We almost never do plain old balloon angioplasty in our place anymore. To many, that technique seems so last century. We have moved on to better procedures that have made restenosis a relatively rare occurrence. We have even changed the name of the procedure. If an intern on rounds utters the word “angioplasty,” we quickly correct him or her, using the opportunity to teach the meaning of “percutaneous coronary intervention.”  Angioplasty, we say, derives from Greek words meaning “molding of the vessel” – whereas PCI involves more than molding, often the implantation of a stent. The problem with stenting is that… Continue Reading

As the doctor begins to talk to his patient about smoking cessation, he receives the first “rescue” page. He immediately knows that he has violated — again — the 15-minute-per-patient rule, a rule that surprisingly even patients in the waiting area expect their doctors to follow. Nurses, administrators, and patients coalesce into one giant chronometer, timing every move the doctor makes. We are living in a time-efficiency era in medicine — nothing wrong with that if we provide good care. The rescue page serves a crucial function in today’s health… Continue Reading

In an unofficial survey of attendees, the most striking feature of this year’s AHA Scientific Sessions was how few attendees there were and how empty the exhibit hall was. The ARBITER study came in a somewhat distant second. With an official estimated total attendance (including exhibitors) just under 22,000, the meeting still drew a robust crowd, but well off of its highs (total attendance in 2006 was nearly 29,000, and it’s declined each year since). Maybe Orlando isn’t very exciting. Maybe it’s the economy. Maybe it’s that cardiology is splitting… Continue Reading

I think we can all agree that counseling patients on diet is one of the least rewarding parts of being a doctor. Nobody likes telling adults what they can and cannot eat. And sometimes the recommendations seem so obvious that, to us, it borders on nagging. Of course patients with hypertension and heart failure should avoid salt. Of course patients with heart disease should avoid high-fat food. Of course patients with diabetes should avoid sugar.  But a recent study in the American Journal of Medicine caught my eye. Hummel and colleagues examined… Continue Reading

The ACC/AHA guidelines endorse prophylactic ICDs for NYHA Class II/III patients with an LV ejection fraction ≤35%, but I’m reluctant to recommend this to my patients who are doing really well. Why put them through the hassle and risk? Will they really benefit, especially if I think they’re just as likely to get an inappropriate shock as a life-saving one? A recent paper in Circulation has caused me to reconsider my approach. Wayne Levy and colleagues used a modified version of the Seattle Heart Failure Model to identify which patients… Continue Reading

Three weeks ago, Cedars-Sinai Medical Center in Los Angeles revealed that since February 2008, 206 patients undergoing CT brain perfusion scans at their hospital routinely received radiation doses 8 times what they should have been. The hospital only became aware of the problem after a patient complained of patchy hair loss. The good news is that the scans were performed in older patients, making it less likely that significant long-term complications, such as brain cancer, will result. While much of what happened remains unclear, the error appears to have resulted when… Continue Reading