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.