Heart and cardiology

1,642 articles · Since 2004

Articles, page 43

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

October 16, 2011Oct 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…

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 …

Conditions and diseases

Chest pain is where protocol driven medicine breaks down

Shadowfax, MD

October 15, 2011Oct 15, 201111

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…

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 …

Conditions and diseases

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

Stephen C. Schimpff, MD

October 10, 2011Oct 10, 20113

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 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 …

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Conditions and diseases

Genetically informed therapy and technical innovations in cardiology

Stephen C. Schimpff, MD

October 3, 2011Oct 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…

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 …

Conditions and diseases

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

John E. Brush, MD

September 23, 2011Sep 23, 20114

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,…

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

…

Patient voices

How our resuscitation efforts would be interpreted by fate

StorytellERdoc, MD

September 17, 2011Sep 17, 20112

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,…

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

Physician voices

Promoting a rational approach for the reduction of cardiovascular risk

Michel Accad, MD

September 7, 2011Sep 7, 20115

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…

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 …

Conditions and diseases

Should teenagers be screened to prevent sudden cardiac death?

Chris Rangel, MD

September 6, 2011Sep 6, 20113

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 …

Conditions and diseases

Heart valve repair without open surgery

Stephen C. Schimpff, MD

September 2, 2011Sep 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…

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

Physician voices

Coronary CT screening is low value health care

Kenneth Lin, MD

August 30, 2011Aug 30, 20113

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 …

Physician voices

Celebrating 50 years of coronary angiography

Eric Van De Graaff, MD

August 28, 2011Aug 28, 20112

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 groin).

Patients …

Conditions and diseases

Intuition saved this patient from a potentially fatal diagnosis

Sharon Bahrych, PA-C, MPH

August 27, 2011Aug 27, 20118

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…

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 …

Health policy

The interests of doctors and patients sometimes conflict

George Lundberg, MD

August 22, 2011Aug 22, 20112

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…

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 …

Conditions and diseases

Beware whenever you hear a story about a simple blood test

Gary Schwitzer

August 22, 2011Aug 22, 20118

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…

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 …

Health technology

Medical device innovation saves lives but often at a high cost

Stephen C. Schimpff, MD

August 19, 2011Aug 19, 20112

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 …

Physician voices

Using RFID tags to track physician movement at conferences

Wes Fisher, MD

August 7, 2011Aug 7, 20113

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…

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 …

Drugs and prescribing

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

Kevin Pho, MD

August 4, 2011Aug 4, 201111

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…

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 …

Physician voices

Decision aids need to be used for angioplasty and stents

Shannon Brownlee

August 1, 2011Aug 1, 20113

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…

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 …

Drugs and prescribing

How dabigatran is an atrial fibrillation paradigm shift

John Mandrola, MD

July 28, 2011Jul 28, 20113

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…

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 …

Conditions and diseases

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

mksap

July 23, 2011Jul 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…

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 …

Heart and cardiology

Articles, page 43

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