A 68-year-old man with dyspnea and lightheadedness shows signs of heart failure and left bundle branch block (LBBB) on ECG. Given his symptoms and reduced ejection fraction, the most appropriate management step is Cardiac Resynchronization Therapy (CRT), which enhances cardiac function and alleviates heart failure symptoms.More
Author Archives: Simon Downes, MD, PhD
Medical educator
62-year-old female presents with intermittent severe pain on the lateral side of the left tibia
Case Presentation A 62-year-old female presents with intermittent severe pain on the lateral side of the left tibia. The pain is spontaneous, lasts about 24 hours, and is not related to exercise. She has a history of atrial flutter treated with ablation, transient ischemia on a stress test (suspected LAD spasm), and suspected microvascular dysfunction…More
58 yo male describes his symptomatic LBBB (left bundle branch block) to AI
Case: 58 yo male with no previous cardiac history, not taking an medications. Pt statement: “I have a normal cardiac MRI and echo. Since COVID and the vaccine, I’ve experienced transient chest pain with LBBB, sometimes with mild shortness of breath, resolving within 30 seconds. It worsened with exercise, leading to a serious episode that…More
Key Differences Between Polymyalgia Rheumatica and Rheumatoid Arthritis
Polymyalgia rheumatica (PMR) and rheumatoid arthritis (RA) are both inflammatory conditions that can cause joint pain and stiffness, but they have key differences in presentation, pathology, and management. Key Differences Between Polymyalgia Rheumatica and Rheumatoid Arthritis Feature Polymyalgia Rheumatica (PMR) Rheumatoid Arthritis (RA) Onset Sudden or subacute Gradual and insidious Age Group >50 years (usually…More
Is sodium valproate a good choice for an acute manic episode of bipolar disorder in a breastfeeding woman?
A good choice for treating an acute manic episode in a breastfeeding woman with bipolar disorder would be haloperidol or quetiapine due to their relative safety during lactation. Preferred Options: Alternatives (with caution): Medications to Avoid: If symptoms are severe and require immediate stabilization, haloperidol is often used due to its quick onset and safety…More
Is it still worth going to a carribean medical school?
Why Going to Medical School is Worth It—Even If It’s a Caribbean School or Takes a Long Time Pursuing a medical degree is one of the most rewarding and fulfilling decisions one can make. While attending a top-tier U.S. or European medical school is the ideal path for many, there are plenty of reasons why…More
Are they close to develping effective medicines for long covid?
As of January 2025, the development of effective treatments for long COVID remains a significant challenge. While various therapeutic approaches are under investigation, no universally effective treatment has been identified to date. The National Institutes of Health (NIH) has initiated clinical trials to explore potential treatments targeting specific symptoms of long COVID, such as sleep…More
Why does stress make LBBB (Left bundle branch block) more symptomatic?
Left bundle branch block (LBBB) can become more symptomatic under stress because stress increases the demand on the heart, making any underlying cardiac inefficiencies more apparent. Here’s why: If you experience worsening symptoms during stress, managing stress levels (e.g., through relaxation techniques, exercise, or medications) and consulting with a cardiologist for potential interventions can be…More
Could it be atrial flutter?
Scene: A cardiologist’s office The patient, Mr. Thompson, a 58-year-old male, is seated in front of the cardiologist, Dr. Patel. Mr. Thompson has been experiencing chest pain and shortness of breath during physical activity. Dr. Taylor: Good morning, Mr. Thompson. I understand you’ve been having some chest pain. Can you tell me more about what’s…More
How can increased sugar cause inflammation in the heart?
Increased sugar intake can contribute to inflammation of the heart primarily through metabolic and immune-related pathways. Here’s how: Reducing added sugars and adopting a balanced diet rich in whole foods, fiber, and anti-inflammatory nutrients can mitigate these risks and promote heart health.More
Simon Downes, MD, PhD 