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Introduction:European, American and UK guidelines all endorse the prescription of the 'four pillars' of treatment (ACE/ARBs, b-blockers, MRAs and SGLT2 inhibitors) for heartfailure with reduced LV systolic function (HFrEF). Circulation, Volume 150, Issue Suppl_1 , Page A4134483-A4134483, November 12, 2024.
David Didlake Firefighter / Paramedic Acute Care Nurse Practitioner @DidlakeDW Peer review provided by Dr. Steve Smith [link] @SmithECGblog A 72 y/o Male experiences a syncopal episode while seated. LBBB may be the precipitating cause of the heartfailure syndrome, or may portend high mortality when identified in preexisting heartfailure.
David Didlake Acute Care Nurse Practitioner Firefighter / Paramedic (Ret) @DidlakeDW Expert contribution by Dr Robert Herman @RobertHermanMD @PowerfulMedical (Chief Medical Officer) An adult male called 911 for new-onset epigastric burning. Fire/EMS crews found him clammy and uncomfortable. Breath sounds were clear in all lung fields.
There is also bradycardia. Bradycardia puts patients at risk for "pause-dependent" Torsades de Pointes. Torsades in acquired long QT is much more likely in bradycardia because the QT interval following a long pause is longer still. It would be difficult to get a nurse to give it faster! Is 40 mEq too much?
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