As the commenters correctly pointed out, this Sunday’s case involving the patient with recurrent syncope is indeed polymorphic ventricular tachycardia–aptly named torsades de pointes (‘twisting of the points’). TDP is associated with prolongation of the QT interval, and pause-dependent PVCs (and VT). A serious malady indeed. ICD evaluation showed hundreds of these episodes The initial ECG strengthened […]
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The best part of doctoring is its humanness. Machines cannot do it–not even Apple products. But that’s the worst part too. Since humans practice medicine, there will be ‘medical errors.’ Â And when doctors err, people–not spreadsheets or profits–are hurt. Â That’s the rub. Â Like any endeavor, the greater the reward, the greater the risk. Â […]
I have an easy solution to a vexing problem in today’s healthcare crisis. A problem so widespread it is worth hundreds of words in the WSJ: long wait times at the doctor’s office. But first, before I give my simple, pragmatic, master-of-the-obvious solution let me say something truthful. I try. I try really hard—to run […]
It has been a very busy few weeks. Â Â Medicine is like that; seldom is ‘business’ steady. Â Like rainy weeks in the southeast when you think it will never be sunny again, there are weeks when you think everyone’s atria are fibrillating. So, there were shocks, and burns, and wires installed. The heart rhythm was rocking, […]
“Did you sign those (three) consents?” “This patient needs a short form; your office letter was done 30 days and one hour ago.” (just over the legal limit) “The insurance ‘people’ in area code (***) denied the stress test.” “Mr Smith’s son, an alternative medicine specialist in California wants a phone call to discuss herbal […]
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 […]
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One year!!!
One year ago, this weekend, what started as some simple commentary on a bike race, or a ride, has morphed into opinion statements on many different aspects of what life presents to me. Since what I know the most about is electrophysiology, writing on matters of the heart seemed logical. Even after nearly two decades, […]
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Questions…
The patient asked me–in a very serious tone–a series of unusually frank questions. “You look young, how many ablations have you done? How many years of experience do you have? “I have read the success rate is 90% at ___ institute… What is your success rate?” Honestly, it caught me by surprise. For a brief moment, […]
Have you ever had a cold beer after a mountain bike ride? Oh my! But does such indulgence put one at risk for an arrhythmia? Does alcohol exacerbate an existing arrhythmia? How much, if any, alcohol is acceptable? These are questions I am asked frequently. And for those asking, they are very important questions. I […]
The first link from an email source of medical news reads, “better patient-centered care reduces mortality risk.” It made me think, exactly what do they mean with this new verbiage, “patient-centered care?” And so I learned. Thank goodness, I think my care is indeed patient-centered, even though the terms patient- and family-centered are news to […]
It happened. Guilty. I confess. Reading about Dr Berwick’s recess appointment to lead CMS induced me to watch a Fox news clip. Gosh, I feel bad about it. It felt good, though. Patients–that’s you and me–should know that CMS controls doctors, nurses and especially hospital/practice managers. They are ten times more scary than the radar […]