cardiomyopathy (EF 30%), has ICD. Three ICD shocks in the past 6 months for sustained monomorphic VT at 180 bpm. Currently on amiodarone 200mg OD. Electrophysiolo…

52F with known lung adenocarcinoma presents with progressive dyspnea and hypotension (BP 88/60). Echo shows large circumferential effusion with RV collapse. Pulsus paradoxus is 18 …