Cardiology

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.

Denial and rationalization will not save you from a heart attack

Debbie Moore-Black, RN

Conditions and Diseases

October 16, 2019

Smoking was cool. And he started smoking at the age of 15. Two packs a day — every day.

When he was 32 years old, we had our first-born son. And he decided to quit cold turkey.

But the damage was done.

Somehow, someway, it would catch up with him in devastating ways.

By the time my husband was 66 years old, he developed shortness of breath and chest pain. With exertion and without …

A cardiologist’s take on red meat consumption

Anthony Pearson, MD

Conditions and Diseases

October 13, 2019

The Skeptical Cardiologist was recently greeted by headlines announcing that an international panel of 14 unbiased researchers had concluded that it was OK for humans to continue eating red meat and processed meat at current levels.

The startling news was a reversal of what the Dietary Guidelines for Americans, the American Heart Association, and the American Cancer Society …

How physician burnout hurts patients

Natalia Usoltseva, MD

Physician

October 9, 2019

On Saturday morning at the breakfast table surrounded by my husband and kids, I suddenly felt chest pain, palpitations, and was about to collapse. Being an internist, I knew it: arrhythmia. Paramedics at arrival confirmed it. I was running ventricular tachycardia.

Out of the chaos surrounding me at that moment, my physician’s brain assessed the situation: “VT. Serious arrhythmia.”

After that, I lost it. I became a scared-to-death patient who has a …

Read more…

How physician burnout hurts patients

What it means to be an attending physician

Mary Braun, MD

Physician

October 4, 2019

Dr. Ryme had been retired at least thirty years from medicine when he met me, his last pupil. I was a freshly minted doctor, and he became the first teacher of a new course at my new school called “Life as an Independent Doctor.”

At our first office visit, after telling me his life story, he quizzed me, “And furthermore, Dr. Braun, you’re an attending physician now. You are no longer …

Being on the stretcher instead of beside it changed this nurse

Susan Bartlett, RN

Patient

October 1, 2019

Lying in a hospital bed while awaiting heart surgery, I looked at my teen daughter and my parents, then smugly pointed out the irregular slashes on the cardiac monitor.

“See these?” I said. “They’re called PVCs. My doctor is going to fix them. Make them all go away.”

The asymmetrical rhythm, a frequent and annoying pattern of multiple skipped heartbeats, had plagued me for the last three years, despite my swearing off …

Artificial intelligence in medicine raises legal and ethical concerns

Sharona Hoffman, JD

Health Technology

September 29, 2019

The use of artificial intelligence in medicine is generating great excitement and hope for treatment advances.

AI generally refers to computers’ ability to mimic human intelligence and to learn. For example, by using machine learning, scientists are working to develop algorithms that will help them make decisions about cancer treatment. They hope that computers will be able to analyze …

It’s time for AI-enabled solutions in health care to live up to their buzz

Chris DeRienzo, MD

Health Technology

September 24, 2019

Artificial intelligence is incredibly buzzy in health care right now, and for a good reason. Other industries are already experiencing AI-enabled radical transformations, like real-time fraud monitoring and detection in banking and finance and instantaneous image recognition across the web and social media. Health care now stands similarly positioned to capitalize on the transformative power of machine learning, and the massive potential is driving levels of investment expected to Read more…

It’s time for AI-enabled solutions in health care to live up to their buzz

It’s OK if doctors can’t memorize everything

David Mann, MD

Health Technology

September 22, 2019

The storage capacity of the human mind is amazing. One estimate of the size of the brain’s “RAM” is as high as 2.5 petabytes (a million gigabytes). The number is based on the total number of neurons in the brain and the total number of possible connections per neuron. I suspect it is an overestimate, given the vagaries and innate inefficiency of biological systems. Nevertheless, the true figure …

MKSAP: 52-year-old woman with chest pressure

mksap

Conditions and Diseases

September 20, 2019

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 52-year-old woman is evaluated for a 6-week history of chest pressure. The symptom occurs when she walks up an incline on her daily 2-mile walk and is relieved with rest. She also had chest pressure during a stressful meeting at work last week. She reports no associated symptoms. …

A primary care physician’s decisions are questioned and second-guessed daily

Steven Reznick, MD

Physician

September 3, 2019

A 67-year-old woman with a high-stress job had a vigorous disagreement with her neighbors last week. She developed severe substernal chest pain and called 911 fearing a heart attack. She is thin, has never smoked, has normal blood pressure and normal cholesterol. She is not a diabetic and runs on a treadmill for two hours at five miles per hour with an elevation for two hours four times a week. …

Can the cardiac risk of red meat be measured? And is it useful?

Steven Reznick, MD

Conditions and Diseases

August 20, 2019

Prevention of heart disease has centered on smoking cessation, controlling blood pressure, achieving an appropriate weight, regular exercise, control of blood sugar, and control of your cholesterol. Despite addressing and controlling these items, individuals still have heart attacks and strokes and vascular events. Researchers are now directing their attention to a dietary metabolite of red meat called trimethlamine N-oxide or TMAO.

Recent peer-reviewed and published studies have shown …

The limitations of artificial intelligence in cardiology

Sherry-Ann Brown, MD, PhD

Health Technology

August 11, 2019

Artificial intelligence (#AI) seems to be all the rage these days, as it should be, given its potential to revolutionize medicine in many ways. #AI is actually already an integral part of many of our lives on Google, Amazon, Facebook, and other sites. Siri and Alexa use #AI too, so we can’t easily escape it. Why would we want to?

Of course, one concern about the algorithms is that they often …

What are patients’ responsibilities for their health?

Anonymous

Conditions and Diseases

August 11, 2019

I expect my patients to develop or sense responsibility in connection to their health because I believe personal responsibility creates the basis for a constructive, therapeutic relationship and healing process.

My experiences as a patient have made me understand how difficult it can be to maintain a sense of responsibility. I often yearn for clarity and a “gameplan,” but instead find myself confronted with medical guideline gray areas and conflicting treatment …

The importance of patient education before surgery

Steven Young, MD and Joseph Answine, MD

Conditions and Diseases

August 6, 2019

A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.

For years, research and common belief have supported the concept that patient education alters patient behavior and improves patient outcomes. For instance, lifestyle changes, implemented after improved physician-patient engagement and education, have demonstrated clinical benefits in a wide range of chronic illnesses, …

UpToDate? Information my cardiologists didn’t have.

Anonymous

Conditions and Diseases

August 4, 2019

I have always felt lucky and relieved when a cardiologist told me I seemed to be fine despite my heart condition. My condition, referred to as congenital, complete AV block, is estimated to affect between 1 in 15,000 to 22,000 live-born infants. The electrical block is more commonly seen among older, adult patients where it presents an acute pacemaker indication.

Researchers do not know very much about what causes the condition …

When should physicians read the House of God?

Paul Sax, MD

Physician

August 2, 2019

Many consider the novel the House of God, written by Samuel Shem (pen name for Stephen Bergman), to be a must-read for any physician or soon-to-be physician. A fictionalized account of his internship year, the book details how the accumulated stress, fatigue, and powerlessness of being a first-year doctor inexorably accumulates during that year — with sometimes hilarious, and but also disastrous, results.

The survival strategies of the interns in …

MKSAP: 69-year-old man with chest pressure and dyspnea

mksap

Conditions and Diseases

July 6, 2019

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 69-year-old man is evaluated during a follow-up visit. He initially presented with a 3-month history of chest pressure and dyspnea that occurred primarily with exertion. Despite maximal medical therapy, his symptoms have not abated and adversely affect his quality of life. Medical history is significant for type 2 …

The tension between guidelines and individualized treatment

Steven Reznick, MD

Physician

July 1, 2019

I recently read an article in a peer-reviewed journal citing the benefits of a few eggs per week as part of a low carbohydrate dietary intervention for Type 2 diabetes. The information was so meaningful about a controversial food source of protein that I decided to write about it in my blog and pass it along to my patients. Three days later the American Heart Association and American College of …

Don’t ask caregivers to be data entry clerks for the Joint Commission

Steven Reznick, MD

Physician

June 27, 2019

I received an email from our hospital accreditation coordinator/quality coordinator in a manner that wasn’t clear if it was directed to me personally or if it was sent to the entire medical staff. It said that she was reviewing the Joint Commission’s recent survey which found that the charts did a poor job of reflecting the patient’s “code status.” The institution only received a 40 percent rating.

Some patients were listed …

A lack of understanding for what physicians really do

Robert J. Wagner, MD

Physician

June 25, 2019

I recently had the pleasure of participating in an administrative law judge (ALJ) hearing. Novitas, the Medicare administrative contractor had denied the E/M code 99291, critical care.

The case was appealed to the qualified independent contractor, who also believed that the care, in this case, did not meet the CMS and CPT definitions of critical care. Subsequently, the case was appealed to the administrative law judge. The encounter occurred in an …

Cardiology

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