Your never to young

Last week I took care of two patients with very significant heart disease.

1. 34 year-old male with a strong history of premature coronary heart disease presented with a large acute heart attack. I took him emergently to the cath lab and an angiogram revealed that he had a totally blocked proximal LAD (the most important artery feeding the heart muscle). He required an angioplasty and stent to open the artery.

2. A 29 year old (just one day shy of his 30th birthday) presented with chest pain, shortness of breath and swelling in his ankles. He was clearly in heart failure on exam. He also had evidence of a leaky aortic valve. With the aid of a STAT echocardiogram in the ER, I diagnosed him with an acute proximal thoracic aortic dissection (a tear in his aorta), a huge thoracic aortic aneurysm, severe aortic insufficiency and a large, boggy, poorly functioning heart. He was taken emergently to the operating room where Dr Coady replaced his aorta and his aortic valve.

Both patients did remarkably well and walked out of the hospital.

Nevertheless, it gives me pause when time and again I am reminded that you are never to young to escape the rath of heart disease.

Tumblr

I've now made the leap to the newest social media format. Besides here and on twitter (@drportnay), I will also be posting on tumblr.com. Its a very easy way to share thoughts, links, qoutes, pictures and videos.

Check me out: drportnay.tumblr.com

B Vitamins Reduce Stroke, Heart Disease Deaths

I always find these reports dangerous. Observation studies are helpful for hypothesis generating, not hypothesis testing. In fact, All vitamin randomized controlled trials to date (vit E, vit C, folate) have been negative, despite the fact that obeservational studies seemed to suggest a correlation. For now, I would continue to try and eat a well balanced "mediterranian style" diet.

Foods rich in B vitamins such as folate and B6 may reduce the risk of death from stroke and heart problems, Japanese researchers say.

http://www.webmd.com/heart-disease/news/20100415/b-vitamins-reduce-strokes-and-heart-disease-deaths?src=RSS_PUBLIC

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Tort Reform, Tort Reform, Tort Reform. Where are thou?

Regional variation in cardiac cath rates linked to malpractice concern

Some surveyed cardiologists reported they order cardiac catheterization "frequently" or "sometimes" because of peer pressure or to avoid possible malpractice charges. Such concerns may partly explain...

For complete story visit theheart.org.

http://feedproxy.google.com/~r/Theheartorg/~3/DTjB2rM9vm8/1067277.do

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Study Compares Bypass Surgery To Angioplasty

We've been doing amazing things with stenting lately. One of the absolute indications for cardiac surgery has always been "left main disease". Since the emergence of drug eluting stenting in 2003, we have been working on stenting the left main coronary artery in patients deemed "to sick for surgery." These patient have done remarkably well. Now, we are starting to perform left main stenting on lower risk patients. The below mentioned review reveals that indeed, for the right patient, the results of left main stenting may be equivalent to cardiac surgery. I anticipate that sooner rather than later, both left main stenting and cardiac surgery will be officially indicated for treatment of "left main disease."

From Medical News Today:

At 56, Tim Obrenski found himself getting so exhausted that he couldn't even pull weeds from his garden. A visit to the cardiologist uncovered a major blockage in his heart's left main artery, and he was told he needed bypass surgery. Obrenski's search for alternatives to surgery brought him to UCLA interventional cardiologist Dr. Michael Lee...

http://mnt.to/f/3Bc9

Docs Still Say Malpractice Fears Often Add to Health-Care Costs

I still cannot believe that "tort reform" was not a integral part of the healthcare reform act.

During the health-care debate, the impact of medical malpractice suits was controversial, with the Republicans saying it was a key part of the escalating cost issue and the Democrats saying, not so much. For its part, the CBO estimated tort-law changes would cut only about 0.5% from U.S. health-care spending.

A study now reinforces the long-held belief of many doctors that malpractice -– or fear of same — is really pretty important on the cost front after all. Researchers wanted to know if physicians' behavior and attitudes explain some of the regional variations in the number of intensive procedures. (Citing the Dartmouth Atlas of Health Care, they said the rate of a given cardiac procedure might be three to eight times higher in one area of the country than another, depending on the procedure.) The researchers surveyed 598 cardiologists across the U.S. about what non-clinical reasons might lead them to recommend cardiac catheterization. They also calculated a doctor's "cardiac intensity score" — a quantitative measure of his or her propensity to test and treat, based on his or her response to hypothetical patient scenarios.

The study, published online in Circulation: Cardiovascular Quality and Outcomes, found that nearly 24% of those surveyed reported that fear of malpractice was a non-clinical factor in their decision to recommend catheterization; docs with high intensity scores were more likely to say that legal fears influenced their recommendation. And 27% said if they thought their colleagues were likely to order the procedure, they would too. Researchers also asked doctors if they'd recommend the test because "the patient expects it," "to satisfy the expectations of the referring physician," or to enhance "the financial stability" of a medical practice. (Surprisingly, five doctors actually admitted they frequently or sometimes recommended catheterization for that last reason.)

Only the fear of malpractice, however, was significantly associated with regional differences in the level of health-care services used. "I think this study provides enough evidence to think it's maybe a target for intervention," says F. Lee Lucas, lead author of the study and associate director of the Center for Outcomes Research and Evaluation at Maine Medical Center, who found the malpractice findings surprising. "It seemed to be, for a fair number of physicians, to be a clear motivation for doing something potentially unnecessary."

Even for doctors who aren't directly affected by malpractice suits, the fear of being sued may lead them to order more tests than they otherwise might have – that's so-called defensive medicine.

Image: iStockphoto

http://feedproxy.google.com/~r/wsj/health/feed/~3/5jEnZYTtpxk/

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Cost Concerns Delay Heart Attack Care

This is not good. More evidence that our healthcare system is broken. I'm not sure that our new plan will help this though.

Patients without health insurance and even insured patients worried about paying for medical care are more likely to delay seeking treatment during a heart attack, new research confirms.

http://www.webmd.com/heart-disease/news/20100413/cost-concerns-delay-heart-attack-care?src=RSS_PUBLIC

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