Fathi Idris

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Cardiologist (Interventional / EP) - Nashville - USA

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A 41-year-old lady who presented with syncope. In the emergency room, her high sensitivity troponin went from 48 to 183 in 1 hour. She reported mild shortness of breath and chest pain on exertion.

What was the likely mechanism of her syncope? (answered in the 1st comment)

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This is an EKG on 70-year-old male. He has multiple medical problems including shortness of breath, chronic kidney disease, anemia and other medical problems.

This EKG came through routine EKG reading. What 1st thing comes in mind when you see this EKG, and why?


Giant right atrium if you haven't seen one lately!

Welcome Dr. @Abdelwahab Suleiman to Nashville for his observership rotation!

Please join me in wishing him good luck for his career endeavors!


Volunteering Opportunities with Alistishari 

Dear All,

Here is an opportunity to have some volunteering experience and to boost your resume (if that is missing). In the U.S, having a volunteering experience from a U.S organization is very important. 

My understanding is that, this opportunity is limited to Libyan nationals only, given the nature of the organization (details in their letter below).

Good luck!



Full letter from Alistishari Team:

Calling Libyan Young Adults and Early-Career Professionals: Boost Your Resume and Make an Impact with Alistishari!

Alistishari, a US-based non-profit organization, is dedicated to providing medical guidance to Libyans worldwide and connecting them with Libyan professionals for second opinions and support. We invite both medical and non-medical professionals to join us in a rewarding volunteering opportunity that requires a diverse range of skills.

By completing a short survey, you can contribute your expertise to this important project. Your skills are valuable, whether in medicine or other fields. This volunteering experience offers numerous benefits, including the opportunity to enhance your resume with a letter of experience and reference from Alistishari. Additionally, you'll have the chance to expand your professional network.

We assure you that your application will be handled with utmost confidentiality and will not be shared without your permission. We understand the importance of privacy and respect your preferences.

To be considered for this unique opportunity, please complete the brief survey linked below. Your responses will help us assess your qualifications and assign match you with a volunteering opportunity that aligns with your skills and interests. Please note that all applicants will be vetted, and selected individuals will receive an invitation for an interview.

Survey Link: https://form.jotform.com/231668668177068

Application period will end on August 15, 2023.

Accepted candidates will be contacted directly. 

Thank you for considering this rewarding experience to make a meaningful impact and enhance your career. We appreciate your dedication. For any questions or further information, please contact us at: admin@alistishari.org

Warm regards,

Alistishari Membership Team

Eid Mubarak and blessed to you and your families!


Can you believe this ?!!

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I would like to share this interesting case from couple of days ago.

A 63-year-old African American lady with acute coronary syndrome. During her catheterization, when injecting the left main coronary artery, the catheter slid and jumped into another vessel. That turned out to be the RCA originating just very close to the left main. A repeat cranial view, (angiogram 2.) Clarifies the relationship between to the separate ostia in the left coronary cusp.

CX was occluded and RCA has two proximal tandem lesions.

We elected to perform intervention on both vessels. Finding a guide catheter for the apparent RCA was a bit challenging, however we used a JR4 guide catheter but needed to engage the ostium with an interventional wire of the cusp and then advanced the JR4 guide catheter to the ostium of the aberrant RCA. The rest was straight forward.

I wonder, if we did not luckily jump in to the RCA from the left coronary cusp injection, we could have wasted long time trying to search for the RCA on the right coronary cusp. Rare anomaly, but keep it in mind!


Interesting changes may be coming in the U. S. healthcare system for adopting foreign medical grads without "residency" requirement to treat physician shortage that is expected to worsen.

 Care Systems


Hope is free, so grab it when you can. Smile is also free, so give it when you can.

Added a post   to  , Fathi Idris

Dear Dr. Fathi,

I hope you are doing well.

In order to better connect the members of the forum, I think it would be better to ask everyone to fill out their profile with a short introductory/summary text about themselves. I think this approach will speed up connection and networking. The summary could include the following points:

1- Name, 2- Degree, 3- Work/occupation, 4- Affiliation, and 5- Current and future planned clinical and/or research activities.

Best wishes,


Excellent presentation by Dr. @Mahmoud Abdou on pulmonary hypertension. Highly recommended to watch

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A 41-year-old male presented with 2-hr history of severe retrosternal chest pain and diaphoresis. He has no prior history other than h/o smoking. In ED, he was diaphoretic and in severe pain rated 7/10.

His vital signs stable. Presenting EKG is shown below.

Question: Is this a STEMI or Not? What is the culprit lesion?


Was honored by Mohsen’s visit to Nashville. Short one, but we had a great time!

@Mohsin Salih


What is happening?

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Interesting article...

Twitter is a communication platform, and, therefore, it is a neutral medium. It’s not the medium itself, but how you use the medium that makes Twitter “good” or “bad.” In my five years of being an anonymous and five months of being a named individual on Twitter, I have come to realize that different people use Twitter for different purposes. In general, these are the five people (or doctors) I have met on Twitter. They have enriched my experience on social media and taught me much about life and doctoring.

1. The knowledge distributor. These are the ones who frequently tweet and retweet various information, news, latest studies, guidelines, and opinions. Following a few of these people will add to your knowledge base. They often have tens of thousands of followers, and they usually have tens of thousands of tweets. They are good at disseminating information. Their timeline is full of information. The downside? They read like a newsfeed and therefore often lack the personal and social engagement that is an enjoyable part of Twitter. But they serve their purpose well. I learn lots of new things from them.

2. The court jester. The court jester is the one who entertains, enlightens and yet educates at the same time. They’re the ones who put up a mirror to our faces. They poke fun at important issues, sometimes even taboos, and bring up a very important message. They are often the ones behind the mask who would tell the truth when no one else would. They provide the behind-the-scenes look at the medical industry (or any industry) and challenge the status quo. As you can guess, they’re often anonymous. They’re the ones the lawyers and administrators warn you about. But I see great value in following them. Because they tell the truth behind their masks, I reckon every industry needs some of these, with respect of course. I can think of a few doctors who are anonymous who make a massive impact through their tweets and blogs.

3. The social collaborator. They are fun to hang out with. They are one of the main reasons for joining social media. It is social after all. There are lots of conversations about life. Lots of food photos and baby photos. And cat photos, of course. One must never forget the abundance of cat photos on Twitter. Sometimes, in their eminently sociable space, the line between public and personal lives get crisscrossed. Raw emotions, anger, bitterness and hurts make their way into their tweets. It can be painful to watch. Sometimes downright unprofessional. But I love following them, because at the end of the day, we’re human. I need to always be in touch with the raw and unpredictable nature of human emotions and relationships.

4. The relentless commentator. The devil’s advocate. They seem to have an opinion on and a comment for anything and everything. Some of them good, some of them very critical and negative. They always provide a contrasting view, and they’re happy to let loose with their opinions. You’ll find them debating certain issues with passion and their timeline reads like an angry verbal joust. It’s good to follow them because there are always many sides to any story, and you get to learn from them. However, the line between respectful difference versus discourteous disagreement can be very thin at times. The first rule of Twitter: Be respectful of others.

5. The thought leader. Here’s the one everyone wants to be. The person who leads the world with contemporary ideas and tweets their sophisticated perspective to everyone. Twitter truly adds to their impact and in some immeasurable ways, they are truly changing the world. They are examples of what’s good on Twitter. The synthesis and harnessing of people and expertise. There are not too many of them around, true thought leaders. When you’ve found them, they’re a treasure to follow as they enrich your days with colorful thoughts and perspectives. I’m certain that they would be as amazing in real life as they are on Twitter.

It would be great to follow a few of these different kinds of tweeps to challenge your thinking and enhance your perspective. What about yourself? What kind of a twitter person are you? My guess is that most of us would be a bit of all of them. Who we are on Twitter is probably defined by who we are in real life and what our purposes are in joining social media.

Eric Levi is an otolaryngologist in Australia who blogs at his self-titled site, Dr Eric Levi.  He can be reached on Twitter @DrEricLevi.

Original article:


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A 69-year-old man who is in the ER with palpitations. His past medical history is not immediately available. Physical exam is otherwise unremarkable.  

What is going on? 

Last day in ACC - Lunch time! I heard you guys had a fun time. I missed it...have safe travel home ISA.

@Mansour Khaddr @Aiman Smer @Ali Elfandi @Mohamed Ayan @Mohamed Zghouzi

Great dinner and hangout with Libyan buddies at ACC in New Orleans, close to but NOT at the French quarter…

Reposted Mansour Khaddr's post.

A 60-year-old male s/p bioprosthetic AVR for severe AS/CABG in 2022 complicated with ischemic stroke, atrial flutter, hypertension and tobacco abuse who was seen ED yesterday for slurred speech.

EKG was done and reported as ventricular bigeminy. What are the EKG findings?

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This is a 37-year-old female who was seen in the ER for left lower abdominal pain.

While in the ER sleeping, the following rhythm strip was noticed. The ER provider ordered stat magnesium, cardiac troponins, EKG, which was within normal limits.

 What would you do next?


A group of talented Libyan Cardiologists in ACC-22 (Washington, DC):

Right to left (@Mansour Khaddr , Yazeid Alshebani, Haitham Mazek, Mohammed Ayan, Khalid Sharif, @Aiman Smer, Mahmoud Traina, @Mohsin Salih, @Mohamed Zghouzi).

Courtesy of @Aiman Smer

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This is a 41-year-old African American male referred because of abnormal EKG that was noticed during an ER visit for uncontrolled hypertension.

He denies chest pain, palpitation, shortness of breath, syncope or any other symptoms. He has a recent echocardiogram shows LVH, otherwise It is unremarkable.

His job is a social worker.

What is wrong with his EKG? and what is the next step of management? (answer the poll below)

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A very motivated paramedic shared this EKG tracing done on one of his patients. 

No clinical details on the patient; however, this tracing depicts two basic cardiac physiological phenomena, one electrical and the other one is mechanical, what are they?

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A 20-year-old African American lady that is 34 weeks pregnant. She is in the ER with nausea and vomiting and feels weak.

  1. What's going on?
  2. What diagnostic test should you order?

Upcoming event for Libyan Cardiac Society

Zoom link - https://us02web.zoom.us/j/4029726854

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Imagine you are taking care of a patient that you have some moral conflict or problem with his/her behavior or choices in life. Will this affect you and/or the care you provide to that patient?

Very nice and easy reading and good food for thought below! 

Helping Clinicians Cope With Moral Distress Can Improve Patient Care

“Consider a physician who is morally distressed over a patient with a substance use disorder who chooses to leave the hospital prematurely. This provider’s distress happens to be based on their idea that drug use is immoral and they wonder how much effort they are expected to expend in caring for patients who choose to live this way. In this case, the physician should be empathically supported in caring for patients who may be “difficult to help” because of a substance use disorder by confidentially helping the provider process their concerns and helping them manage their values in the context of providing needed care…..”


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Would like to share this case from last week. It is an acute MI but with a couple of twists in presentation that I thought worth sharing.

A 61 year-old-male with family h/o CAD. Presented to ED with 30 min of left sided chest pain radiates to the left shoulder. EKG on arrival shown.

Initial hs-cTnT: 7 and 1-hr later was 11 (normal NTG lowered CP from 10/10 to 4/10, morphine helped as well.

Repeat hs-cTnT at 3-hr is: 41. EKG 2 hours later shown:

The patient was taken to the Cath lab and found to have a coronary lesion.  Where is that lesion?

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The title is a joke, but here's an interesting article.

1 in 4 cardiologists may have a mental condition. This is global and not only in the U. S.

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You are seeing this 50-year-old male with new-onset diabetes. You confirmed the diagnosis based on his symptoms and blood work he brought with him. You gave him a prescription for diabetic medications and a self-test glucometer, and also gave him instructions about healthy diet and lifestyle. 

He paid you and left your office. He didn’t show up at his next appointment to see you a couple of weeks later.

In your opinion, how much is the contribution of this clinical care you provided to his overall outcome (morbidity and mortality)?

  1. 80%
  2. 50%
  3. 20%
  4. 5%

If you are curious about the answer but not sure, then I ask you to explore the concept of “Social determinants of health, or SDOH”, and then you will know the answer. 

I invite you to look at this very nice and short PDF document to further clarify the concept of health equity and SDOH.

Also, I invite you to take the poll at the end (answers anonymous). Also, I am curious about your comments about the topics and hearting input from colleagues practicing in different parts of the globe.  

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