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.

Vitamins are not magic. We need good science and better sense.

Afshine Ash Emrani, MD

Medications

August 6, 2014

The scientific literature is replete with the failure of vitamins to support diseases. Yet, the industry is booming and people’s cabinets are filled with potentially harmful, poorly studied colorful bottles that make unsubstantiated magical claims.

This year, we witnessed Dr. Mehmet Oz, a celebrity doctor who frequently extols weight loss products, supplements and vitamins on his syndicated television show come under fire from regulatory committees for false claims and poor outcomes.

The …

Welcome to the world of metamedicine

Hans Duvefelt, MD

Physician

July 30, 2014

Knowing what to do when faced with a sick patient is relatively straightforward. We learned a lot of it in medical school, picked more up by experience, and usually have the opportunity to look things up quickly on the Internet. Even when faced with a brand new situation, we can usually fall back on our general knowledge of science and medicine.

But in today’s practice of medicine, that’s not enough. Physicians, …

Read more…

Welcome to the world of metamedicine

MKSAP: 68-year-old woman with exertional leg discomfort

mksap

Conditions and Diseases

July 26, 2014

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

A 68-year-old woman is assessed for a 6-month history of progressive exertional leg discomfort, described as a “heaviness” involving both calves. The symptoms are relieved within 5 to 10 minutes of rest. She has noted the same limiting heaviness with bicycling. Medical history is significant for hypertension, type 2 diabetes mellitus, and …

Cost-effective diagnosis was the only option

Andreas Mauer, MD

Medical Education

July 17, 2014

Most physicians recall the medical school ritual of unboxing our first stethoscope. From the first physical diagnosis course, we were all solemnly instructed as to the importance of the physical examination in the diagnosis and of management of illness. Given that perhaps the most notable use of the stethoscope is cardiac auscultation, it would seem that this should hold particularly true for cardiology.

And yet, on moving from classroom to bedside, …

Medical judgment is paramount

Michael Kirsch, MD

Physician

July 16, 2014

The world is asunder. Iraq is sinking into a sectarian abyss. ISIS, a terrorist group, now controls a larger territory than many actual countries. Russia has swallowed Crimea and has her paw prints all over eastern Ukraine. China is claiming airspace and territories in Southeast Asia increasing tensions with Japan, Vietnam and the Philippines. The Israeli-Palestinian peace process is in another deep freeze. Terrorists in Sudan and Nigeria are kidnapping …

Read more…

Medical judgment is paramount

How physicians can retire the right way

David Mann, MD

Physician

July 11, 2014

To paraphrase General MacArthur, old doctors never retire, they just fade away. Despite having greater than average financial resources and more burdensome than average work load, many doctors seem to have a hard time knowing when it is time to call it quits. I know doctors who continue to practice into their 70s and 80s. Some continue to work until the day they die. Why is this?

I think that some …

Read more…

How physicians can retire the right way

Why are doctors still prescribing Zetia?

Janice Boughton, MD

Medications

July 10, 2014

A health research company just released a list of the 100 top drugs in America according to sales. 29th on the list, with sales of over $1.8 billion, is the cholesterol lowering drug ezetimibe, brand name Zetia.

This drug was released over 10 years ago because it worked really well in combination with statin drugs such as Zocor (simvastatin) to lower LDL cholesterol levels. It was released as a single agent and combined …

Should doctors be paid overtime for taking call?

David Mann, MD

Physician

July 2, 2014

shutterstock_1634374

Taking call is the worst thing about being a doctor. There, I said it. But wait! What about medical malpractice lawsuits? What about dealing with patients’ suffering or dying either from their illness, or far worse, relating to decisions you made or procedures your performed? Certainly these are far worse events than being on call.

Granted. However, these awful events are part of …

A love-hate relationship with practice guidelines

Ira Nash, MD

Physician

June 27, 2014

I have a love-hate relationship with practice guidelines. Love because it is often helpful to refer to a set of evidence-based recommendations as part of clinical decision-making; hate because of all of the shortcomings of the guidelines themselves, as well as the evidence upon which they are based.

A recent piece in JAMA and the editorial that Read more…

A love-hate relationship with practice guidelines

The bus driver and the destiny of the children in the bus

Jordan Grumet, MD

Physician

June 26, 2014

It was a sunny spring day as the bus turned the corner. It was a yellow school bus filled with young children jumping up and down in their seats. It was an average day in an average school year. Nothing about it stood out. Let’s take a closer look.

The boy sitting in the front of the bus holding tightly to his lunch box is named William. His clothes are tattered …

The slippery slope of shorter hospital stays

David Mokotoff, MD

Conditions and Diseases

June 25, 2014

This story has become all too familiar. The patient enters the ER with crushing chest pain and their EKG shows an acute MI, (known today in the colloquial as STEMI, for ST-elevation myocardial infarction). The interventional cardiologist is summoned quickly and in less than 90 minutes from the patient’s arrival across the ER door threshold, he or she is on a cardiac cath lab table, where a coronary stent is …

Can conflicting guidelines be good for patients?

Kenneth Lin, MD

Physician

June 17, 2014

After I left my position as a staffer for the U.S. Preventive Services Task Force in November 2010, it was three years before I was tapped for another guideline post, this time at the American Academy of Family Physicians. Recently I joined the AAFP’s Commission on Health of the Public and Science, which formulates guidance for family physicians on a variety of topics, including clinical preventive services. My appointment coincided …

When will technology actually transform health care?

Joe Flower

Health Technology

June 12, 2014

After decades of bravely keeping them at bay, health care is beginning to be overwhelmed by “fast, cheap, and out of control” new technologies, from BYOD (“bring your own device”) tablets in the operating room, to apps and dongles that turn your smart phone into a Star Trek tricorder, to 3-D printed skulls. (No, not a souvenir of the Grateful Dead, a Harley decoration or a pastry for the Mexican Dia de …

How to reduce the risk of stroke in women

Afshine Ash Emrani, MD

Conditions and Diseases

June 8, 2014

Cardiovascular disease still remains the number one cause of death in women. Heart attacks account for 24% and strokes 7% of all deaths. Among minority women, these numbers are even higher. The challenge remains that doctors traditionally have not identified women at high risk of stroke. Internists and cardiologists do not routinely think of stroke prevention in women, and neurologists have been busy treating stroke victims and have had no …

The problem with an anti-medication bias

Albert Fuchs, MD

Medications

June 6, 2014

“I don’t like taking medicines.”

All physicians hear some form of this opinion very frequently. Even more frequently, patients don’t state this view outright but rely on it to completely subvert their doctor’s plans.

When I was new to practice such an utterance would shock and confuse me.

“I don’t want to take any medicines,” a patient would declare.

“That’s fine,” I would reassure my interlocutor. “It’s a free country. No one is going …

A requiem for handwritten admitting orders

Janice Boughton, MD

Physician

June 4, 2014

When I first learned to take care of patients in the hospital, as a third-year medical student, we used a mnemonic to help us remember what to order when a patient was first admitted. Patients would come in to the hospital from a doctor’s office or from the emergency room and the nurses needed a set of orders to know what to do for the patient. The mnemonic we used …

The patient offered a diagnosis, and the doctor missed it

Ira Nash, MD

Physician

June 4, 2014

I recently got back from a brief trip to Florida. I went down there to celebrate my mother’s 85th birthday. As you might expect, her social circle has shrunk in recent years, but she did get a number of cards and calls from friends and family members. The cards were on display in her kitchen, and a few calls came in while I was there. One in particular pointed out some …

The health care industrial complex is stronger than ever

Wes Fisher, MD

Physician

May 30, 2014

Walking to the 2014 Heart Rhythm Society (HRS) Scientific Sessions recently, I couldn’t help but marvel how beautiful San Francisco was. The weather was perfect, the streets bustling, the quaint shops and eateries doing brisk business in a very hip metropolitan city with a distinctive West Coast vibe. As I walked up to the Moscone Conference Center, I was struck by …

How do we fix the high blood pressure problem?

Robert Pearl, MD

Conditions and Diseases

May 28, 2014

It’s a leading cause of death and disability in the U.S., leading to hundreds of thousands of preventable heart attacks, strokes and failed kidneys each year. About one-third of all American adults have it, according to the Centers for Disease Control, and it costs the nation about $50 billion annually to treat it and its complications.

“It” is high blood pressure, also known as hypertension. It is a symptomless, silent killer.

There are …

MKSAP: 63-year-old man with pleuritic left-sided anterior chest pain

mksap

Conditions and Diseases

May 10, 2014

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

A 63-year-old man is evaluated for pleuritic left-sided anterior chest pain, which has persisted intermittently for 1 week. The pain lasts for hours at a time and is not provoked by exertion or relieved by rest but is worse when supine. He reports transient relief with acetaminophen and codeine and occasionally when …

Cardiology

Most Popular

Past Week

Past 6 Months

Recent Posts

Subscribe to KevinMD and never miss a story!

Most Popular

Past Week

Past 6 Months

Recent Posts