A 58‑year‑old male presents with crushing chest pain radiating to the left arm, diaphoresis, and shortness of breath.

Stabilize the patient, confirm diagnosis, and initiate reperfusion therapy as quickly as possible.

Administer aspirin, sublingual nitroglycerin, and oxygen; obtain a 12‑lead ECG within 10 minutes; activate the cath lab for primary PCI; give anticoagulation (heparin) and consider P2Y12 inhibitor; monitor vitals and provide analgesia.

ECG shows ST‑elevation in leads II, III, aVF; patient undergoes successful PCI with restoration of flow, pain resolves, and troponin trend stabilizes.

Post‑PCI patient with uncomplicated anterior STEMI, stable hemodynamics.

Determine whether a beta‑blocker should be initiated to improve long‑term outcomes.

Review guidelines: start beta‑blocker within 24 hours if no signs of heart failure, bradycardia <60 bpm, hypotension <90/60 mmHg, or contraindicating pulmonary disease; choose metoprolol succinate and titrate to target HR 50‑60 bpm.

Patient tolerates beta‑blocker, HR reduces to 58 bpm, no adverse events, and 1‑year follow‑up shows reduced recurrent ischemia.

A 65‑year‑old female with a history of hypertension presents for routine follow‑up after a prior NSTEMI.

Assess cardiac function and determine implications for management.

Identify reduced EF (35%) indicating systolic dysfunction; note hypokinetic segments in the inferior wall consistent with prior infarct; evaluate for valvular disease, diastolic parameters, and pulmonary pressures; recommend guideline‑directed medical therapy (ACE‑I/ARB, beta‑blocker, mineralocorticoid antagonist) and consider referral for cardiac rehab.

Therapy optimized, EF improves to 40% over six months, symptoms stable, and patient remains active in rehab.

A 72‑year‑old man with severe aortic stenosis was evaluated for surgical replacement, but his comorbidities made him high‑risk.

Communicate the recommendation against surgery and discuss alternative management.

Scheduled a private meeting, used clear, compassionate language, explained risks versus benefits, provided visual aids of valve anatomy, listened to concerns, and offered a shared decision‑making approach with medical therapy and close monitoring.

Family appreciated the honesty, patient opted for transcatheter valve implantation under a modified protocol, and expressed confidence in the care plan.

During a heart failure conference, a cardiothoracic surgeon advocated for early LVAD implantation, while I felt optimal medical therapy had not been maximized.

Reach consensus on the safest, evidence‑based pathway for the patient.

Presented recent guideline data, reviewed the patient’s hemodynamics, invited the surgeon to discuss concerns, and proposed a trial of inotropic support with close monitoring before committing to LVAD; scheduled a follow‑up multidisciplinary meeting to reassess.

Team agreed to the trial, patient stabilized, and LVAD was avoided; the collaborative approach reinforced mutual respect.

Cardiology is rapidly evolving with new trials on SGLT2 inhibitors for heart failure.

Continuously update knowledge and apply it to patient care.

Subscribe to major journals (JACC, Circulation), attend annual ACC meetings, participate in local journal clubs, and complete CME modules; after the EMPEROR‑Reduced trial, I incorporated SGLT2 inhibitors into guideline‑directed therapy for eligible HFrEF patients.

Within six months, 30% of my HFrEF cohort started SGLT2 inhibitors, showing improved NYHA class and reduced hospitalizations.

Patient scheduled for diagnostic coronary angiography due to atypical chest pain and positive stress test.

Conduct the procedure safely while minimizing discomfort and radiation exposure.

Obtain informed consent, verify allergies, ensure IV access, administer pre‑procedure sedation; use radial artery access with ultrasound guidance; administer heparin weight‑based; perform diagnostic runs with low‑frame rate fluoroscopy; monitor vitals continuously; achieve hemostasis with a compression device post‑procedure; provide post‑procedure monitoring for complications.

Procedure completed without complications, patient reported minimal discomfort, and no access site issues observed during 4‑hour post‑procedure observation.

During a left heart catheterization, the patient’s rhythm changes to rapid irregularly irregular AF with HR 130 bpm.

Stabilize rhythm, ensure hemodynamic stability, and decide on immediate management versus post‑procedure strategy.

Immediately assess blood pressure and symptoms; if stable, administer IV beta‑blocker (esmolol) to control rate; consider anticoagulation if procedure >30 min and CHA₂DS₂‑VASc ≥2; monitor for hypotension; if hemodynamically unstable, prepare for synchronized cardioversion; document episode and arrange outpatient electrophysiology follow‑up.

Rate controlled to 80 bpm, patient remained stable, procedure completed, and AF was successfully managed with outpatient ablation planning.

A 70‑year‑old patient with severe mitral regurgitation is being evaluated for surgical repair.

Obtain high‑quality TEE images to assess valve anatomy, severity, and suitability for repair versus replacement.

Review contraindications (esophageal pathology), obtain informed consent, ensure fasting, administer topical anesthetic and conscious sedation; insert probe with gentle advancement under direct visualization; acquire standard TEE views (mid‑esophageal, trans‑gastric) focusing on mitral valve morphology, regurgitant jet, leaflet motion, and annular dimensions; document measurements; monitor vitals and oxygenation throughout.

TEE confirmed posterior leaflet prolapse with flail segment, suitable for minimally invasive repair; surgical team proceeded with successful mitral valve repair.