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.

Understanding what patient centered care really means

Jordan Grumet, MD

Physician

February 21, 2012

There was nothing the professor despised more then the syrup that oozed out of his partner’s lips when dealing with patients. He often cringed as he walked by the examining room and imagined the hand holding that was taking place behind closed doors.

Privately, they argued about the different approaches. One saw the world in terms of black and white, while the other was steeped in a foggy haze of gray. …

What you need to know about antithrombotic guidelines

Gordon Guyatt, MD

Conditions and Diseases

February 19, 2012

The lack of evidence supporting the “economy class syndrome” myth in air travel made major news headlines recently. While certainly interesting and accurate, that topic was just one among many topics addressed in the larger framework of the new evidence-based guidelines.

The American College of Chest Physicians (ACCP) released the Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines in its February issue …

Question the price of drugs and medical procedures

Court Nederveld

Patient

February 15, 2012

Hypertension was the trigger that forced medical cost awareness to the forefront. My doctor decided that with my rise in blood pressure it would be prudent to prescribe a blood pressure medication and order a nuclear stress test. With only a catastrophic insurance policy and a $5000 deductible it was imperative for my financial health to know the cost of both the drugs and the procedure up front.

The prescription was …

How erectile dysfunction might save your life

John Ludlow, MD

Conditions and Diseases

February 11, 2012

Just the other day, I saw a 52 year old man in my office for what I thought was a routine prostate issue. I walked in the exam room, introduced myself and immediately knew his prostate was fine. His eye contact was non-existent. He was nervous and his handshake was clammy and brief. I see these patients everyday. Their prostates are just fine. It’s their love life that’s the issue. …

There is a patient attached to that implantable defibrillator

David Lee Scher, MD

Health Technology

February 9, 2012

As a follow-up to my post on why patients with implantable defibrillators should have access to their device’s data, I am going to talk about what your physician looks for when a device is interrogated. Many times this happens in silence or with few words, and some pushes of a button, when done in the office, and when done with remote patient management, is accomplished either automatically or with …

Treating heart failure on a budget

Molly Kantor

Conditions and Diseases

February 7, 2012

As a third year medical student, I spent one afternoon each week at a health clinic at a community hospital affiliated with my medical school. This health clinic was focused on primary care for patients with HIV, and many of our patients were poor, homeless, immigrants, or uninsured. Many were also living with their diagnosis in secrecy and had to hide their medications and medical bills from family members.

One of …

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Treating heart failure on a budget

Why patients with implantable defibrillators deserve their data

David Lee Scher, MD

Health Technology

February 2, 2012

The Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act of 2009, was signed into law on February 17, 2009.

The objective of Measure 12/15 of Meaningful Use regulations of the HITECH act which refer to electronic health records, states that eligible professionals “provide patients with an electronic copy of their health information (including diagnostic test results, problem lists, medication …

Meaningful treatments in the battle against coronary disease

Eric Van De Graaff, MD

Conditions and Diseases

January 16, 2012

I saw a patient in my office this week who had received a stent from one of my partners last month. The man was highly satisfied with his experience—the procedure was tolerable, the recovery short, and the nurses were pretty (he specifically made a point of this, presumably because the post-hospitalization customer surveys don’t include what seemed to him to be the most important feedback metric)—but his wife had a …

Overcoming tragedy requires a team

Stephanie Lyn Lewis

Patient

January 1, 2012

When tragedy strikes, one looks for comfort in many places. When traditional resources–relatives, physicians, clergy members–do not completely satisfy, one may reach out for comfort from unexpected places. Increasingly, people turn to online health and wellness support communities.

My family’s tragedy occurred when my father suffered a Sudden Cardiac Arrest, or SCA, in 2010. As I watched him lay lifelessly on life-support in that hospital bed, the man who was undoubtedly …

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Overcoming tragedy requires a team

MKSAP: 67-year-old man with confusion, agitation, and malignant hypertension

mksap

Conditions and Diseases

December 31, 2011

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

A 67-year-old man is evaluated in the emergency department for confusion and agitation secondary to malignant hypertension. Initial blood pressure is 230/130 mm Hg, and funduscopic examination reveals papilledema.

He is admitted to the intensive care unit, and therapy with nitroprusside by continuous infusion is begun; the …

Creating a practical, uniform policy on vein treatment

Ted King, MD

Conditions and Diseases

December 22, 2011

The general public, and much of the medical profession, has unfortunately little understanding of the connection between varicose veins and more serious manifestations of chronic venous disease, represented by higher CEAP classes. This is a fact that keeps many with vein disease from obtaining, or even considering, treatment. Fortunately, public education concerning venous disease and its potential complications, including chronic venous insufficiency and deep venous thrombosis, is growing.

Organizations such as …

Making tailored health education standard of care

Shantanu Nundy, MD

Patient

December 18, 2011

The recently instituted 30-hour-shift work restrictions placed on medical residents have created a need for “dayfloat” services to safeguard potentially unsafe handoffs in patient care and help residents adhere to duty hour limits. The past two weeks I’ve been the dayfloat resident for the cardiology inpatient service. My job is to round with the post-call team, help them get out of the hospital on time, and then take care of their …

A doctor resolves to cut his heart attack risk

PalMD

Physician

December 13, 2011

I have a 5% chance of having a heart attack in the next 10 years. That’s not so high, but it’s higher than I want it. Most of that risk is due to my cholesterol and my age. I can’t do anything about the latter, but the former is under my complete control. Cholesterol medications can improve my cholesterol significantly. So can proper diet and exercise. That’s not true of everyone; …

Let’s close the chapter on statin safety

John Mandrola, MD

Medications

December 6, 2011

There was important news recently on statin drugs. As one of the world’s most effective and commonly used medications, statins provide great writing topics. Lots of people have high cholesterol–including cyclists. Lots of people are interested in avoiding our mostly deadly disease.

I’d like to tell you about a recently-published landmark study in the Lancet that should quell safety concerns over statin drugs.

The punch line after I tell you the study’s …

MKSAP: 55-year-old man to undergo coronary artery bypass graft surgery

mksap

Conditions and Diseases

December 4, 2011

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

A 55-year-old man with a history of coronary artery disease and diabetes mellitus will undergo elective coronary artery bypass graft surgery. His last hemoglobin A1c value was 7.8%, and his plasma glucose level 2 hours prior to scheduled surgery was 238 mg/dL (13.2 mmol/L). Hemoglobin is …

Considering cancer and heart disease in opposing ways

Norman Silverman, MD

Physician

November 18, 2011

The American public seems to consider cancer and cardiovascular disease in diametrically opposing ways. Cancer evokes the threat of relentless, painful suffering and whatever medical science can do to delay the judgement day is appreciated. Therapeutic regimens may involve disfiguring operations, prolonged toxic irradiation and chemotherapeutic agents that may be beneficial if they do not kill you first.

Response to treatment of limited incidence and duration are accepted and deemed beneficial. …

What patients with heart disease need to learn from cancer patients

Carolyn Thomas

Patient

November 15, 2011

Cardiologist Dr. Richard Fogoros has issued this blunt warning to those at risk for developing heart disease: “You need to change your life. If you don’t, you will suffer the consequences – possibly decades earlier than is necessary.”

In his Heart Health Center column, he observed that most high-risk people end up making only half-hearted efforts to modify their heart attack risk. And he blamed doctors for enabling this …

Simple tips to improve your blood pressure checks

Dr. Charles

Conditions and Diseases

November 13, 2011

A recent study confirmed that the doctor’s office may be one of the worst places to determine if your blood pressure is under control. The automatic rise in tension many people experience when they are being scrutinized contributes to artificially high blood pressure readings. Although many times the only way improve one’s blood pressure is through treatment (such as medication, a low salt diet, and weight loss), other times …

MKSAP: 60-year-old man with type 2 diabetes mellitus and hypertension

mksap

Medications

October 16, 2011

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

A 60-year-old man with type 2 diabetes mellitus and hypertension visits the office to establish medical care. He reports monitoring his blood pressure and blood glucose measurements at home with good results. He had a cholesterol panel checked approximately 5 years ago, at which time he …

Chest pain is where protocol driven medicine breaks down

Shadowfax, MD

Conditions and Diseases

October 15, 2011

On the theme of knowing when and when not to follow the diktats of emergency medicine, one of the greatest challenges for a practicing ER doc is chest pain. Missed MI is still the biggest driver of malpractice costs, and last I hear, ER docs still send home something like 2% of patients who are having MI or unstable angina. Not good. So over the last decade we’ve gotten all …

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