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.

Dabigatran (Pradaxa) questions in atrial fibrillation

Larry Husten, PhD

Patient

January 27, 2011

The approval of dabigatran (Pradaxa) has been long awaited in the cardiology community. Although just about everyone agrees that a good alternative to warfarin is highly desirable, there are many remaining questions about the drug as it prepares to enter the marketplace.

Here are a few questions raised by electrophysiologist John Mandrola on his blog:

In the RE-LY trial, dabigatran was used twice daily. When not symptomatic, patients often …
Read more…

Dabigatran (Pradaxa) questions in atrial fibrillation

How often to see your doctor when feeling well

Eric Van De Graaff, MD

Patient

January 17, 2011

How often do you see your doctor? Once a year? Every 6 months? Never? Most of you are pretty healthy and only show up for screening physical exams or aches and pains. Some of you may have more health problems and come more frequently.

What if you had diabetes, coronary disease, hypertension, high cholesterol, and sleep apnea, but no symptoms to indicate any …

Heart attack symptoms in women, in their own words

Carolyn Thomas

Patient

December 31, 2010

heart attack symptoms in women

Having a heart attack felt nothing like I thought it would feel. For one thing, unlike sudden cardiac arrest, in which the heart stops beating and you stop breathing, during my heart attack (myocardial infarction), my heart continued beating, and I was conscious throughout despite horrific symptoms – so how could I possibly be having a heart …

Suspicious withdrawal of a publication from an academic journal

Larry Husten, PhD

Physician

November 30, 2010

The official ESC journal Europace publishes an online case report by Dr. Martin Hudec about the extremely rare and spectacular failure of a recently implanted Biotronik 340 VR-T ICD in a 46-year-old man. The battery of the device apparently overheated, causing the device to malfunction and leading to severe internal burning.

On Wednesday, October 6, US electrophysiologist Westby Fisher summarizes the Europace article on his blog and reprints several extremely gruesome …

Never hesitate to seek a second medical opinion

Eric Van De Graaff, MD

Patient

November 19, 2010

To celebrate your 50th birthday you head to your doctor’s office to get your yearly exam. He rewards you for your diligence by poking and prodding you, sticking you with needles, and arranging for a colonoscopy (happy birthday!). He also sends you for a stress test out of concern about your strong family history of premature heart disease.

A slightly abnormal treadmill test leads to …

How dietary guidelines can help prevent disease

Stephen C. Schimpff, MD

Physician

November 13, 2010

Most of the illnesses that occur today are chronic like diabetes, heart disease, cancer or kidney disease.

These stay with us for the rest of our lives, are debilitating, and are expensive to treat. But in many cases they are not all that difficult to prevent. Unfortunately, our dietary guidelines are of little or no help in this regard but could be.

In 1941, following studies that demonstrated …

Conflicting stories on alcohol and heart disease

John Mandrola, MD

Physician

November 4, 2010

Have you ever had a cold beer after a mountain bike ride?

Oh my!

But does such indulgence put one at risk for an arrhythmia? Does alcohol exacerbate an existing arrhythmia? How much, if any, alcohol is acceptable?

These are questions I am asked frequently. And for those asking, they are very important questions.

I wish the answer was straightforward. But it is not.

Undoubtedly, excessive alcohol can precipitate an abnormal rhythm. Look no farther …

Controversy about NSAIDs and heart health

Kevin

Medications

October 18, 2010

by Marianna Rakovitsky, RPh

Recently there has been a lot of controversy about the use of NSAIDs and heart health.

NSAIDs are medications for pain and inflammation. Many of them are sold over the counter and they are used by millions of people for various aches and pains as well as for more serious chronic conditions such as arthritis. Aspirin is technically an NSAID, but its effects …

Why a marketing study for Niaspan was published in a medical journal

Larry Husten, PhD

Medications

September 3, 2010

The authors call it “an in-office linguistic study” and write that it “was conducted to assess physician–patient discussions of mixed dyslipidemia.” But it’s really an Abbott marketing study for Niaspan, the company’s long-acting niacin product, and the question is: why is it published in the American Journal of Cardiology?

The study involves the recorded conversations of 12 cardiologists and 12 PCPs with 45 patients with low levels of HDL. The …

Statins for heart disease and stroke, and debunking statin myths

Eric Van De Graaff, MD

Medications

August 27, 2010

There is no class of medications in the history of the world that has been better studied that statins.

This class of drugs is more properly termed HMG CoA reductase (3-hydroxy-3-methyl-glutaryl co-enzyme A reductase) inhibitors, but with a name like that a terser nickname is almost mandatory (the name statin comes from the suffix of the members of this class: lovastatin, pravastatin, etc.).

Simply …

Heart health depends on healthy behaviors

John Mandrola, MD

Conditions and Diseases

August 17, 2010

Everyone knows that the heart health of Americans is dismal. Obesity, diabetes, and high blood pressure are all on the rise.

For now, technological advances in cardiac care continue to maintain, or in some cases, lower the death rate from heart disease. Squishing blockages, ablating abnormal heart tissue, and installing cardiac devices have successfully kept the abysmal lifestyle habits of so many at bay. Despite all the fury of modern technology …

Unread echocardiogram fallout at Harlem Hospital Center

Larry Husten, PhD

Conditions and Diseases

August 3, 2010

Recently, the New York Times reported that Harlem Hospital Center had finally completed its investigation into thousands of echocardiograms that after receiving an initial reading by a technician had never been read by a physician.

It turns out that out of 7,000 tests that went unread, only 14 patients “might have been misdiagnosed because their tests had not been handled properly,” according to the hospital spokeswoman quoted in the story. …

Diabetes is responsible for many heart disease deaths

Kristina Fiore

Conditions and Diseases

July 30, 2010

by Kristina Fiore

More than one in 10 heart disease deaths may be attributable to diabetes, researchers say.

In a meta-analysis of more than 100 studies, diabetes was associated with a twofold increased risk of the disease and was estimated to be accountable for 11% of vascular deaths, according to Nadeem Sarwar, MD, of the University of Cambridge in England, and colleagues.

They reported their findings online in The Lancet and will present …

Homocysteine lowering does not reduce heart attack risk

Crystal Phend

Medications

July 29, 2010

by Crystal Phend

Homocysteine-lowering supplements do not help prevent further cardiovascular events in heart attack survivors, a large randomized trial affirmed.

The trial, which followed more than 12,000 heart attack survivors over nearly seven years, found that folic acid plus vitamin B12 effectively reduced homocysteine levels, but did not reduce major vascular events overall nor any other individual endpoint compared with placebo, reported Jane M. Armitage, BM BChBSc, MBBS, of the University …

Smoking, hypertension, obesity, and 7 other stroke risk factors

Kristina Fiore

Conditions and Diseases

July 22, 2010

by Kristina Fiore

There are 10 factors that appear to make up the vast majority of stroke risk, and half of those are modifiable, a large population study found.

Hypertension appears to be the strongest predictor of stroke, along with smoking, abdominal obesity, diet, and physical activity, according to Martin J. O’Donnell, MB, PhD, of McMaster University in Hamilton in Ontario, Canada.

“This is good news in the sense that the causes of …

Echocardiogram reading by cardiologists needs to improve

Crystal Phend

Conditions and Diseases

July 16, 2010

by Crystal Phend

Insufficient training among cardiologists in reading echocardiography results is wasting healthcare dollars and subjecting patients to unnecessary procedures, researchers said.

A review by sonographers of cardiologist-interpreted echocardiography findings at a Milwaukee medical center during a period of just over a year indicated major discrepancies in 29% of cases, leading to unnecessary further diagnostic testing or treatments for the wrong indication, according to a study presented here at the American …

Stents to treat blocked heart arteries are not an easy fix

John Mandrola, MD

Conditions and Diseases

July 15, 2010

Cardiologist Richard Fogoros — aka DrRich — has put out an incredibly timely and pertinent piece of advice concerning the common practice of stenting blockages in the coronary arteries.

He succinctly summarizes a small retrospective study that showed an increased risk of cardiac events after non-cardiac surgery in patients who have recently undergone either a bare metal or drug-eluting coronary stent.

On a website clearly designed to educate patients, DrRich rightly points …

Short stature increases heart disease risk

MedPage Today

Conditions and Diseases

July 9, 2010

by Todd Neale

People of short stature appear to have a heightened risk of adverse cardiovascular outcomes compared with their taller counterparts, according to a new meta-analysis.

Among 22 studies analyzed, the shortest people had a 1.46-fold greater risk of coronary heart disease or death, Tuula Paajanen, MD, of the University of Tampere in Finland, and colleagues reported online in the European Heart Journal.

A critical height cutoff point for increased risk could …

Mark Midei and the failure of peer review

Robert Wachter, MD

Conditions and Diseases

July 8, 2010

A couple of months ago, a Baltimore reporter called to get my take on a scandal at St. Joseph’s Hospital in Towson, an upscale suburb.

A rainmaker cardiologist there, Dr. Mark Midei, had been accused of placing more than 500 stents in patients who didn’t need them, justifying the procedures by purposely misreading cath films. In several of the cases, Midei allegedly read a 90 percent coronary stenosis when the actual …

A cardiologist discusses screening for vascular disease

Eric Van De Graaff, MD

Conditions and Diseases

June 28, 2010

Just last week I saw a full-page ad in the newspaper for a series of medical screening tests — EKG, echocardiogram, aortic ultrasound, and the like (all interpreted by “certified doctors”) — that a person could arrange for oneself or a loved one.

We newspaper readers were told we could arrange to have these tests performed without a doctor’s order as …