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.

Atrial fibrillation as experienced by an electrophysiologist

Conditions and Diseases
March 20, 2010

Middle age introduces itself in many ways; one is atrial fibrillation. Youth, vigor and a medically-problem free life was seemingly right there in the recent past. A rhythm doctor often hears this suddenness of onset described as “Doc, yesterday, I was fine.” As is always the case for a first episode of an arrhythmia, yesterday, you were fine, but today is indeed a new day.

It happened during a bike ride. …

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Atrial fibrillation as experienced by an electrophysiologist

Coronary angiography is being overused

Conditions and Diseases
March 19, 2010

Originally published in MedPage Today

by Kristina Fiore, MedPage Today Staff Writer

For patients without known heart disease, the diagnostic yield of coronary angiography appears to be low, researchers found.

Only about 38% of those referred to the cath lab for the elective procedure had obstructive coronary artery disease, Manesh R. Patel, MD, of Duke University, and colleagues reported online in the New England …

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Coronary angiography is being overused

Using CT scans to diagnose chest pain in the ER

Physician
March 6, 2010

During residency, there was always a case of misdiagnosed chest pain to discuss in conference.  Incorrectly sending a patient home and missing the diagnosis of cardiac chest pain was an infrequent, but repetitively observed, phenomenon.

So as to tread carefully with words, it is sufficient to say that even now, chest pain triage remains a vexing problem.

Chest pain diagnosis is like appendicitis; there are always small numbers of unusual cases in …

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Using CT scans to diagnose chest pain in the ER

Becoming vegetarian can help fight high cholesterol

Physician
March 5, 2010

I made a New Year’s resolution to become a vegetarian. Or a mostly vegetarian.

I’ve been thinking about it for a long time, but with young children who love meat and don’t have the broadest palates, I think it’s important to feed them protein any way I can get it in them.

Having passed 40, I’ve finally realized that I can no longer eat what I want with impunity. Further, as a …

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Becoming vegetarian can help fight high cholesterol

Does your cardiologist deserve his salary?

Health Policy
February 20, 2010

Conflicted am I on reading of the strategy of a group of South Miami cardiologists who have written their patients complaining of the cuts to reimbursement, primarily cuts in imaging procedures. A tension emerges from within upon reading the following quote from a “healthcare expert.”

“I’m not at all sympathetic with the cardiologists,” said Robert Berenson, a doctor who was once in charge of Medicare payment policy and now is a …

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Does your cardiologist deserve his salary?

Treating atrial fibrillation with catheter ablation on TV may not be ethical

Conditions and Diseases
February 17, 2010

Mauricio Arruda performed a live atrial fibrillation ablation at University Hospitals in Cleveland on the Today Show recently.

The 6-minute segment was relentlessly upbeat. The TV producers pulled every trick in the book to overcome the inherent difficulty of portraying a hard-to-explain disease like atrial fibrillation and an even harder-to-explain procedure like catheter ablation. Instead of making any effort to truly educate their viewers, the producers took the easy …

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Treating atrial fibrillation with catheter ablation on TV may not be ethical

The power of a doctor’s choice of words in explaining CPR

Conditions and Diseases
February 8, 2010

Words have power. Language has power.

The words we use may comfort or shock, allay or provoke, sooth or batter. Words often imply layers of meaning that are not explicitly articulated, yet rest beneath the surface:

“I worry that time is short for you” (You are dying) (I care about you)

“I wish we could have done more” (Nothing would have changed her death) (I am on your side)

“I hope with you that …

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The power of a doctor’s choice of words in explaining CPR

How hypertension increases the risk of dementia

Conditions and Diseases
February 7, 2010

Originally published in MedPage Today

by John Gever, MedPage Today Senior Editor

Another study has found that hypertension may contribute to increased risk of dementia, this time with evidence of actual brain abnormalities.

Data from an offshoot of the Women’s Health Initiative found that participants’ baseline blood pressure was strongly correlated with volume of lesions in their brains’ white matter, according to Lewis …

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How hypertension increases the risk of dementia

How television can shorten your life

Conditions and Diseases
January 24, 2010

Originally published in MedPage Today

by Todd Neale, MedPage Today Staff Writer

Too much television watching could be shortening lifespans, a study of Australian adults showed.

Aussies who reported watching four or more hours of TV a day were 46% more likely to die during a 6.6-year period than those who watched less than two hours a day, according to David Dunstan, PhD, of Monash University in Melbourne, and colleagues.

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How television can shorten your life

Cardiologists discuss how far myocardial infarction management has come

Medications
January 10, 2010

Originally published in MedPage Today

by Peggy Peck, MedPage Today Executive Editor

“What we did for patients with acute MI was place them in a cool, dark place. Give them morphine for pain and lidocaine to prevent arrhythmias and hope for the best.”

The speaker is Steven Nissen, MD, director of Cardiovascular Medicine at the Cleveland Clinic. He is describing standard care 25 …

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Cardiologists discuss how far myocardial infarction management has come

How does Zetia and niacin affect the carotid intima-media thickness (CIMT)?

Medications
November 22, 2009

Originally published in MedPage Today

by Peggy Peck, MedPage Today Executive Editor

By a margin of 0.014 mm in carotid intima-media thickness (CIMT), extended-release niacin (Niaspan) demonstrated superiority over ezetimibe (Zetia) as an add-on for high risk patients on long term statin therapy.

But is a difference of 0.014 mm clinically significant?

The niacin versus ezetimibe findings come from the ARBITER 6-HALTS trial, …

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How does Zetia and niacin affect the carotid intima-media thickness (CIMT)?

Why you should stop taking Vytorin for high cholesterol

Medications
November 16, 2009

At the American Heart Association meeting in Orlando, the results of the ARBITER 6-HALTS study were released. No Vytorin was used in the study, but I am sure that all the headlines will mention Vytorin.

The actual study published ahead of press online in the New England Journal of Medicine. Essentially, they enrolled over 200 patients from Walter Reed and Washington Adventist who had known heart disease or were at …

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Why you should stop taking Vytorin for high cholesterol

Niacin beats Zetia in the ARBITER 6-HALTS trial, and what this means for ezetimibe

Medications
November 16, 2009

Originally published in MedPage Today

by Peggy Peck, MedPage Today Executive Editor

Boosting HDL cholesterol with extended-release niacin (Niaspan) is a more effective way of slowing atherosclerosis in high-risk patients on long-term statin therapy than seeking additional LDL cholesterol reductions by adding ezetimibe (Zetia), researchers here reported.

Compared with ezetimibe, 2 grams of niacin led to significant reductions in both the mean …

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Niacin beats Zetia in the ARBITER 6-HALTS trial, and what this means for ezetimibe

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Did the 1918 flu pandemic increase the risk of heart disease?

Conditions and Diseases
October 5, 2009

Originally published in MedPage Today

by Michael Smith, MedPage Today North American Correspondent

Men who were in utero during the peak of the 1918-1919 flu pandemic were at increased risk of heart disease when they reached their 60s, 70s, and 80s, researchers said.

medpage-today In those men, the rate of heart disease was more than 23% higher than among those whose mothers …

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Did the 1918 flu pandemic increase the risk of heart disease?

Will there really be an impending shortage of cardiologists?

Health Policy
September 28, 2009

There can be little doubt that the lethal combination of aging baby boomers, the obesity epidemic, and the growing success of medical and interventional therapies for CV disease (resulting in more and more survivors of major events) is going to produce a flood of cardiovascular disease in the coming decades, and cardiologists in great numbers will be needed to care for these people.

However, that doesn’t mean that the message conveyed …

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Will there really be an impending shortage of cardiologists?

How to protect yourself from abdominal aortic aneurysms

Conditions and Diseases
September 22, 2009

by Mark Adelman, MD

While diseases like prostate cancer and heart disease have become household concerns, abdominal aortic aneurysms (AAA), the 10th leading cause of death in men age 55 and older, have been overshadowed by more prominent diseases for far too long. It’s time we pull back the curtain and take a closer look at this serious disease and how it can be both detected and prevented.

An AAA, which …

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How to protect yourself from abdominal aortic aneurysms

Is the flu a heart attack risk factor?

Conditions and Diseases
September 22, 2009

by Todd Neale, Staff Writer, MedPage Today

Flu appears to act as a trigger for myocardial infarction and cardiovascular death, a review of the literature showed.

medpage-today All observational studies included in the review found an association between times when influenza viruses were circulating and increases in cardiovascular death, according to Charlotte Warren-Gash, MBChB, of University College London, and colleagues.

There was …

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Is the flu a heart attack risk factor?

New troponin tests to better diagnose a heart attack

Conditions and Diseases
August 27, 2009

by Crystal Phend, Senior Staff Writer, MedPage Today

A generation of new, more sensitive troponin assays has improved hospitals’ ability to diagnose a heart attack to a point as early as the time of emergency department presentation, two separate studies affirmed.

medpage-today1 In one multicenter study, a sensitive troponin I assay had an early diagnostic accuracy of 96%, compared with conventional …

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New troponin tests to better diagnose a heart attack

How to make industry influence transparent in continuing medical education

Medical Education
August 25, 2009

by Larry Husten, Ph.D.

A recent hearing of the Senate Aging Committee on continuing medical education (CME) should scare anyone who might need to see a doctor in the next few years. But you don’t need to be a Washington policy wonk to discover that there’s a huge problem with CME.

Just walk into the lobby of any major downtown hotel when a large medical conference is in town and you will …

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How to make industry influence transparent in continuing medical education

Did Demerol cause Michael Jackson’s cardiac arrest and death?

Conditions and Diseases
June 26, 2009

Michael Jackson’s death continues to consume the news cycle.

There is currently no clear explanation. Some have speculated that it may be related to the narcotic pain drug, Demerol. According to this report from the UK’s The Sun, “An Emergency Room source at UCLA hospital said Jackson aides told medics he had collapsed after an injection of potent Demerol …

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Did Demerol cause Michael Jackson’s cardiac arrest and death?

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