Athletic heart Cycling Stuff Health Care Reform Knowledge

The feasibility of routine ECG screening of athletes?

Sudden death in a young athlete is surely a tragic event.  Sadly, many of the afflicted had an underlying undiagnosed heart anomaly that might have been detected with a screening ECG. On the surface, the idea seems so simple: just add an ECG to the routine pre-sport’s history and physical exam.  ECGs are painless, non-invasive […]

Doctoring Knowledge


“I’ve read that…” “Did you hear about…” “So and so (publication) said this…” These days, medical information is like Kudzu in the Smoky mountains.  But just a few years ago, or so it seems, researching a medical topic took personal initiative and a not inconsequential time commitment.  Now, on an elevator at work with a […]

ICD/Pacemaker Knowledge

An answer to this week’s clinical vignette

The case involved a 70 year-old man with an eight year-old medical device.  He suffered the abrupt onset of chest pain and shortness of breath.  His ECG is here: Click to enlarge The Answer: First, the ‘medical device’ is an eight year-old Medtronic dual chamber pacemaker. Second, as was correctly stated, the ECG shows a […]

Exercise General Cardiology General Medicine Healthy Living Knowledge

Get smart

As if we need more evidence that schools should bring back daily gym class. Researchers at the University of Illinois studied 9-10 year-old children with MRIs (no radiation exposure), VO2 treadmill testing, and memory evaluations. Their findings should spank those in the educational elite who give regular gym class only lip service. “Dr M, you […]

Atrial fibrillation General Cardiology General Medicine Knowledge

See everything…

Do you see anything wrong with this picture? (Hint: right column) It is certainly true that atrial fibrillation management guidelines needed an update; the last comprehensive update was in 2006.  Much has changed in AF therapy, including the expanded role of catheter ablation and the soon-to-be warfarin substitutes. I guess the European electrophysiologists couldn’t wait […]

Doctoring Knowledge Reflection

Still asking the question…

It is a holiday weekend, the decibels of medicine and bike racing are tuned down low, so I ask myself, “why do I have this blog?” Then, as if on cue, Dr Ves’ tweet about personality traits of bloggers appears.  The study said that only openness to new experiences was predictive of being a male […]

Doctoring ICD/Pacemaker Knowledge Reflection

Clinical decision making 301: The Sprint Fidelis ICD lead…

The implantable defibrillator (ICD) is an amazing life-saving device.  When used in the appropriate patient, the scientific data supporting its benefit is rock solid. The sudden death-averting appropriate ICD shock in the middle of the night, allows the patient to enjoy breakfast with his spouse, rather than admission to the morgue. ICD function seems simple: […]

Health Care Reform ICD/Pacemaker Knowledge Reflection

Impending ICD oversight may not be a bad thing…

At the risk of exposing my naivete, or being too much like the geeky student who sits in the front of the classroom, I can’t help but welcome the upcoming policing of cardiac device implants.   As recently written by Dr Wes, government policing agencies, the DOJ and RAC folks, are planning to focus on […]

General Medicine Knowledge Reflection

142 seconds…

On a lighter note… Many years ago, in medical school there were a brave few who–for generous compensation–agreed to participate in various drug trials.  They were mysteriously sequestered and given various potions and elixirs and then poked and prodded. Here would have been a far more interesting trial to have been a subject of study. […]

General Medicine Knowledge

COPD and Beta-blockers: another myth dispensed…thanks to Twitter…

In medical practice, the words, “in my experience,” or “this is the way we have done it forever,” are scary. Do these words imply an out of date doctor who fails to embrace the new, or is it really true that older less expensive therapy is still better–like Classic Coke. So much of medical dogma lingers […]


A really bad idea…

It’s terrible news. Speeding through college to save 10,000 dollars. Seriously? As a mid-forty year old solidly ensconced in the mini-van era of life, it saddens me to see young people–in an effort to save a few dollars–rushing through the finest of times,  life in college.  Treating college as some sort of right of passage to […]