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.

Physicians: Sometimes it’s not what you say, but how you say it

Val Jones, MD

Conditions and Diseases

February 3, 2016

Most physicians will be thrust into the role of patient or caregiver at some point during their careers. Unfortunately, it’s not until this occurs that many become fully aware of the finer points of excellent care and communication. Take, for example, the simple act of reporting test results to a patient. We do this every day, but may not realize that how we frame the information is as important as …

MKSAP: 59-year-old woman with continued substernal chest pain

mksap

Conditions and Diseases

January 30, 2016

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

A 59-year-old woman is evaluated for continued substernal chest pain. She presented with exertional chest pain 6 months ago that occurred with minimal ambulation. She was evaluated with a stress nuclear medicine myocardial perfusion study that showed no ST-segment changes but a small area of inducible ischemia in the lateral area of the left ventricle …

Miracles are happening in medicine. We just need to learn to recognize them.

Chiduzie Madubata, MD

Physician

January 12, 2016

A few months ago, I came across a young man who had come in with increasing fatigue and shortness of breath that was limiting his quality of life. As a barber, he looked forward to cutting hair and talking with his clients about the events that were happening in their lives. On the surface, it appeared that things were going well for him overall, but people were not aware that …

These are the moments why we practice medicine

Tara F. Bishop, MD, MPH

Physician

January 6, 2016

When I was a new attending, an older man came to see me as a new patient. He had not seen a doctor in over thirty years and was experiencing worsening chest pain that first occurred when he walked upstairs but had progressed to pain at rest. An electrocardiogram in the office showed signs of ischemia, and I advised him that I wanted to call an ambulance to take him …

MKSAP: 48-year-old man with newly diagnosed hypertension

mksap

Conditions and Diseases

January 2, 2016

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

A 48-year-old man with newly diagnosed hypertension is referred for an echocardiogram to assess findings of left ventricular hypertrophy noted on the electrocardiogram. He is asymptomatic, and his medical history is unremarkable other than hypertension. His only medication is chlorthalidone.

On physical examination, blood pressure is 128/70 mm Hg, pulse rate is 60/min and regular, and …

Why this specialist went to a direct patient care model

Joel Kahn, MD

Physician

November 26, 2015

September first was a big day for me. After over 25 years of practicing invasive cardiology, I sent an affidavit to CMS to indicate for the next two years I was opting out of their insurance program. As of October first, I have begun accepting patients on a direct patient care (DPC) model that will not involve insurers, ICD-10, or billing fees. Why would a specialist consider this dramatic move?

Practice enjoyment …

A physician’s personal experience with evidence-based medicine

Chad Hayes, MD

Conditions and Diseases

November 24, 2015

It’s no secret that I have a special place in my electronically-regulated heart for evidence. There’s a good reason for that. Our primary job as physicians is to avoid harming our patients, but it’s followed closely by our calling to help them in some way. The problem is that, until we test our theories, we don’t really know which treatments will help our patients (or which ones might harm them), …

Technology in health care requires context

Howard Luks, MD

Health Technology

November 15, 2015

Robert was the picture of health. He had run eight marathons and finished countless 5K and 10K races. He tracked everything from sleep to food intake, logging his exercise parameters religiously.

A seven-minute mile was a routine workout for Robert. But over the course of a few days, he noticed that he felt more winded during his run. One morning, when he awoke and checked his heart rate variability (HRV), it …

Test your medicine knowledge: 62-year-old man is evaluated during a routine visit

mksap

Conditions and Diseases

November 14, 2015

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 mm Hg, …

Is routine home blood pressure monitoring really such a good idea?

Rocky Bilhartz, MD

Conditions and Diseases

November 5, 2015

It has occurred to me that this is a terrible idea.

In fact, it’s possibly the least beneficial thing for the general health of a population to have gained momentum in recent years. I’m not discussing cigarettes or e-cigarettes or low-yield cancer screening procedures. I’m not talking about diet drinks or sugary drinks.

I’m talking about home blood pressure monitoring.

It’s a terrible idea.

OK, I get it. The idea sounds benign. Buy your own …

An episode of low-value care delivered to my father

Victor Lee, MD

Physician

October 30, 2015

My father recently visited his internist with complaints of vague chest symptoms and was referred to a cardiologist who recommended coronary CT, ultrasonography, and angiography. A cardiac workup would seem to be a reasonable course of action given that he has a history of coronary artery disease (CAD) with prior angioplasty.

However, upon further exploration, I felt that his chest symptoms were due to stress and were not of cardiac origin. …

Choosing the right cardiologist takes longer than you think

Raymond Abbott

Patient

October 25, 2015

After having an echocardiogram recently, I saw a cardiologist, which seemed the prudent thing to do. I was not symptomatic, and I think the echo was pretty much unremarkable — to use a bit of doctor’s lingo. I saw the word “mild” here and there in the report describing processes of my heart’s functions. When you’re over seventy-three, “mild” sounds pretty all right. Better than the word “acute,” I figure. …

A patient turns down hypertension treatment. What happens next is tragic.

Sharon Bahrych, PA-C, MPH

Physician

October 8, 2015

I have previously written about a patient on this site: “How elderly patients can be stubborn to their own detriment.” In that post, I discussed how the patient repeatedly turned down appropriate therapy for her hypertension, saying she didn’t need the help. Now I’m writing an update.

Due to the patient’s refusal to accept treatment for her hypertension, despite counseling on the part of her cardiologist and primary care …

It’s time for health care to stand up to medical errors. Will we?

Carol E. Gunn, MD

Physician

October 6, 2015

It’s been over a year since my older sister Anna died, so I choke up less readily while speaking about it. The raw anger is less, but the frustration of losing someone to a preventable medical mistake will always remain with me. Anna was five years older than me, my only sister, and the one I often turned to for advice. We were close despite living 600+ miles apart. She …

Find a cost-effective way for drug companies to innovate

Kevin R. Campbell, MD

Medications

October 3, 2015

Recently, two significant pharmaceutical breakthroughs have resulted in a renewed debate about the costs of drug therapy. In the last year, a new drug class for the treatment of hepatitis C has been released by two different manufacturers and has been found to cure a once incurable chronic liver disease for nearly 90 percent of patients who are treated with a full course of therapy. The drug appears to be …

Test your medicine knowledge: 58-year-old man with type 2 diabetes

mksap

Conditions and Diseases

October 3, 2015

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

A 58-year-old man is evaluated during a routine appointment. He is asymptomatic. He was diagnosed with type 2 diabetes mellitus 4 years ago and has hypertension, dyslipidemia, and obesity. His medications are enteric-coated low-dose aspirin, lisinopril, fluvastatin (20 mg/d), and metformin.

His calculated 10-year risk of atherosclerotic cardiovascular disease (ASCVD) using the Pooled Cohort Equations is …

Test your medicine knowledge: 33-year-old woman with atrial fibrillation

mksap

Conditions and Diseases

September 19, 2015

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

A 33-year-old woman is evaluated as an outpatient following an episode of atrial fibrillation. The episode resolved shortly after she arrived at the emergency department. She has a history of tetralogy of Fallot with repair performed at the age of 4 years.

On physical examination, blood pressure is 110/70 mm Hg, pulse rate is 62/min and …

All actors should have to take a CPR class

Caroline Tredway, MD

Conditions and Diseases

September 13, 2015

The doctor sprinted to the side of the bed and slapped her interlaced hands over the man’s heart. What made his heart stop remained a mystery, but she knew she had to get it beating again. She pushed her hands into his chest, an internal metronome pacing her efforts. After every few pumps, she glanced up at the cardiac monitor. Still no pulse.

“Well, it’s obvious why he’s dying, isn’t it?” …

The price of certainty in the ICU

Tom Peteet, MD, MPH, MEd

Physician

August 19, 2015

Mr. J was as close to a typical sixty-year-old patient as possible, wary of doctors and selective in when he took his blood pressure medications. On a sunny Thursday, he woke up nauseated and called an ambulance. During evaluation in the emergency room, his blood pressures reached atmospheric levels (nearly 300 systolic). He began seizing, which soon stopped and was transferred to the ICU. As the admitting resident, I dutifully …

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The price of certainty in the ICU

OTC Lipitor? Why Pfizer made the right decision for the wrong reason.

Ira Nash, MD

Medications

August 15, 2015

There were several news stories recently that reported that Pfizer had abandoned its efforts to have its Lipitor brand of atorvastatin made available over the counter (OTC), without a prescription. I was never a big fan of OTC statins, but I was struck by the reason that Pfizer put out:

The study did not meet its primary objectives of demonstrating patient compliance with the direction to check their low-density lipoprotein cholesterol …

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OTC Lipitor? Why Pfizer made the right decision for the wrong reason.