The patient Patient is a 61-year-old male with a past medical history significant for mitral valve prolapse (diagnosed at age 14). He presented to a Norton Immediate Care Center location with complaints of rash on his lower legs. He had been having shortness of breath for several months after a back injury left him with…
The patient An active 60-year-old male with atrial fibrillation (A-fib) had been seen by Norton Heart & Vascular Institute cardiothoracic surgeon Steven M. Peterson, M.D., and after endocardial ablation was still symptomatic. His condition limited his ability to exercise and engage in his role as a soccer referee and long-distance runner. The challenge Despite five…
The patient A 33-year-old male with heroin use and an abscess to left arm: Workup revealed methicillin-sensitive Staphylococcus aureus bacteremia with tricuspid endocarditis and pulmonary septic emboli with cavitations and central nervous system septic emboli. This condition is common with intravenous drug use and increasing in prevalence. His course was complicated by COVID-19. The challenge…
The patient A 13-year-old female presented with bilateral shin pain that began after she increased her gymnastics training from nine to 21 hours per week around nine months prior. Her right leg pain was worse than left. She was seen by an outside sports medicine specialist clinic in August of 2024 and treated with rest…
The patient A 54-year-old man with chronic severe pulmonic regurgitation due to history of valvar pulmonary stenosis, the patient had a Brock procedure at age 8. Right heart failure symptoms included dyspnea, early satiety, ascites and peripheral edema, qualifying as New York Heart Association Class III heart failure. A cardiac MRI showed a severely dilated…
The patient A 41-year-old pregnant patient at 38 weeks’ gestation was admitted for elective cesarean section. Her medical history included three pregnancies, two live births, two prior cesarean sections, anterior placenta with polyhydramnios (amniotic fluid index 35), pituitary macroadenoma, gastroesophageal reflux disease (GERD), and headaches. Echocardiogram in 2019 demonstrated an ejection fraction (EF) of 56%….
The patient A man in his forties with a history of epilepsy and ankylosing spondylitis presented with acute onset neck pain after he was found down on the ground next to his bed by his father. The patient is amnesic to the event. The challenge The care team The solution The patient was placed in…
The patient A 4-year-old child with complex form of long QT syndrome needed surgical revision of her implantable cardioverter-defibrillator (ICD) due to device malfunction. Long QT syndrome is a congenital heart condition that predisposes affected patients to suddenly develop serious heart rhythm disturbances (for example, ventricular tachycardia/fibrillation) that can be life-threatening. In addition to taking…
The patient A 12-year-old male initially was seen for significant bowing of the right tibia, causing knee pain — and his mom noted increasing deformity as he was growing older. There was concern for continued bowing of the leg, causing long-term issues with the right knee. He was having mild to moderate knee pain, which…
The Patient A 52-year-old male with a long-standing history of poorly controlled high blood pressure despite adherence to a four-drug antihypertensive regimen (including a calcium channel blocker, ACE inhibitor, thiazide diuretic and beta-blocker). The patient reported persistent systolic blood pressures in the range of 170–190 mmHg, confirmed by ambulatory monitoring. He had no evidence of…
The patient A 79-year-old man with essential tremor in the bilateral hands for at least 10 years Over the years, the severity of the tremor worsened, along with its negative impact on his life. First-line medications, propranolol and primidone, both were tried, without significant impact on the severity of tremor and the patient’s disability. Feeding…
The patient A 45-year-old man with bilateral thumb carpometacarpal joint arthritis for several years (Figures 1 and 2): He tried bracing and steroid injections, which eventually provided diminishing relief. He works as a mechanic for UPS but was having an increasingly difficult time at work due to pain and loss of pinch and grip strength….