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.

Stem cells, surgery free heart valve repair and nutraceuticals advance heart care

Stephen C. Schimpff, MD

Conditions and Diseases

October 10, 2011

The last post in this series discussed new advances in cardiology – the two themes of genetically informed therapy and technical advances. I will continue with three additional themes – regenerative medicine, minimally invasive approaches and prevention.

The third of the five themes is regenerative medicine. One major area of investigation is whether stem cells can heal the damaged heart. Perhaps the field is “more glamour than fact” just now …

Genetically informed therapy and technical innovations in cardiology

Stephen C. Schimpff, MD

Conditions and Diseases

October 3, 2011

I want to give an overview of cardiac care advances – the first two themes are discussed here. I want to thank Dr. Mandeep Mehra, chief of cardiology at the University of Maryland for conceptualizing these themes for me.

First is genetically informed therapy. Pharmacogenomics is having an impact in the use of warfarin (Coumadin) and clopidogrel (Plavix). Warfarin dosage can now be titrated in part based on a person’s genomic makeup. In …

Achieving a 90 minute door-to-balloon time in STEMI patients

John E. Brush, MD

Conditions and Diseases

September 23, 2011

At a recent committee meeting, my hospital’s administration announced new quality measures and targets. Striving for top performance, the board of the hospital system set the bar extraordinarily high. The bonuses of senior management are tied to achieving the targets, so the announcement had everyone’s attention.

One target that caught my interest was for achieving a door-to-balloon time of less than 90 minutes in STEMI patients. As an interventional cardiologist who …

How our resuscitation efforts would be interpreted by fate

StorytellERdoc, MD

Patient

September 17, 2011

I walked up to the closed door and paused, exhaling a deep breath weighted with disappointment, trying to clear my thoughts for the conversation about to come. My clenched fist was briefly suspended, mid-air, ready to knock. Beyond the door, I could hear muffled conversation and movement.

A calm, pretty woman stood beside me. An emergency department case manager. She held a notebook and pen, ready to jot down any useful …

Promoting a rational approach for the reduction of cardiovascular risk

Michel Accad, MD

Physician

September 7, 2011

It is a rare occasion nowadays when academic journals treat us to an editorial debate of some substance. The staff at the Journal of the American College of Cardiology can be applauded for publishing last summer two articles representing fundamentally opposed viewpoints on the best strategy to avoid cardiovascular illness. Amusingly, both claimed in the title of their piece the distinction of promoting a “rational approach” for the reduction …

Should teenagers be screened to prevent sudden cardiac death?

Chris Rangel, MD

Conditions and Diseases

September 6, 2011

It seems as if teenage student athletes have been dying by the month in often spectacular and dramatic fashion. Last September Texas high school senior Reggie Garrett died suddenly just after throwing a touchdown pass . Last week a 16-year-old Michigan basketball player died dramatically just after becoming a hero by scoring the winning basket to preserve an undefeated season. Then just a week later another 16 …

Heart valve repair without open surgery

Stephen C. Schimpff, MD

Conditions and Diseases

September 2, 2011

A major innovation are the recent reports of success in replacing or repairing diseased or damaged aortic or mitral valves via catheter-based techniques instead of open surgery.

Mitral regurgitation is when the valve becomes unable to close tightly. Once the regurgitation becomes sufficiently severe to cause heart failure, the death rate reaches about 5% per year. Most such individuals are referred for cardiac surgery to either try to repair the valve, …

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Heart valve repair without open surgery

Coronary CT screening is low value health care

Kenneth Lin, MD

Physician

August 30, 2011

Like many states, Texas is facing a fiscal crisis caused by decreased revenue from the economic recession and skyrocketing health care costs. Even without the expansion of publicly financed health insurance mandated by last year’s health reform law, the percentage of the state budget devoted to Medicaid expenses is projected to rise from 28 percent to 46 percent by 2020, even faster if the law withstands current constitutional …

Celebrating 50 years of coronary angiography

Eric Van De Graaff, MD

Physician

August 28, 2011

When I recommend that a patient needs coronary angiography (synonyms: heart catheterization, coronary angiogram, cardiac catheterization, or simply “cath”) I take a moment to bring up the risks of the procedure—complications that include the rare likelihood of stroke or heart attack (less than one in a thousand), a reaction to the dye, and bleeding at the arterial access site (most often the femoral artery in the …

Intuition saved this patient from a potentially fatal diagnosis

Sharon Bahrych, PA-C, MPH

Conditions and Diseases

August 27, 2011

I was working in a rural health clinic when I went into to see a new patient. Amy was 18 years old, with her 6 day old newborn son by her side.

I introduced myself and then asked, “what brings you into the clinic?”

Amy responded, “Shortly after giving birth, I started having problems with shortness of breath, ankle swelling, and high blood pressure. I told the OB residents and they brushed …

The interests of doctors and patients sometimes conflict

George Lundberg, MD

Health Policy

August 22, 2011

Organized American medicine would like for physicians to “speak with one voice.”

If they could do so, and if that voice were in the public interest, not only in the self-interest of those physicians, it would be a very powerful voice indeed.

Arnold (Bud) Relman, the esteemed former editor of the New England Journal of Medicine, once rightly told the International Committee of Medical Journal Editors that physicians speak with many …

Beware whenever you hear a story about a simple blood test

Gary Schwitzer

Conditions and Diseases

August 22, 2011

After seeing the NBC Nightly News last night, a physician urged me to write about what he saw: a story about a “simple blood test that could save women’s lives.”

Readers – and maybe especially TV viewers – beware whenever you hear a story about “a simple blood test.”

And this is a good case in point.

Brian Williams led into the story stating: “Two of three women who die suddenly of cardiac heart …

Medical device innovation saves lives but often at a high cost

Stephen C. Schimpff, MD

Health Technology

August 19, 2011

Innovation in medical devices has been profound in recent years – cardiac devices are a good example. The combination of engineering advances to create small, strong and wear-resistant devices and computational advances with smaller and smaller semiconductors loaded with more and more information have led to truly amazing advances. With more and more people with more and more chronic illnesses, the need is great and the opportunities for innovators is …

Using RFID tags to track physician movement at conferences

Wes Fisher, MD

Physician

August 7, 2011

Not everything that counts can be measured.
Not everything that can be measured counts.
-Albert Einstein

Recently, a disturbing trend of monitoring physician quality and accountability has taken another ominous turn: tracking physician’s movements at scientific conferences (so called “tag and release”) using RFID tags embedded in attendees name badges at national scientific sessions. Having had personal experience with the American College of Cardiology meeting, this technology was also embedded in the …

Should Lipitor go OTC? A cardiologist says yes, an internist says no

Kevin Pho, MD

KevinMD

August 4, 2011

With the patent for Lipitor expiring, Pfizer is considering selling an OTC version of the statin.

It’s generated a firestorm of debate, with doctors speculating on the impact for patients.

According to Pharmalot, “an OTC version would allow Pfizer to capture some of the sales that will be lost when the Lipitor patent expires in November. In fact, Pfizer execs recently changed …

Decision aids need to be used for angioplasty and stents

Shannon Brownlee

Physician

August 1, 2011

For those who have been following the back and forth over the Less is More blog I posted last week, here’s the poster that upset some cardiologists when it was up on the Parsemus Foundation’s site.

Over the top? Of course it is — it’s satire! And like all good satire, it contains a few grains of truth mixed with a hefty dose of exaggeration.

Still, it’s only fair to point …

How dabigatran is an atrial fibrillation paradigm shift

John Mandrola, MD

Medications

July 28, 2011

My iPhone vibrated with an urgent message that read: “Please call … the INR on your atrial fibrillation patient scheduled for cardioversion is too low. He is on that new blood thinner, Pradaxa. What do you want to do?”

I responded, sounding like an expert: “It’s ok. Pradaxa thins the blood adequately, it just doesn’t change the INR.”

She astutely responded, “How do know the blood is thin? What if …

MKSAP: 52-year-old man with coronary artery disease

mksap

Conditions and Diseases

July 23, 2011

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

A 52-year-old man is evaluated regarding treatment of his coronary artery disease. He had a myocardial infarction 8 years ago and was treated with a coronary stent placed in his right coronary artery. Over the last 8 years he did well with medical therapy, with only …

Should young athletes be screened for heart disease?

Richard N. Fogoros, MD

Conditions and Diseases

July 8, 2011

In the wake of sudden deaths in a young athletes, the question arises – as it does after each of these tragic events – whether all young athletes should be screened for occult heart disease before participating in sports. It appears, for instance, that 16-year-old Wes Leonard had an underlying heart condition which likely could have been identified with a simple echocardiogram.

The question is controversial, and accordingly, even the …

Summer palpitations

Katherine Ellington

Conditions and Diseases

June 30, 2011

It was early Saturday morning, I was making my plans for the day, crossing-off a few items that seemed unreasonable with others that had been accomplished. As I moved toward the kitchen, a voice from the living room bellowed “the coffee is ready.”

Turning my head I could see bright rays of sunshine making a visible path through the open front door. My morning greeting followed …

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Summer palpitations