A very physically active 49-year-old male with a history of labile hypertension and hypercholesterolemia with an LDL cholesterol of 126 mg%. He underwent an exercise stress test which revealed reversible inferoseptal ischemia at a peak heart rate of 171 bpm and peak blood pressure of 195/85. In the expert's opinion, the results suggest that the patient has silent myocardial ischemia and may be at risk for sudden cardiac death, especially in light of the marked exertional level of activity.
49-year-old-male complained of a feeling of oppression behind the sternum, always when there was emotional stress. His coronary CT showed Severe high level stenosis with wall irregularities of the right coronary artery. The treatment options are coronary revascularization procedure versus optimized pharmacologic management.
41-year-old female with 2nd infertility and repeated implantation failure was treated with 4 long protocols with no success. The expert suggests to perform diagnostic hysteroscopy, hysterosalpingogram, and thrombophylia workup, to switch from the long protocols to a short one, and try to do double transfer or blastocyst transfer and consider assisted hatching as well.
60-year-old patient was diagnosed with Still's disease. He was treated with high doses of corticosteroids (methylprednisolone, 110 mg daily). The dose was gradually lowered to 4 mg daily. In the last 2 years he had two exacerbations of the disease which were successfully treated by the increased dose of methylprednisolone. The expert recommends different complementary treatments that can be helpful to reduce pain , other symptoms and inflammation, reduce the dose of the drugs needed to control the disease, and improve quality of life.
31-year-old woman suffering from secondary recurrent abortions. During a 2 year period, she underwent 4 miscarriages with a thorough investigation, including genetic, anatomic, immune and thrombophilic testing. Nothing of significance has emerged to justify 4 miscarriages.
42-year-old patient with hypothyroidism (Hashimoto's) with a history of primary recurrent abortions, probably due to a uterine septum. She underwent 2 IVF cycle, the 2nd – with poor response. The expert suggests some diagnostic and therapeutic strategies.
p68-year-old male with recurrent asymptomatic paroxysmal atrial fibrillation underwent ablation of the cavo-tricuspidal isthmus. Holter exams showed sinus rhythm with brief and isolated episodes of atrial fibrillation, again with focal trigger. The choices of therapy are rate control, rhythm control, catheter ablation or antithrombotic therapy.
54-year-old obese male with end stage renal disease due to membranous nephropathy, has received 2 renal transplants in the past and is highly sensitized. He underwent coronary angiography for vessel CAD, and PTCAs and stanting were performed. His current treatment consists of multiple medications including mycophylate according to the instructions of his transplant nephrologist. His cardiologists sees no contraindication to transplantation.
