Cardiologists, other physicians, and patients writing on KevinMD about heart disease: statins and the cholesterol guidelines argued since 2013, blood pressure thresholds, stroke and the clock, cardiac arrest and what CPR can and cannot do, stents and atrial fibrillation, heart failure drugs that go unprescribed, prevention from salt to calcium scores, and a specialty that became procedural because procedures were paid. One maintained record draws on this archive: Heart disease: what physicians say, in their own words.

How CREST-2 changes asymptomatic carotid stenosis treatment

Conditions and Diseases
September 19, 2026

Carotid artery disease remains a major contributor to ischemic stroke, one of the leading causes of death and long-term disability in the United States. While symptomatic carotid stenosis has well-established treatment pathways, the management of asymptomatic carotid artery disease remains an area of ongoing debate. Traditional treatment methods such as intensive medical management have largely functioned as the standard of care for asymptomatic carotid artery disease, with revascularization (carotid endarterectomy …

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How CREST-2 changes asymptomatic carotid stenosis treatment

Is personalized antithrombotic therapy ready for practice?

Medications
September 6, 2026

Peripheral artery disease (PAD) affects millions of Americans and remains a leading cause of disability, repeat hospitalizations, and limb loss. Advances in endovascular devices, surgical techniques, and medical therapies have dramatically improved our ability to restore blood flow to the legs. Yet despite this progress, one challenge continues to limit long-term success: what happens after the procedure.

Following lower extremity revascularization, most patients are prescribed blood thinners to help prevent clot …

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Is personalized antithrombotic therapy ready for practice?

When AI misses a diagnosis, the cardiologist signs alone

Conditions and Diseases
September 3, 2026

Artificial intelligence (AI) has rapidly reshaped cardiovascular imaging, particularly echocardiography, where machine learning algorithms now assist in image acquisition, chamber quantification, valvular assessment, strain analysis, and diagnostic interpretation. While these technologies promise enhanced efficiency and diagnostic accuracy, they also introduce an unresolved legal dilemma: When AI contributes to a missed diagnosis, who bears responsibility? Traditional malpractice principles designate the interpreting cardiologist as the primary legal decision-maker. Yet these doctrines evolved …

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When AI misses a diagnosis, the cardiologist signs alone

Nattokinase vs. statins and the limits of plaque data

Medications
August 23, 2026

The latest health craze from the wellness world is growing across social media platforms, leaving many wondering if they can stop taking their cholesterol medications. According to Google Trends, Americans are Googling “nattokinase” 130 percent more now than they did this time last year, and #natto pulls up over 200,000 posts on Instagram. Interest has also been fueled by high-profile influencers like Joe Rogan, whose podcast published an enthusiastic …

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Nattokinase vs. statins and the limits of plaque data

Interpreting heart rate variability beyond wearable scores

Conditions and Diseases
August 19, 2026

A patient recently sat across from me, phone in hand, scrolling through months of heart rate variability (HRV) data. He wasn’t asking me to interpret a lab value or an MRI. In a sense, he was asking me to interpret himself, filtered through an algorithm he strongly trusted, one that would not be contradicted by medical advice or even his own body.

He’s 58, a recreational cyclist, motivated and well-read. He …

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Interpreting heart rate variability beyond wearable scores

The quiet beliefs that lead to a delayed diagnosis

Conditions and Diseases
August 19, 2026

During my time as a registered nurse, I once cared for a woman in her late fifties (with identifying details changed) who had spent nearly a year adapting to symptoms she never thought signaled something serious: body aches, fatigue, frequent nighttime urination, constant thirst, breathlessness, and headaches. Each time the pain flared, she visited a local clinic, received an injection, felt better within hours, and returned to her life. Weeks …

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The quiet beliefs that lead to a delayed diagnosis

Rethink why inflammation persists before suppressing it

Conditions and Diseases
August 16, 2026

Inflammation is having an important moment in cardiovascular medicine. That is appropriate. Atherosclerosis is unquestionably an inflammatory disease. Chronic inflammation participates in plaque initiation and progression, plaque instability, thrombosis, and ultimately myocardial infarction and stroke.

But a recent clinical trial gives us reason to ask a question that may take us one step further: not whether inflammation matters, but why inflammation persists in the first place. Before attempting to suppress it, …

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Rethink why inflammation persists before suppressing it

Electrophysiology malpractice: conduct, not outcome

Conditions and Diseases
July 22, 2026

Cardiac electrophysiology is uniquely demanding. Even in the most experienced hands, procedural risk cannot be eliminated. Yet in malpractice litigation, adverse outcomes are frequently misinterpreted as evidence of negligence. This conflation threatens both physician practice and patient care. A more precise articulation of the standard of care in electrophysiology is essential.

Under tort principles, malpractice requires proof of duty, breach, causation, and damages. The standard of care is defined by the …

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Electrophysiology malpractice: conduct, not outcome

Reclaiming physician career meaning before you retire

Physician
July 19, 2026

I remember medical school orientation clearly. I was excited, nervous, confident, and full of self-doubt, all of it wrapped up in a kind of nervous energy. I had a clear vision of what my life would look like. I would finish medical school, complete residency, and practice primary care back in my hometown. The white coat they draped over me at the ceremony did not sit comfortably on my shoulders, …

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Reclaiming physician career meaning before you retire

Cardiac arrest is a human problem, not a training problem

Podcast
July 16, 2026
YouTube video

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When a patient’s heart stops, the person leading the code is running on memory alone, and memory fails under that kind of pressure. Michael Peck is an anesthesiologist and retired faculty member at …

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Cardiac arrest is a human problem, not a training problem

What Lindsey Graham’s death reveals about aortic dissection

Conditions and Diseases
July 16, 2026

Senator Lindsey Graham died on Saturday, July 11, at his home in Washington, D.C., at 71. Emergency responders had been called to his home for a cardiac arrest. His office initially described only a “brief and sudden illness”; the next day it released preliminary findings from the District’s chief medical examiner: aortic dissection due to arteriosclerotic cardiovascular disease.

Nothing in the public reporting suggests Graham’s care was delayed or that anyone …

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What Lindsey Graham’s death reveals about aortic dissection

AI is filling a gap doctors have no time for

Conditions and Diseases
July 9, 2026

On a Friday afternoon, my cardiologist sent me a message through the patient portal. It read, in full: “You do have coronary atherosclerosis resulting in moderate narrowing but no major narrowing of the arteries. I unfortunately do not have a clear sense of total plaque burden based on this study. Look forward to discussing in more detail next visit.”

My next appointment was four months away.

I am 55 years old. I …

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AI is filling a gap doctors have no time for

Home-based cardiac care needs clinical-grade proof

Physician
July 9, 2026

For over 60 years, the hospital has been the epicenter of cardiac care. It made sense: The technology and equipment required to test, treat, and manage patients could only be found within the walls of a clinic, due to both cost and logistical complexity. For decades, the “gold standard” was tethered to the zip code of the nearest medical center.

The disruption of this model over the last five-plus years has …

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Home-based cardiac care needs clinical-grade proof

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Diversity in cardiology is a power problem, not a pipeline

Physician
July 7, 2026

A Black medical student with top board scores applies to cardiology fellowship. She has no research mentor, no letter from a famous cardiologist, and no one to tell her which programs to target. She does not match. The system calls it merit. But was it?

Health inequity is often discussed at the bedside, focusing on access to care, treatment decisions, and clinical outcomes. Yet by the time a patient reaches the …

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Diversity in cardiology is a power problem, not a pipeline

The hidden liability inside continuous patient monitoring

Conditions and Diseases
June 29, 2026

Over time, the medical environment has witnessed several happenings that point to an interesting shift in the way patients are monitored. Of late, patients now wear smartwatches that quietly track heart rate variability and oxygen saturation throughout the day. Others rely on a continuous glucose monitor that sends metabolic data to a smartphone in real time. Someone else sleeps with a ring that records temperature, respiratory rate, and patterns of …

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The hidden liability inside continuous patient monitoring

How to use patient wearable data in cardiology visits

Health Technology
June 21, 2026

A patient handed me his phone in clinic last week. He was 58, a runner, no known cardiovascular disease. “Doc, my WHOOP says my recovery has been in the red for two weeks. Should I be worried?”

Ten years ago, I would have politely deflected and ordered an echo if I felt the visit needed a deliverable. Today, I look at his screen. Because his wearable was telling me something his …

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How to use patient wearable data in cardiology visits

How anchoring bias in medicine missed a heart attack

Conditions and Diseases
June 20, 2026

3 a.m. was the time I witnessed a case that changed the way I think.

He came in complaining of epigastric pain. He had eaten a whole chicken that night, a heavy meal, a simple explanation. The residents in the emergency department, exhausted at the end of a 15-hour shift and overwhelmed by the crowd of patients around them, gave him an IV H2 blocker and left him for monitoring. He …

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How anchoring bias in medicine missed a heart attack

Insurance denial after transplant: Approval isn’t access

Conditions and Diseases
June 7, 2026

I am alive because of a heart transplant.

That heart belonged to a young man in his twenties. His mother is now part of my life. She loves me, worries about me, and carries the unimaginable reality of losing her son while knowing his heart is still beating inside someone else. That “someone else” is me.

Because of that, taking my anti-rejection medication is not optional. It is survival.

For my entire transplant, …

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Insurance denial after transplant: Approval isn’t access

Is anticoagulation bleeding risk worse in the real world?

Medications
June 6, 2026

For decades, the medical community has accepted a foundational principle of cardiovascular care: patients with non-valvular atrial fibrillation (AFib) require aggressive, lifelong stroke prophylaxis. When a patient also presents with stable coronary artery disease (CAD), standard practice has historically gone a step further, layering an antiplatelet such as aspirin on top of an oral anticoagulant such as warfarin or a modern direct oral anticoagulant (DOAC). To frontline hospitalists and patients, …

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Is anticoagulation bleeding risk worse in the real world?

Finding meaning in medicine at a career’s quiet edge

Physician
June 2, 2026

There are experiences that do not ask to be understood right away. They ask to be felt.

On Teshima Island in the Seto Inland Sea of Japan, tucked quietly away from the rhythm of daily life, sits Les Archives du Cœur, The Heart Archive, by Christian Boltanski. It is, in essence, a collection of heartbeats. Thousands of them, recorded, stored, and offered back into the world as sound, light, and memory. …

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Finding meaning in medicine at a career’s quiet edge

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