Dr John M

cardiac electrophysiologist, cyclist, learner

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Observations from the Outback…

November 22, 2009 By Dr John

November marks the annual American Heart Association (AHA) meeting. This is one of the few major heart meetings each year.

AHA focuses on the newest technologies for the treatment of ongoing cardiac disease. Termed, “secondary prevention,” this year there were studies on implantable devices for heart failure, new blood thinners to assist in the squishing of blockages and new drug and drug combinations to treat high blood pressure and high cholesterol.

Cardiology is famous for their innovation in developing therapies to treat existing disease. Arrhythmia management has exploded in the past decade. The irony is that heart disease remains the most preventable disease known. The most dependent on lifestyle factors.

We fail miserably in our challenge to prevent heart disease (“primary prevention”) in the first place. I fail, my colleagues fail and it is obvious from our observations at dinner last night at the Outback Steakhouse (Indy) that Indianapolis docs are failing as well. There exists no drug, no device or intervention to controls one’s lifestyle.

A vignette:

The main arrhythmia I deal with is atrial fibrillation (AF). In many cases it is highly lifestyle dependent with obesity, body fat composition, sleep, high blood pressure and alcohol consumption all being highly contributory. A very overweight businessman type comes to me for treatment of AF. He does not exercise, sleeps poorly, drinks a few at night and eats too much. Zero time per day invested in his own health. I know that I can transiently correct the arrhythmia with a procedure and drug (add another medicine to his list). I make a deal -a bad idea. He promises a change. “If I could just feel better, I would exercise.” We agree and move forward. Procedure, 3 day hospital stay and a new drug for AF. This is the easy part.

Six weeks later in the office he reports feeling great. Heart rhythm is normal. I ask, “cool, you remember our agreement about exercise and weight loss?” A sad look comes upon him. No, a lifestyle change has proven elusive again. I understand, I am numb to this scenario.

Our challenge is to change this cycle. How? Ideas?

Pretty sure procedures and medicines are not the answer.

JMM

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Filed Under: Atrial fibrillation, Cycling Stuff, General Medicine, Health Care, Healthy Living Tagged With: Lifestyle

John Mandrola, MD

Welcome, Enjoy, Interact. john-mandrola I am a cardiac electrophysiologist practicing in Louisville KY. I am also a husband to a palliative care doctor, a father, a bike racer, and a regular columnist at theHeart.org | Medscape

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Find me on theheart.org | Medscape Cardiology

  • Electrophysiology commentary on Medscape/Cardiology

Mandrola on Medscape

  • My Medscape column on general medical matters

For patients...Educational posts

  • 13 things to know about Atrial Fibrillation — 2014
  • A new cure of AF
  • Adding a new verb to doctoring: To deprescribe is to do a lot
  • AF ablation — 2015 A Cautionary Note
  • AF Ablation in 2012–An easier journey?
  • Atrial Flutter — 15 facts you may want to know.
  • Benign PVCs: A heart rhythm doctor’s approach.
  • Caution with early Cardioversion
  • Decisions of 2 low-risk cases of PAF
  • Defining success in AF ablation in 2014
  • Four commonly asked questions on AF ablation
  • Inflammation and AF — Get off the gas
  • Ten things to expect after AF ablation
  • The medical decsion as a gamble
  • The most important verb in our health crisis
  • Wellness Requires Ownership

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