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.

Supplemental oxygen during cardiac arrest resuscitation

MedPage Today

Conditions and Diseases

June 26, 2010

by Michael Smith

Administering high concentrations of supplemental oxygen during resuscitation after cardiac arrest is associated with increased inhospital mortality, researchers said.

So-called blood hyperoxia resulting from being given pure oxygen after cardiac arrest was associated with an 80% increase in the risk of death, compared with patients whose blood gases were normal on admission to the intensive care unit (ICU), according to Stephen Trzeciak, MD, of Cooper University Hospital in Camden, …

Heart catheterization worries that every cardiologist face

John Mandrola, MD

Physician

June 18, 2010

Malpractice and heart catheterization have been in the news recently.

A spicy concoction for sure. An epidemiological study published in an online subsidiary of Circulation addresses the role of three major medical issues facing cardiologists today: malpractice, heart catheterization, and medical costs.

It is hard to get more controversial.

Heart catheterization, the invasive assessment of the coronary artery lumen, has always been a hot-potato topic. The “percent-normal” was the buzz word when I …

Statins do not decrease the risk of many cancers

Kristina Fiore

Medications

June 14, 2010

by Kristina Fiore

Claims of unintended benefits of statins appear to be largely unsubstantiated and known risks — including liver and renal problems and myopathy — confirmed, British researchers concluded based on findings from a large prospective open cohort study.

The study involving more than two million people, “largely confirmed other studies that reported no clear association between statins and risk of cancers,” Julia Hippisley-Cox, MD, and Carol Coupland, MD, of the …

Can chest pain patients be evaluated in the ER waiting room?

MedPage Today

Physician

June 12, 2010

by John Gever

Emergency department patients with chest pain may safely be evaluated in the waiting room when necessary, researchers said.

Among 303 patients triaged to waiting-room evaluation in a prospective study, no acute coronary syndromes were missed and adverse event rates overall were lower than among 804 patients who were assessed in conventional monitored beds, reported Frank Scheuermeyer, MD, of St. Paul’s Hospital in Vancouver, British Columbia, and colleagues online in …

Peer review may require random over-reads

Larry Husten, PhD

Conditions and Diseases

June 9, 2010

“Let’s kill all the lawyers.” It’s every doctor’s favorite Shakespeare quote. And if you’re giving a talk to doctors there’s no better way to get the audience on your side than by starting with a lawyer joke.

But perhaps we shouldn’t be too hasty about killing all those lawyers. As recent commentary about the Mark Midei case makes clear, modern medicine doesn’t know how to police itself. And until medicine does …

Working overtime can increase coronary artery disease risk

MedPage Today

Physician

June 2, 2010

by Todd Neale

British civil servants working three to four hours longer than usual per day appear to have an increased risk of having a coronary heart disease event, a prospective cohort study showed.

After accounting for traditional cardiovascular risk factors and other variables, those working 11 to 12 hours per day had a 56 percent greater risk of coronary death, nonfatal myocardial infarction, or angina than those who worked normal hours, …

Cholesterol can be improved by eating nuts

MedPage Today

Physician

June 1, 2010

by Todd Neale

Eating nuts improves blood lipid levels, which may help stave off heart disease, researchers found.

In a pooled analysis of 25 intervention trials, eating an average of 67 grams of nuts a day (2.4 ounces) reduced total cholesterol by 5.9% and LDL cholesterol by 7.4% (P<0.001 for both), according to Joan Sabaté, MD, DrPH, of Loma Linda University in California, and colleagues.

The ratios of total to HDL cholesterol and …

Healthcare needs to be simpler and more like real economics

John Mandrola, MD

Health Policy

May 27, 2010

A middle aged patient whom I have seen in the past for benign palpitations called today because of atypical chest pain. Although I have criticized the overuse of nuclear imaging studies, and probably order the fewest of any cardiologist in the city, there are times when they are appropriate –this was one of those occasions. Symptoms did not rise to the level of an invasive angiogram, but could not be …

Added sugars worsen cholesterol levels

Shantanu Nundy, MD

Patient

May 13, 2010

Added sugars hit a new low this week. A study published in JAMA found that people who consume higher quantities of added sugars have worse cholesterol profiles than those who consume less.

First of, what are added sugars? Added sugars simply put are sugars that are added into foods (in contrast to naturally-occurring sugars that you find in fruits). The JAMA article writes that added sugars are “defined as caloric sweeteners …

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Added sugars worsen cholesterol levels

Malpractice fears influence cardiology decisions

Charles Bankhead

Physician

May 4, 2010

by Charles Bankhead

For nearly a quarter of cardiologist respondents, malpractice concerns influenced their decisions to order tests or treatment for hypothetical cases included in a national survey.

Almost 30% of cardiologists acknowledged ordering cardiac catheterization because colleagues did so in the same situation, according to an article published online in Circulation: Cardiovascular Quality Outcomes.

Concerns about malpractice had a significant association with regional use of tests and treatment, Frances Lee Lucas, PhD, …

Money prevents patients from seeking timely heart care

Crystal Phend

Physician

May 3, 2010

by Crystal Phend

Lack of insurance and financial concerns keep patients from treating a heart attack like the emergency it is, researchers affirmed.

A delay in getting to the hospital for treatment of acute MI was 38% more likely among the uninsured and 21% more likely among insured patients with financial concerns, reported Paul S. Chan, MD, MSc, Mid America Heart Institute in Kansas City, Mo., and colleagues.

More than two in every …

Cardiac arrest resuscitation, with wife as witness

StorytellERdoc, MD

Physician

April 29, 2010

The patient arrived in cardiac arrest. He had been brought to our emergency department in the middle of the night. Although he had a significant cardiac history, he was only in his late-forties. His transport from his house to our department had been less than ten minutes and, along the way, the pre-hospital team had done an excellent job of intubating this patient and establishing an IV.

His wife was with …

Statins for heart disease prevention, is the luster fading?

MedPage Today

Medications

April 29, 2010

by Peggy Peck

First, my disclosure: I’ve written at least one news article about every major statin trial since 4-S, and I’ve been mightily impressed with almost all of the statin data. So, I was also impressed when the JUPITER results were reported about a year and a half ago — although I became a little less “impressed” as JUPITER continued to …

Patient adherence to drugs is low and what doctors can do

Shantanu Nundy, MD

Medications

April 22, 2010

Frequently in preventive health we ask patients to take medications that will reduce the risk of a certain bad medical outcome years down the road: cholesterol-lowering agents that lower the risk of a heart attack, blood pressure-lowering agents that reduce the risk of kidney disease, glucose-lowering medications that reduce the risk of diabetes-related complications.

Sometimes these medications make patients feel better — for example, insulin in patients with symptomatic diabetes or …

High blood pressure treatment that patients need to know

Erin Marcus, MD

Conditions and Diseases

April 21, 2010

When her gynecologist told her she had high blood pressure, Marie had a simple solution: switch doctors. After all, she had gone to him for a different problem, and this was the first time he had ever checked her blood pressure.

“He said, ‘Oh my God, you’re like a bomb waiting to explode.’ I said, ‘I didn’t come here for that, I came here for something else,’” she explained.

Two years later, …

Dabigatran is superior to warfarin, but at what cost?

John Mandrola, MD

Medications

April 18, 2010

Dysrhythmias like atrial fibrillation (AF), more often than not, require medical therapy.

The dreaded blood thinner, warfarin (Coumadin) comes to the fore often. In aggregate, I have likely spent months of my life discussing the risks and benefits of this much maligned drug. Common rat poison is made from the same ingredients as warfarin — only rats keep eating it and die days later of bleeding, while humans have the blood …

Aortic dissection symptoms and current treatment options

Kevin

Physician

April 4, 2010

by Joseph Lombardi, MD

You probably remember the tragic death of actor John Ritter in 2003.

Recently, his family partnered with the Thoracic Aortic Disease (TAD) Coalition to shed light on the condition that took his life: aortic dissection.

In addition to TAD Coalition’s “Ritter Rules,” which focus on recognizing, treating and preventing the condition, the American Heart Association and American College of Cardiology also released new guidelines designed to prevent unnecessary …

Diet Coke and the AHA red dress endorsement

Kevin

Medical Education

March 29, 2010

Originally published in MedPage Today

by Peggy Peck, MedPage Today Executive Editor

A red dress jauntily displayed on cans of Diet Coke has become the latest symbol in the ongoing debate about pharmaceutical company support of research or CME.

But whose dress is it? The American Heart Association says it’s “not our red dress,” even as leading pharma critic Steven Nissen, MD, …

10 salt reducing tips that can lower your blood pressure

Erin Marcus, MD

Patient

March 26, 2010

It’s hard for Cassandra Mathieu to describe her mother’s cooking without mentioning the salt shaker.

“I remember my mother used to cook with seasoning salt, garlic salt, every kind of salt you can imagine,” she said recently. “We grew up on salt.”

Cassandra grew up fixing food the same way, adding generous amounts of salt to dishes she prepared and to her food at the table. At age 42, she discovered her …

ED can predict heart death

Kevin

Physician

March 24, 2010

Originally published in MedPage Today

by Joyce Frieden, MedPage Today News Editor

Patients with erectile dysfunction (ED) who were treated with telmisartan, ramipril, or both were at greater risk for cardiovascular events than other patients on the same medications, researchers found.

In men who reported ED at baseline, all-cause mortality during a median follow-up of four years was double that seen …

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ED can predict heart death