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Case Presentation An 80-year-old man was found confused and somnolent at home. On EMS arrival, his blood pressure was 73/46 mmHg and heart rate fluctuated between 25 and 50 beats per minute. The ECG demonstrated a wide-complex bradycardia (rate 26). Atropine had no effect. He received intravenous adrenaline. On hospital arrival, the patient appeared pale, cold and hypotensive, with clinical signs of pulmonary edema and acute kidney injury. His creatinine was 260 µmol/L with

Palpitations are a very common symptom that most people experience at least once in their lifetime.They can feel like your heart is beating fast, irregularly, skipping a beat - or suddenly pounding harder than usual. Most of the time, this is completely harmless. But in some cases, palpitations can be a sign of an underlying heart rhythm disorder that should be evaluated by a doctor. How Are Palpitations Evaluated? When you see a doctor for palpitations, the most important te

Heart Failure with Reduced Pump Function (HFrEF) When people hear the word “heart failure,” this is often the type they imagine – when the heart’s pump has become too weak to deliver enough blood to the body. In medical terms, this is called heart failure with reduced ejection fraction (HFrEF) . A related condition is HFmrEF , or heart failure with moderately reduced ejection fraction. For most patients, the distinction between these two is less important – the principles of

A man in his 60s with a history of deep vein thrombosis and known factor V Leiden mutation was admitted with exertional, squeezing chest pain. The chest pain subsided, but the dyspnea persisted. On admission he was hemodynamically stable with a heart rate of 90/min and a blood pressure of 130/90 mmHg. He was asymptomatic at rest but became clearly dyspneic when walking to the bathroom. Sinusrythme. T-inversions in leads V1-V3. T-inversion i lead III. S-wave in lead 1. The ECG

What Is Heart Failure with Preserved Ejection Fraction (HFpEF)? This is Part 2  in the series “What Is Heart Failure?” In Part 1 , we explained what heart failure actually means - that the heart is unable to pump enough blood to meet the body’s needs. But did you know that about half of all the people with heart failure have a preserved  pumping function? So, what does that really mean? Echcardiography of a heart with HFpEF When the heart pumps normally - but still fails When

Case Presentation A young woman was admitted with sudden-onset palpitations lasting approximately three hours before arrival. On admission, she was clammy, cold, and diaphoretic, and reported pre-syncopal episodes. Blood pressure was normal, and heart rate approximately 200 bpm. The admission ECG showed a wide-complexed, irregular tachycardia. Irregular wide-complexed tachycardia - Pre-excited AF Same ECG - More complexes (Standard leads) Same ECG - more complexes (precordial

Heart failure is a common but often misunderstood condition. Many people think it means the heart has “stopped,” but that’s not the case. Heart failure means the heart is pumping less efficiently than before, and it can affect anyone, often without obvious symptoms in the early stages. Heart failure sounds dramatic — but it doesn’t mean that the heart has “stopped.”It means that the heart is not able to pump enough blood  to meet the body’s needs, either because the pumping f

Atrial fibrillation (AF) is an increasing public health challenge — but prevention is absolutely possible. Good control of blood pressure, body weight, blood sugar, and alcohol intake , along with appropriate management of heart failure and diabetes , can significantly reduce the risk of developing AF and its serious complications. Much has been written about what  atrial fibrillation is and how  it is treated. But far too little attention is given to how it can actually be p