We have to talk about drugs. No, not illicit drugs, but medications used by doctors and patients. Plaintiff attorneys run ads on TV that fool people into thinking certain meds are bad. The current one I deal with is the clot-blocking drug rivaroxaban (Xarelto.) Before that, it was dabigatran (Pradaxa). If, or when, the makers […]
Category: General Cardiology
Yesterday I posted the four most important questions to ask your doctor. Let’s apply those questions to a typical scenario: Whether or not to take an anticoagulant drug for prevention of stroke in the presence of AF. We need a typical patient. For this example we will pick a typical CHADS-VASC 2 patient. 65 year-old […]
A large study presented at last month’s American College of Cardiology meeting reported that slightly more than 1 in 10 patients with aortic valve replacements (tissue valve) had small clots on the leaflet of the new valve. The study included 890 patients. The clots, which doctors call “subclinical thrombosis,” cannot be seen on regular echo […]
A colleague recently asked me if atrial fibrillation (AF) ablation was overused. Yes it is. AF ablation has become the wild west of electrophysiology. There is essentially no scrutiny of this invasive, expensive and risky procedure. I also include here the add-on “maze-like†procedures done during heart surgery for other conditions. I believe they too […]
I recently served on the faculty of the tenth annual Western AF Symposium in Park City, Utah. Dr. Nassir Marrouche of the University of Utah has grown Western AF into a huge gathering of global experts in atrial fibrillation. During the intense two-day meeting, I took notes and put together a post of top-ten highlights. […]
Cardiology is on the brink of making a big mistake. We have embraced a new procedure called left atrial appendage occlusion. You may be seeing the ads for a device called Watchman. Like this one> The appendage-closure idea was a good one: during atrial fibrillation (AF), blood can pool in the left atrial appendage, and […]
Medicine does not stand still. You want innovation; you want progress. But you also want safety. Millions of patients have coronary stents placed in the arteries supplying blood to the heart. It’s big business. Metal cages placed in the setting of a heart attack can be life saving. In other settings, however, the strongest quality […]
Turkish authors boldly raised this question in a recent editorial. They likened AF ablation to renal denervation, a procedure in which RF ablation in the kidneys was felt to reduce BP. Many studies showed kidney ablation markedly lowered BP. Then a trial was done with a sham control (people got part of the procedure but […]
I have been seeing a new trend in the AF clinic. I never thought this would happen, but I’d estimate that at least once daily, often multiple times daily, a patient says they have read this blog before the visit. That is nice. Many of these patients, some who have traveled across the country, or […]
In my last post, I wrote my initial thoughts of an important new study on how the decision to take a medication or have a screening test in the name of prevention is similar to playing the lottery. I promised to think and write about the study more carefully. My latest thoughts are now published […]
A new study published last week in an open heart journal changes the conversation about how patients and doctors think about and discuss preventive therapies–such as statins. Dr. Richard Lehman may be the smartest doctor on Twitter. This is what he said: This is a game-changer https://t.co/WgGdLlodbL — Richard Lehman (@RichardLehman1) March 20, 2016 Most […]