Heart and cardiology

1,642 articles · Since 2004

Articles, page 27

The price of certainty in the ICU

August 19, 2015Aug 19, 20153

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

Drugs and prescribing

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

Ira Nash, MD

August 15, 2015Aug 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…

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

…

Drugs and prescribing

Do proton pump inhibitors cause heart attacks?

Frederick Gandolfo, MD

July 18, 2015Jul 18, 2015

There has been concern for several years about commonly prescribed antacid drugs called proton pump inhibitors (PPIs) and the heart. PPIs are used to treat gastroesophageal reflux disease (GERD), peptic ulcer disease, and other acid-related diseases. Common drugs in the PPI class are omeprazole (Prilosec), esomeprazole (Nexium), pantoprazole (Protonix), lansoprazole (Prevacid), and dexlansoprazole (Dexilant), among others.

Specifically, there is a potential interaction …

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Conditions and diseases

Test your medicine knowledge: 60-year-old asymptomatic man

mksap

July 18, 2015Jul 18, 2015

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 60-year-old asymptomatic man is evaluated during a routine examination. He has a long history of heart murmur. With normal daily activities, he has…

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

A 60-year-old asymptomatic man is evaluated during a routine examination. He has a long history of heart murmur. With normal daily activities, he has not experienced shortness of breath, chest discomfort, or palpitations.

Blood pressure is 138/78 mm Hg, pulse rate is 82/min and regular, and respiration rate is 16/min. BMI is 27. …

Conditions and diseases

Looking back on a life teaching CPR

Rob Burnside

July 2, 2015Jul 2, 201515

"Turn out the light, the party's over," sang color commentator Dandy Don Meredith on ABC's Monday Night Football when a seminal fourth quarter play occurred and the game was suddenly in the bag. For me, that's where it's at right…

“Turn out the light, the party’s over,” sang color commentator Dandy Don Meredith on ABC’s Monday Night Football when a seminal fourth quarter play occurred and the game was suddenly in the bag. For me, that’s where it’s at right now — just a few ticks of the clock away

First, for the American Heart Association then for the American Red Cross, …

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Looking back on a life teaching CPR

Health technology

Heart surgery in Silicon Valley: The future is already here

Barb Dehn, NP, RN

June 30, 2015Jun 30, 2015

Here is a behind-the-scenes peek into an operating room in the midst of Silicon Valley. Here, routinely there is a groundbreaking intersection of technology and medicine that's blurring the lines between what's possible today and what you'll come to expect…

Here is a behind-the-scenes peek into an operating room in the midst of Silicon Valley.

Here, routinely there is a groundbreaking intersection of technology and medicine that’s blurring the lines between what’s possible today and what you’ll come to expect as routine in the future.

Imagine two experienced surgeons working side by side to replace a calcified, stenotic and tired aortic valve within a man’s heart without ever having to cut into …

Conditions and diseases

The problems with a low salt diet

Edwin Leap, MD

June 3, 2015Jun 3, 20157

One of my favorite physician sayings is, "Don’t just do something, stand there!" Which means that it’s better to do nothing than to do something that doesn’t help. As I move through my career, I find myself agreeing. I am…

One of my favorite physician sayings is, “Don’t just do something, stand there!” Which means that it’s better to do nothing than to do something that doesn’t help. As I move through my career, I find myself agreeing. I am endlessly amazed at the number of things we do for no good reason, and that patients come to expect, also for …

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The problems with a low salt diet

Patient voices

You’re taking my blood pressure wrong. Listen to this patient.

Raymond Abbott

May 27, 2015May 27, 201540

I went to the doctor yesterday, my semi-annual visit, as it were. These days I see a nurse practitioner, a woman. Recently, she and the practice she is a part of moved into a renovated building, state-of-the-art, they are calling it. It almost sparkles in its newness. The practice is owned by one of the large hospital corporations in our city.

See …

Physician voices

A powerful reminder of medicine’s humbling nature

Chiduzie Madubata, MD

May 27, 2015May 27, 2015

“A thousand times we die in one life. We crumble, break and tear apart until the layers of illusion are burned away, and all that is left, is the truth of who and what we really are.” The coronary care…

“A thousand times we die in one life. We crumble, break and tear apart until the layers of illusion are burned away, and all that is left, is the truth of who and what we really are.”

The coronary care unit (CCU) rotation is a unique place. Postoperative cardiothoracic surgery patients among many other pathologies from heart failure to heart transplant fill the unit, and it is the job of the …

Conditions and diseases

Resistant hypertension? Or failure to take blood pressure correctly?

Janice Boughton, MD

April 30, 2015Apr 30, 20159

I recently read a discussion by three hypertension specialists, Drs. Jan Basile, Dominic Sica and David Kountz, on how to treat resistant hypertension. Resistant hypertension is blood pressure that remains above goal despite treatment with three drugs, from different classes, one of which must be a diuretic. 10 to 15 percent of patients with high blood pressure will have resistant hypertension. These are the people who always seem to have …

Physician voices

Stay away from doctors: From a patient who listens

Hans Duvefelt, MD

April 26, 2015Apr 26, 201521

Earnest Tipp was very overdue for his blood pressure follow-up. Almost a year and a half overdue, as a matter of fact. The last few times I had refilled his medications, I had added “needs follow-up” to the signum on…

The other day I finally saw him in my schedule. I thought about him all morning. A tall, muscular 90-year …

Conditions and diseases

MKSAP: 38-year-old pregnant woman with hypertension and diabetes

mksap

April 26, 2015Apr 26, 2015

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 38-year-old woman is evaluated during a follow-up visit. She has a history of well-controlled hypertension and type 1 diabetes mellitus. She is at…

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

A 38-year-old woman is evaluated during a follow-up visit. She has a history of well-controlled hypertension and type 1 diabetes mellitus. She is at 16 weeks’ gestation with her first pregnancy. Prior to conception she was taking lisinopril, which was discontinued in anticipation of the pregnancy, and labetalol was initiated. Other medications …

Physician voices

The day that I truly became a cardiology fellow

Chiduzie Madubata, MD

March 24, 2015Mar 24, 2015

As a fellow in cardiology, you sign up to be part of a specialty that can involve emergencies. As a first-year fellow, usually you are running things by other senior fellows and attendings, and typically you are not the first…

As a fellow in cardiology, you sign up to be part of a specialty that can involve emergencies.

As a first-year fellow, usually you are running things by other senior fellows and attendings, and typically you are not the first person to make a decision on a plan. At times, though, there can be an exception to that rule, and it is …

Conditions and diseases

Are cardiac risk calculators accurate?

Kenneth Lin, MD

March 23, 2015Mar 23, 2015

After more than a decade of titrating medications to low density lipoprotein cholesterol targets, family physicians who have transitioned to the 2013 American College of Cardiology / American Heart Association cholesterol treatment guideline now base treatment decisions on a patient’s estimated 10-year risk for a cardiovascular event. Although it endorsed the ACC/AHA guideline last year, the American Academy of Family Physicians expressed concern that the guideline’s new risk calculator had not been validated in …

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Are cardiac risk calculators accurate?

Physician voices

What this patient needs for a normal blood pressure

Hans Duvefelt, MD

March 22, 2015Mar 22, 20157

Dwight Frost had all the risk factors, plus he had already had a stroke several years ago. His blood sugars were too high, his lipid profile was near the top of the class, he still smoked a cigar now and then, and his blood pressure hovered around 200. He also seemed a little vague about which medications he actually took and which ones he didn’t.

He spoke rapidly with a slight …

Drugs and prescribing

We are overprescribing statin medications for high cholesterol. Here’s why.

Richard Young, MD

March 16, 2015Mar 16, 20159

The American Heart Association (AHA) recently proposed new guidelines for all doctors to screen and treat for high cholesterol. For doctors and patients to follow, this would result in a large increase in the number of Americans taking statins. One…

One of the things I like about the new proposal is that there is no more chasing a number. This was frustrating for doctors and patients to keep having lab draws and medication …

Physician voices

Waiting for problems to become emergencies is terribly expensive

Rob Lamberts, MD

March 12, 2015Mar 12, 20158

"I've been getting winded lately." He's a middle-aged man with diabetes. This kind of thing is a "red flag" on certain patients. He's one of those patients. "When does it happen?" I ask. "Just when I do things. If I…

“I’ve been getting winded lately.”

He’s a middle-aged man with diabetes. This kind of thing is a “red flag” on certain patients. He’s one of those patients.

“When does it happen?” I ask.

“Just when I do things. If I rest for a few minutes, I feel better.”

Now the red flag is waving vigorously. It sounds like it could be exertional angina. In a diabetic, the symptoms of ischemia (the heart not getting …

Medical education

What does it take to collaborate in health care? Here are 3 ideas.

Kevin R. Campbell, MD

March 11, 2015Mar 11, 20152

Recently, I had the honor and pleasure of introducing my book, Women and Cardiovascular Disease, in London. During the event, I was able to meet with many of my European colleagues from both the media as well as the health care space. I spoke with countless bright and motivated attendees who are excited to be part of a wave of change in cardiac care for women. We identified many ways …

Conditions and diseases

MKSAP: 21-year-old male student is evaluated for a murmur

mksap

March 8, 2015Mar 8, 2015

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 21-year-old male student is evaluated for a murmur heard during an athletic preparticipation physical examination. He is asymptomatic. His medical and family history…

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

A 21-year-old male student is evaluated for a murmur heard during an athletic preparticipation physical examination. He is asymptomatic. His medical and family history is unremarkable and he takes no medications.

On physical examination, the patient is afebrile, blood pressure is 118/76 mm Hg, pulse rate is 68/min, and respiration rate is 14/min. …

Conditions and diseases

4 things this doctor learned after his heart stopped beating

Chad Hayes, MD

February 26, 2015Feb 26, 20153

I sometimes think doctors forget what it’s like to be patients. But I’ve been there, and I know how frustrating and scary it can be. I remember one night, I was lying in a hospital bed, resting peacefully. I heard a noise and opened my eyes to a room full of chaos. Nurses everywhere. A crash cart. Someone holding paddles. I tried to speak, but couldn’t. …

Heart and cardiology

Articles, page 27

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