I got a guy in about four months ago, he was lost to cardiology followup, in AFib and simmering failure running about 100 BPM, EF was about 15%, big legs.

Using some very old-fashioned methods from experience, I pruned about 25 lbs of fluid off him, balanced him out and got a rate around 55, kept the pressure low but asymptomatic.

Then I echoed him.  Then I sent him to cardiology.

I had anterioinferior wall AK/HK in the 2014 echo.  His last EF sucked.  But everything was peachy on this 2015 echo.  Everything.  After I pruned him down, no notable WMA and EF >55%.  Gave him about a 3lb range around his fighting weight.

Majik.  You unload the sick heart, it works better.

Then I sent him to cardiology.  With a preserved EF.

The fellow complained that there was no afterload reduction with ACE inhibitor.  That’s just book larnin’ as I stopped it when he couldn’t hold a pressure over 100 systolic.

The attending came on, patted the fellow on the head and said “shhh,” and gave the patient back to me, saying – if you need cardiology again, give us a call, we sign off.

That’s what experience gives you.  I love it.  That’s what I mean when I say I love medicine.