Heart and cardiology

1,642 articles · Since 2004

Articles, page 26

How my cardiology practice changed with a click

February 13, 2016Feb 13, 20162

I was a bit nervous as I had never done this before. I wasn’t even sure what I was going to do once I saw him. The only certainty in my mind at that time was that this was not…

I was a bit nervous as I had never done this before. I wasn’t even sure what I was going to do once I saw him. The only certainty in my mind at that time was that this was not the Norman Rockwell image of the physician-patient encounter that I proudly displayed in my office. He was my age, 40 years old, living on Nantucket with his wife and two …

Physician voices

Will cardiologists become slow and methodical internists again?

Hans Duvefelt, MD

February 10, 2016Feb 10, 20162

When I started my first internship, back in Sweden in 1979, I worked under a fifty-something cardiologist who spoke slowly with a southern drawl -- yes, there is a southern drawl there, too, slightly reminiscent of Danish, spoken not far…

When I started my first internship, back in Sweden in 1979, I worked under a fifty-something cardiologist who spoke slowly with a southern drawl — yes, there is a southern drawl there, too, slightly reminiscent of Danish, spoken not far from where my supervisor grew up.

He epitomized the old school of cardiology, before it became a procedural specialty. He diagnosed heart murmurs by auscultation with his stethoscope, and he even …

Conditions and diseases

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

Val Jones, MD

February 3, 2016Feb 3, 20163

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 …

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Conditions and diseases

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

mksap

January 30, 2016Jan 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.…

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 …

Physician voices

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

Chiduzie Madubata, MD

January 12, 2016Jan 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 …

Physician voices

These are the moments why we practice medicine

Tara F. Bishop, MD, MPH

January 6, 2016Jan 6, 20162

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 …

Conditions and diseases

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

mksap

January 2, 2016Jan 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…

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 …

Physician voices

Why this specialist went to a direct patient care model

Joel Kahn, MD

November 26, 2015Nov 26, 20159

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 …

Conditions and diseases

A physician’s personal experience with evidence-based medicine

Chad Hayes, MD

November 24, 2015Nov 24, 20153

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), …

Health technology

Technology in health care requires context

Howard Luks, MD

November 15, 2015Nov 15, 20152

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.…

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 …

Conditions and diseases

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

mksap

November 14, 2015Nov 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…

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, …

Conditions and diseases

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

Rocky Bilhartz, MD

November 5, 2015Nov 5, 201512

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…

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 …

Physician voices

An episode of low-value care delivered to my father

Victor Lee, MD

October 30, 2015Oct 30, 201523

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…

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

Patient voices

Choosing the right cardiologist takes longer than you think

Raymond Abbott

October 25, 2015Oct 25, 201511

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…

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. …

Physician voices

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

Sharon Bahrych, PA-C, MPH

October 8, 2015Oct 8, 201594

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…

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

Physician voices

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

Carol E. Gunn, MD

October 6, 2015Oct 6, 201527

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 …

Drugs and prescribing

Find a cost-effective way for drug companies to innovate

Kevin R. Campbell, MD

October 3, 2015Oct 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 …

Conditions and diseases

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

mksap

October 3, 2015Oct 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…

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 …

Conditions and diseases

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

mksap

September 19, 2015Sep 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…

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 …

Conditions and diseases

All actors should have to take a CPR class

Caroline Tredway, MD

September 13, 2015Sep 13, 201510

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?” …

Heart and cardiology

Articles, page 26

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