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.

My story isn’t Serena Williams’ story, but some things sound the same

Diana Cejas, MD

Conditions and Diseases

August 16, 2018

I’m not much of a tennis fan, but I am a fan of Serena Williams. Who wouldn’t be after hearing her story? Her rise to the upper echelon of athletics was remarkable, and her longevity is incomparable. All the while, she has challenged the sporting world’s notions about who and what an elite tennis player is supposed to be. I watched her interviews after this year’s Wimbledon finals and was …

The many ways to describe chest pain

Hans Duvefelt, MD

Conditions and Diseases

August 15, 2018

There are at least 50 words in the Eskimo languages for snow, 25 in mainstream Swedish, and supposedly 180 or so in the Sami language of the nomadic inhabitants of the northernmost parts of Norway, Sweden, and Finland.

But there are even more words than that for “chest pain” among my patients, many of whom do not consistently or fully comprehend the English phrase, “If you have chest pain, call 911 …

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The many ways to describe chest pain

Changing the treatment plan when covering for another doctor

Hans Duvefelt, MD

Physician

August 8, 2018

I was a little taken aback when Dr. C. changed my patient from warfarin to one of the novel anticoagulants. And one I seldom use, at that.

I have only worked with her for about three years, and we seem to come from the same mold: seasoned family docs with a penchant for teaching and patient empowerment. I had not imagined she would step in and completely change my treatment plan …

How to improve the care of in-flight emergencies

Janice Boughton, MD

Conditions and Diseases

August 8, 2018

“If there is a physician on the plane, please press your call light!”

The vast majority of doctors who have flown on airplanes have heard this, and most of us are willing, if not entirely eager, to respond. What follows is usually a far from ideal encounter with inadequate information, too much noise, a cramped space to work in and little knowledge of what is expected or even possible.

My experiences (I …

3 steps for doctors who are grieving

Michelle M. Kittleson, MD

Physician

July 26, 2018

As an advanced heart failure and transplant cardiologist, I witness plenty of tragedy. But I don’t lay awake at night anymore grieving bad outcomes — that is the privilege and purview of loved ones. While family and friends may move through Elizabeth Kubler-Ross’ classic stages of grief, doctors do not have that luxury. To give tragedies a purpose, I take three steps when faced with bad outcomes: Separate fault from …

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3 steps for doctors who are grieving

Guidelines, multiple specialists, and the science versus the art of medicine

Steven Reznick, MD

Physician

July 16, 2018

My 80-year-old patient presented with symptoms and signs of kidney failure. I hospitalized him and asked for the assistance of a kidney specialist. We notified his heart specialist as a courtesy. A complicated evaluation led to a diagnosis of an unusual vasculitis with the patient’s immune system attacking his kidney as if it was a foreign toxic invader.

Treatment, post kidney biopsy, involved administering large doses of corticosteroids followed by a …

MKSAP: 68-year-old man with heart failure

mksap

Conditions and Diseases

July 7, 2018

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

A 68-year-old man is evaluated at a follow-up appointment. He has a 7-year history of heart failure secondary to ischemic cardiomyopathy. Over the past 6 months, he has had three hospitalizations for exacerbations of his heart failure. He currently has exertional dyspnea while getting dressed, and his maximal activity level is limited to riding to …

MKSAP: 70-year-old man with a transient ischemic attack

mksap

Conditions and Diseases

June 30, 2018

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

A 70-year-old man is admitted to the hospital with a 1-hour episode of left arm and left leg weakness. He is diagnosed with a transient ischemic attack. The patient has a history of hypertension and type 2 diabetes mellitus and a 30-pack-year history of smoking. Family history is noncontributory. His medications are metformin and lisinopril.

On …

Is the stethoscope a vestigial organ?

Michelle M. Kittleson, MD

Physician

June 21, 2018

In the context of human evolution, a vestigial organ is defined as one that has lost all or most of its original function through evolution. Charles Darwin provided a list of vestigial human organs in “The Descent of Man,” including the muscles of the ear, wisdom teeth, the appendix, the coccyx, body hair and the semilunar fold in the corner of the eye. If you had told me 19 years …

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Is the stethoscope a vestigial organ?

Health misinformation in the news: Where does it start?

Joy Victory

Conditions and Diseases

June 20, 2018

A new study confirms something we here at HealthNewsReview.org have been emphasizing for many years: Health news stories often overstate the evidence from a new study, inaccurately claiming that one thing causes another — as in drinking alcohol might help you live longer, facial exercises may keep your cheeks perky, and that diet soda might be a direct line to dementia.

The researchers looked at the 50 “most-shared academic articles and media articles covering them” in …

Life as a doctor is selfless and selfish at the same time

Farah Karipineni, MD, MPH

Physician

June 20, 2018

It was 5:45 in the morning on a Monday after a full weekend of call. Thoroughly exhausted, I shuffled into the elevator and was met by the stench of stale clothing mixed with cigarette smoke. A painfully thin teenager exited, looking lost. I allowed him to wander out, grateful to be spared his odor. I was apathetic, overtaken by a weariness I vowed as a medical student never to have.

Morning …

Mindfulness is not the answer for burnout

Joy Liu, MD

Physician

June 5, 2018

When I was an intern on the cardiology service, I rarely left before 10 p.m. Call days were longer. One day in the workroom, I noticed my co-intern sniffling as she typed progress notes. Her eyes were red. “Are you OK?” I asked.

She said, “I just cried in the bathroom for about ten minutes. It’s nothing bad; it’s just … I’m so tired. Do you ever feel so tired you …

A doctor cries therapeutic tears with her patient

Cindy Winebrenner, MD

Physician

May 19, 2018

He wasn’t particularly likable upon first encounter. He wasn’t apt to answer questions asked. He had a long pause and a long drawl and a tangential, winded story — and backstory — all of which he was bound and determined to tell to its detailed completion. With an irregular heart rate in the 170s and a respiratory rate in the 30s, I tried to steer him in the direction of …

I’m retiring my first stethoscope

Matthew Bowdish, MD

Physician

April 26, 2018

I retired my first stethoscope today. I bought my Littmann Cardiology III during my first term of medical school in 1999. It came with a penlight, otoscope, ophthalmoscope, manual blood pressure cuff, tuning forks and reflex hammer, all contained within a traditional black leather physician’s bag with my initials in gold. Receiving your medical student diagnostic kit is one of the rites …

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I’m retiring my first stethoscope

Benefit vs. social responsibility: a profound ethical dilemma in medicine today

Hans Duvefelt, MD

Health Policy

April 22, 2018

Brilinta, at $6.50 per pill, twice a day, reduces cardiovascular events more than generic Plavix, which costs 50 cents per pill, once a day. But only a little: 20% relative or 2% absolute risk reduction. The event risk was 10% with the more expensive drug and 12% with the one that costs 82% less.

Put differently, if 100 patients were treated with Brilinta for a year, at a cost …

MKSAP: 62-year-old man is evaluated during a routine visit

mksap

Conditions and Diseases

April 21, 2018

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

A 62-year-old man is evaluated during a routine visit. He is asymptomatic and walks 1 mile most days of the week. Medical history is significant for aortic stenosis, type 2 diabetes mellitus, hypertension, and hyperlipidemia. Medications are aspirin, metformin, lisinopril, metoprolol, and rosuvastatin.

On physical examination, the patient is afebrile, blood pressure is 130/66 …

Death in the cardiac ICU

Adela Wu

Medical Education

April 6, 2018

Death is on our floor. It has been there for far longer than I have.

On my first day in the cardiac surgery ICU, I was running late. I hurried past the dimly-lit rooms, their monitors regularly chiming their final lullabies of the night before the receptionist brightly greets the morning shift nurses and flips on all the fluorescent lights outside the twenty rooms on this floor at 7:00 a.m. sharp.

There …

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Death in the cardiac ICU

Crippling drug costs: the role of insurers

Janice Boughton, MD

Medications

March 27, 2018

Drug costs in the U.S. are higher than in in any other industrialized country in the world. Our cost for an insulin glargine (long-acting insulin) pen is $76.80 and in Canada, so very few miles away, it costs $19.60. The latter price is reasonable. The former price can make the difference between being able to afford a life-saving drug and dying. It is illegal, however, for a U.S. citizen to …

The public’s unrealistic expectations about CPR

Skeptical Scalpel, MD

Physician

March 19, 2018

A survey of 1,000 volunteer adults found 71% regularly watched medical television dramas, but only 12% said the shows “were a reliable source of health information.”

The participants were given some brief vignettes describing scenarios where CPR was administered: a 54-year-old who suffered a heart attack at home and received CPR by paramedics, an 80-year-old with a postoperative cardiac arrest in the hospital after surgery, and a post-traumatic arrest in an …

A patient becomes a medical student

Dr. Vivek Podder

Medical Education

March 8, 2018

I was a four-year-old kid when I was about to begin my first day of school. I was born and raised 20 kilometers away from the big city in a small rural area with minimal essential amenities — schools, roads, and hospitals. Like all other kids, it was a momentous occasion for me to start my first day of school, and I remember how exciting it was.

As I started to …

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A patient becomes a medical student