Heart and cardiology

1,642 articles · Since 2004

Articles, page 33

You can’t legislate doctor-patient relationships

December 8, 2013Dec 8, 20132

I was on call this past weekend, rounding at about 8am on the cardiology floors, and a woman I didn't recognize approached me. She asked if I remembered who she was, and was quick to tell me that if I…

I was on call this past weekend, rounding at about 8am on the cardiology floors, and a woman I didn’t recognize approached me. She asked if I remembered who she was, and was quick to tell me that if I didn’t it was ok. She had had bariatric surgery about 6 months previously, and I had seen her in the office for a pre-surgical consultation.

She went on to tell …

Drugs and prescribing

Speakers need to explicitly state financial relationships

James Colbert, MD

December 8, 2013Dec 8, 201315

I just returned from the annual American Heart Association meeting where I heard distinguished cardiologists and researchers from around the world present the latest in cardiovascular disease. Yet, amidst all the late-breaking clinical trial presentations and ask-the-expert sessions, what I…

I just returned from the annual American Heart Association meeting where I heard distinguished cardiologists and researchers from around the world present the latest in cardiovascular disease.

Yet, amidst all the late-breaking clinical trial presentations and ask-the-expert sessions, what I didn’t hear were the speakers’ financial conflicts of interest.

Don’t get me wrong — the AHA mandates that all speakers present a disclosure slide at the beginning of every talk, and this rule was …

Conditions and diseases

The new cholesterol guidelines: Emphasize patient preference

James McCormack, PharmD & Mike Allan, MD

December 7, 2013Dec 7, 201323

There has been much discussion recently, by journalists and health professionals, on the new guidelines for the treatment of blood cholesterol put forward by the American Heart Association (AHA) and the American College of Cardiology (ACC). Critics have raised concerns the revised guidelines will increase the number of healthy people who take statin drugs by 70 percent, that treatment thresholds are too low and that some guideline writers have links …

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Conditions and diseases

Medicine is a universal language

Heather Lee, MD

December 7, 2013Dec 7, 2013

This past spring, I went to Dar es Salaam, Tanzania to do an internal medicine elective at Muhimbili University of Health and Allied Sciences. I rotated through two sub-divisions of internal medicine while I was there: infectious disease and cardiology.…

The medicine

When I initially stepped onto the infectious disease ward, I saw the janitors mopping the cement floors with soap and water. The ward was crowded and the patients lying on …

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Medicine is a universal language

Conditions and diseases

I see chest pain all day, every day

Edwin Leap, MD

December 5, 2013Dec 5, 20132

Sometimes I feel as if my entire emergency medicine career is dedicated to one patient complaint. And that one complaint is chest pain. It may be that the incidence and prevalence of chest pain was the same during my medical…

I recall how I struggled to learn the salient questions. ‘Where is your chest pain? Is it heavy, dull, …

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I see chest pain all day, every day

Health technology

Who do you want reading your EKG?

Wes Fisher, MD

November 27, 2013Nov 27, 201317

I know what you're thinking, punk. You're thinking "did he fire six shots or only five?" Now to tell you the truth I forgot myself in all this excitement. But being this is a .44 Magnum, the most powerful handgun…

I know what you’re thinking, punk. You’re thinking “did he fire six shots or only five?” Now to tell you the truth I forgot myself in all this excitement. But being this is a .44 Magnum, the most powerful handgun in the world and will blow you head clean off, you’ve gotta ask yourself a question: “Do I feel lucky?” Well, do ya, punk?
– Harry Callahan (played by Clint

…

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Who do you want reading your EKG?

Drugs and prescribing

Digging deeper into the new cholesterol guidelines

Janice Boughton, MD

November 26, 2013Nov 26, 20134

The American Heart Association, in collaboration with the American College of Cardiology, recently released recommendations that should change the way we prescribe medications called statins, including drugs like Lipitor and Crestor and their generics, atorvastatin and rosuvastatin. The headlines say…

The headlines say stuff like, “More Americans may be Eligible to Receive Cholesterol Lowering Drugs!”

I am a bit skeptical of news about statin therapy because Lipitor, before it went generic, was responsible for over …

Conditions and diseases

The cholesterol debate: Seeking truth where there is no truth

Robert Centor, MD

November 25, 2013Nov 25, 2013

The New York Times recently had one of their periodic debates: When Medical Experts Disagree. This debate actually centers on the current cholesterol guidelines, but the problem recurs often. Different experts look at the data and develop differing opinions. We…

The New York Times recently had one of their periodic debates: When Medical Experts Disagree.

This debate actually centers on the current cholesterol guidelines, but the problem recurs often. Different experts look at the data and develop differing opinions. We see this with prostate screening, mammography, and treatment decisions.

As one reads the varying opinions in this debate, an understanding of the affect heuristic makes the debate transparent. When we like …

Health policy

We really need 3 health care systems

J. Russell Strader, MD

November 24, 2013Nov 24, 20133

I was reading a blog about health policy and the failings of the ACA rollout posted on CNN. The author spends time talking about how much we want to change our health care system. And how, since change is hard, no one should be surprised by the pains accompanying this change, particularly in terms of individuals loosing their current insurance policies due to the rollout of the ACA …

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We really need 3 health care systems

Conditions and diseases

Acquitted of cholesterol guideline insubordination

Hans Duvefelt, MD

November 24, 2013Nov 24, 20134

A family physician in the northernmost part of the United States was acquitted last week of charges stemming from years of guideline insubordination. Interviewed this weekend by members of the local press while he was cleaning the stall of his…

A family physician in the northernmost part of the United States was acquitted last week of charges stemming from years of guideline insubordination.

Interviewed this weekend by members of the local press while he was cleaning the stall of his favorite horse, the silver-haired doctor declined making comparisons between the manure he was shoveling and the now-abandoned numeric cholesterol guidelines, and would not comment on his former accusers’ fall from their …

Conditions and diseases

MKSAP: 61-year-old woman with hot flushes

mksap

November 16, 2013Nov 16, 20137

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 61-year-old woman is evaluated for hot flushes, which have been persistent for the last 10 years. They occur at least 7 times per…

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

A 61-year-old woman is evaluated for hot flushes, which have been persistent for the last 10 years. They occur at least 7 times per day, last for approximately 60 seconds, and are associated with severe sweating, palpitations, and occasional nausea. She is awakened several times per night. She has tried herbal medications, …

Conditions and diseases

New cholesterol guidelines: The statin decision lies with patients

Kevin Pho, MD

November 13, 2013Nov 13, 20138

The release of the new cholesterol guidelines from the ACC/AHA is big news. It represents a fundamental shift in how we prescribe statin drugs. As with many sweeping changes, there are some good, and some controversial ideas. I like removing…

The release of the new cholesterol guidelines from the ACC/AHA is big news. It represents a fundamental shift in how we prescribe statin drugs.

As with many sweeping changes, there are some good, and some controversial ideas.

I like removing non-statin cholesterol drugs from the recommendations, such as Zetia. Many haven’t been shown to save lives or decrease cardiovascular events.

Also, removing LDL targets can simplify …

Patient voices

Physician burnout: Don’t blame the patient

Carolyn Thomas

November 12, 2013Nov 12, 201314

My daughter loves her career as a probation officer. She is very good at what she does, and finds the work both challenging and rewarding. Yet her client case load includes some of the most unsavory of individuals, found guilty by the courts of child abuse, domestic violence, sexual assault or worse, many of them living with added complexities like addictions or mental health issues. She’s been insulted and screamed at by …

Physician voices

We must pay careful attention to the pronouns that we use

Kevin R. Campbell, MD

November 5, 2013Nov 5, 2013

Have you ever taken note of how much you or a colleague says “I” versus other pronouns? The pronoun that you choose in conversation may very well provide insight into your psyche and may determine your effectiveness as a leader. Current research has indicated that the frequency at which an individual uses the pronoun “I” speaks volumes about their self confidence, level of empathy and perceived status within an organization …

Health policy

Why health insurance for all obstructs lowering health care costs

David Mokotoff, MD

November 2, 2013Nov 2, 201318

If you are like millions of Americans, at some point in your adult life, your doctor will order you to have a CT or MRI scan. Quick, easy, and painless, these invaluable imaging tests provide a vast amount and array…

However, the real pain usually begins when you receive the bill. It is not uncommon for the charges, including radiological interpretation, to …

Medical education

Does board recertification do more harm than good?

Wes Fisher, MD

October 25, 2013Oct 25, 20135

I continue to study for my third ABIM recertifications in both cardiovascular disease and cardiac electrophysiology. In preparation for the examinations, I purchased the review materials offered by the American College of Cardiology called ACCSAP-8 and took a surprisingly expensive cardiac electrophysiology board review course held in Chicago recently. I find I have little time to study all of this material while delivering patient care, so I’ve been getting up at 4:30-5:00am each day when …

Physician voices

David and Goliath lessons for doctors and our health system

Davis Liu, MD

October 24, 2013Oct 24, 20132

October 1st was a special day. The Affordable Care Act (ACA) also commonly known as Obamacare became official. The federal government shut down because Republicans and Democrats disagreed around Obamacare funding. Most importantly, October 1st was when I could finally…

Gladwell ponders why do underdogs succeed when we least expect them to? Is it possible that advantages a Goliath has can be a disadvantage? …

Drugs and prescribing

Stop mandating narrow studies of cardiovascular and diabetes drugs

Harlan M. Krumholz, MD

October 18, 2013Oct 18, 2013

The state of diabetes drugs has gotten to the point where it is good news that a drug does not produce worse outcomes than a placebo. I am not kidding. The New England Journal of Medicine published two trials, each…

The state of diabetes drugs has gotten to the point where it is good news that a drug does not produce worse outcomes than a placebo.

I am not kidding.

The New England Journal of Medicine published two trials, each testing whether a diabetes drug increased the risk of heart attacks and death from heart disease. The trials are a result of FDA guidance for companies to assess the cardiovascular safety of new …

Physician voices

Don’t be foolish enough to think you control outcomes

John Mandrola, MD

October 17, 2013Oct 17, 20132

Let’s be honest. If you are bold enough to hit the "publish" button, it’s normal to care what readers think. I write about medicine: I like doctors, I respect doctors. So it matters how colleagues react to my words. I…

Let’s be honest. If you are bold enough to hit the “publish” button, it’s normal to care what readers think. I write about medicine: I like doctors, I respect doctors. So it matters how colleagues react to my words.

I was both proud and concerned when the Greater Louisville Medical Society decided to republish my “Changing the Culture of American Medicine” piece in their monthly journal, Louisville Medicine.

The reaction of my colleagues has …

Conditions and diseases

MKSAP: 31-year-old woman with cyanotic congenital heart disease

mksap

October 12, 2013Oct 12, 2013

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 31-year-old woman with cyanotic congenital heart disease is evaluated during a routine examination. She has Down syndrome and is accompanied by her guardian.…

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

A 31-year-old woman with cyanotic congenital heart disease is evaluated during a routine examination. She has Down syndrome and is accompanied by her guardian. She has never had cardiac surgery and has no symptoms.

Her blood pressure is 110/80 mm Hg bilaterally. The cardiac apex is displaced. A left parasternal impulse is present. There is …

Heart and cardiology

Articles, page 33

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