At the core of my doctoring self, I am an internist and cardiologist–just like a heart surgeon is a surgeon, a judge a lawyer, and an electrical engineer an engineer.
Heart rhythm disorders do not occur in a vacuum, they occur in people. And people are complicated. There are nearly always other medical issues that are pertinent to the rhythm problem. Examples include:
- Sleep disorders are relevant to AF, so is high blood pressure, alcohol intake and about a hundred other non-rhythm problems.
- Coronary artery disease (CAD) is always relevant.
- Kidney function affects drug metabolism.
- Infections can increase the heart’s susceptibility to rhythm disturbances.
- Successful management of–not just installation of–cardiac devices mandates understanding the patient as a whole person.
My advocacy for healthy living as a means for preventing (and treating) heart disease often leads me to general cardiology and internal medicine topics. Examples include…
- The role of exercise in preventing and treating heart disease. And how much intensity is OK?
- What are the effects of alcohol on the heart?
- What is the real scoop on statins?
- Exercise lowers inflammation. Too much exercise, however, increases inflammation.
Also, my wife of twenty years is a palliative care specialist. We talk about cases a lot. At the heart of palliative care is patient-centered care. What are a patient’s goals of care? Cardiologists rarely speak this language. I had thought, mistakenly, that recommending hospice for a patient was the same as stopping treatment. Now, I know that hospice and palliative care is simply a different kind of treatment. This knowledge helps me, both as a person and a doctor. Wait, that’s the same.