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 […]
Category: Doctoring
My Facebook feed has been buzzing with news of a breakthrough in the treatment of sepsis–a deadly condition caused by bacterial infection. Do not be fooled. Please. Resist the urge to be duped. A recent study published in the prestigious journal Chest concluded that a combination of high-dose vitamin C, anti-inflammatory corticosteroids and thiamine given […]
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 […]
Three weeks ago I wrote about the growing dominance of the new oral anticoagulant (NOAC) drugs for stroke prevention in patients with atrial fibrillation. (Another common name for these drugs is direct acting oral anticoagulants or DOACs.) The post generated many comments–some privately and some on the blog. Your responses induced me to think a […]
Changing one’s mind is hard. Changing the mind of doctors is even harder. Doctors are supposed to be the medical experts. Often we are. But sometimes I wonder whether our attachments to old ideas gets in the way of seeing the obvious. I am reading Michael Lewis’s book The Undoing Project. Learning how Kahneman and […]
Times have changed in the treatment of patients with atrial fibrillation (AF). First some background: The first of the four pillars of AF care is stroke prevention. The only proven means to protect patients with AF from stroke is use of drugs that block clotting factors–or anticoagulants. Some people call these drugs blood thinners. I […]
Seven years have passed since I started this blog. In that time… I have learned some basics about writing. (I almost wrote, “I have learned to write,” which would have been foolish, since, writing-wise, I have plenty to learn.) I have learned to stay upright on the bicycle. Concussions made me understand that the joys […]
I recently received this message: This is not the first time I’ve been scolded for straying from medical topics. Last October, during the Lown Institute’s RightCare Action Week, I wrote about our ailing healthcare system. This prompted a different reader to send a similar message: Stick with topics about atrial fibrillation–went the gist of that […]
A patient presents with atrial fibrillation (AF) and a rapid rate. He doesn’t know he is in AF; all he knows is that he is short of breath and weak. The doctors do the normal stuff. He is treated with drugs to slow the rate and undergoes cardioversion. During the hospital stay, he receives a […]
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 recently returned from the 2016 Heart Rhythm Society Sessions in San Francisco. I wrote three articles for Medscape. I also did two podcasts from HRS. I will link these below. You need to sign up for Medscape (free) to read the essays and listen to the podcast. In the first article, I discussed […]