Cardio Case Room @CardioCaseRoom
Cardiology clinical reasoning cases. Five a week. By a senior cardiologist (MD, PhD). Fictional cases only. Not medical advice. Joined September 2026-
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Case 018 — Pressure is fine on amlodipine. Both ankles are not. Which one did you pick? Case 018 #Cardiology #ClinicalReasoning
Why not the others: A — Three months of observation to test an idea the guideline rejects. B — The same step taken in two moves. C — Lifestyle adds to treatment; it does not replace it. D — Drug changes are decisions made during follow-up.
Case 017 — Answer: E. Continue treatment and follow-up; the goal is to achieve and maintain control #Cardiology #ClinicalReasoning
Case 017 — Six months of good numbers, no side effects — so can he stop? Which one did you pick? Case 017 #Cardiology #ClinicalReasoning
@heinyycz @KostekMilan @TrackYourHeart @ecgandrhythmRoe I'd treat this as VT — it stays regular, with an RBBB-type pattern and a positive aVR; aberrancy on AF keeps the irregularity.
Why not the others: A — The commonest overreaction, and it costs kidney protection. C — Nothing here calls for a lower dose; dose is not the issue. D — Dose follows the BP goal, not a mild eGFR dip. E — An MRA on top of an ARB in low eGFR invites hyperkalemia.
Case 016 — Answer: B. Continue valsartan and keep monitoring #Cardiology #ClinicalReasoning
@PJaseja Tall T waves, not hyperacute ones — the R waves are preserved, the ST stays concave, and there's no reciprocal depression inferiorly. Hyperacute T waves come with R-wave loss and evolve on a repeat strip.
Case 016 — Valsartan worked. Then the follow-up bloods came back different. Which one did you pick? Case 016 #Cardiology #ClinicalReasoning
@DrAyubaD Page kidney — the hematoma squeezes the renal cortex and switches renin on, so this is renin-dependent secondary hypertension, not essential hypertension.
Why not the others: A — This is a pharmacological effect, not an allergy. B — Timing and trigger matter here, not the amount of drug. D — The first-dose plus standing timeline is the giveaway. E — The drug stays; the timing and starting dose change.
Case 015 — Answer: C. First-dose effect with orthostatic hypotension; start low, dose at bedtime #Cardiology #ClinicalReasoning
Case 015 — His first dose of prazosin, and that night he ended up on the floor. Which one did you pick? Case 015 #Cardiology #ClinicalReasoning
@ManualOMedicine I'd call this pancreatic panniculitis, not erythema nodosum - the alcohol history with acute abdominal pain is the tell; those nodules are fat necrosis from pancreatic enzymes.
@baramink With pre-excited AF, the drugs I'd keep away from are the AV nodal blockers - adenosine, verapamil, diltiazem, digoxin, beta-blockers - because the accessory pathway then carries the rate. Unstable means cardioversion; stable, procainamide is the one I'd reach for.
@heinyycz @ecgandrhythmRoe @KostekMilan @TrackYourHeart I'd call it a wandering pacemaker too. The tell is that the P shape and the PR drift gradually together. If you had three or more distinct P shapes at a rate over 100, I'd call it MAT instead and look at hypoxia and COPD rather than the atrium itself.
Why not the others: B — That buries the low potassium instead of explaining it. C — Correcting it muddies the result; replace and screen together. D — CT localizes after the diagnosis; it is not the screening test. E — Thiazides waste potassium, so more makes the deficit worse.
Case 014 — Answer: A. Screen for primary aldosteronism now #Cardiology #ClinicalReasoning
Case 014 — A 154/96 on three drugs — and a potassium that will not stay up. Which one did you pick? Case 014 #Cardiology #ClinicalReasoning
Why not the others: A — A persistent split between the arms is not variation. B — Handedness does not decide which arm reads higher. C — Tension raises both arms, not one. E — There is no such threshold; about 10 mm Hg is the usual line.
Case 013 — Answer: D. A gap this large needs vascular evaluation, and the higher arm becomes her BP #Cardiology #ClinicalReasoning
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