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Relevant diagnostics and physical examination data. (A) Initial electrocardiogram on presentation to the critical care unit. (B) Still image of clonus on physical examination (refer to supplementary materials for video). (C) Electrocardiogram on discharge after successful treatment of serotonin syndrome.

Serotonin Syndrome Masquerading as Ventricular Tachycardia Storm

A 60-year-old woman with bipolar disorder presented to a local hospital after being found unresponsive at home. When assessed by emergency medical services, she was found to be tachycardic to 180 beats per minute and received 3 doses of adenosine on transport with no effect. Given concern for altered mental status, she was intubated for […]

Apical 4-chamber view of the cardiac metastasis in the right ventricle.

Intracardiac Metastasis as the Initial Presentation ofNon–Small Cell Lung Cancer

Cardiac tumors have generally been considered to be rare. They are often found incidentally, as they tend to remain clinically silent, but they can sometimes present with symptoms secondary to obstruction, embolization, or invasion of the myocardium. Most cardiac tumors are secondary tumors from metastases, with primary cardiac tumors constituting approximately 15% of all cardiac […]


When Guidelines Cause Hypertension

The 2017 ACC/AHA Hypertension Guidelines1 lowered the threshold for diagnosing hypertension from a blood pressure of ≥140/90 mm Hg to ≥130/80 mm Hg. In the United States, this effectively increases the number of adults diagnosed as “hypertensive” from 72 to 103 million.2 It has been stated that “by reclassifying people formerly considered to have pre-hypertension as having hypertension, […]

(A) Inferior vena cava-right atrium thrombus. (B) Right atrium thrombus. (C) Right atrium thrombus.

An Oscillating Thrombus Inside the Inferior Vena Cava

Thrombosis of the inferior vena cava is an under-recognized entity that is associated with significant morbidity and mortality.1 It is estimated that 2.6%-4% of patients with deep vein thrombosis of the lower extremities have inferior vena cava thrombosis. The most common cause of inferior vena cava thrombosis is the presence of an unretrieved inferior vena cava […]


Optimal Systolic Blood Pressure Target in Resistant and Non-Resistant Hypertension

Prior studies suggest benefits of blood pressure lowering on cardiovascular risk may be attenuated in patients with resistant hypertension compared with the general hypertensive population, but prospective data are lacking. Methods We assessed intensive (<120 mm Hg) versus standard (<140 mm Hg) systolic blood pressure targets on adverse outcome risk according to baseline resistant hypertension […]

Dr. Joseph S. Alpert

Sloppy, Greedy, or Overworked?

In early 2010, my administrative assistant, Barbara Raney, came into my office with a worried expression on her face. She told me that a lawyer from the Department of Justice (DOJ) in Washington, DC was on the phone and wanted to speak with me. My immediate thought was “What have I done that would raise […]

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