Comments on: Angioplasty in a healthy patient, and why preventive heart care is dismissed http://www.kevinmd.com/blog/2009/01/angioplasty-in-healthy-patient-and-why.html medical blog Sun, 22 Nov 2009 19:59:44 -0500 http://wordpress.org/?v=2.8.4 hourly 1 By: Jeffrey Dach MD http://www.kevinmd.com/blog/2009/01/angioplasty-in-healthy-patient-and-why.html/comment-page-1#comment-89874 Jeffrey Dach MD Wed, 18 Feb 2009 13:47:00 +0000 http://clients.emmense.com/kevinmd/2009/01/angioplasty-in-a-healthy-patient-and-why-preventive-heart-care-is-dismissed.html#comment-89874 Many people are surprised to learn that invasive treatment with angioplasty, stents and bypass fail to reduce mortality or heart attacks, when compared to conservative medical treatment with drugs.<br/><br/>Dr Richard Shemin writes in Circulation in 2008,"Survival advantages of stent therapy for coronary artery disease over medical therapy have not been a consistent result in clinical trials." <br/><br/>A five year trial published in 2005 comparing stenting to CABG for multivessel disease shows no difference in mortality.<br/><br/>Conventional drugs used for medical treatment of heart disease include: Beta Blockers such as Inderal, calcium channel blockers include Cardizem, Procardia, and Norvasc. Nitrates such as Isordil, Sorbitrate, Cardilate, Dilatrate, and Peritrate. Nitroglycerine skin patches include Minitran, Nitro-Dur and Transderm-Nitro. Diuretics and ACE inhibitors are used.<br/><br/>Why does medical therapy work?<br/><br/>Medical therapy reduces the oxygen demand of the heart muscle and allows time for the heart to develop microscopic collateral vessels which provides blood flow around the blocked arteries. <br/><br/>To read more: <br/><a>Cardiac Bypass, Angioplasty and Stenting by Jeffrey Dach MD</a><br/><br/><i>Jeffrey Dach MD<br/>4700 Sheridan Suite T<br/>Hollywood Florida 33021<br/>954-983-1443</i> Many people are surprised to learn that invasive treatment with angioplasty, stents and bypass fail to reduce mortality or heart attacks, when compared to conservative medical treatment with drugs.

Dr Richard Shemin writes in Circulation in 2008,”Survival advantages of stent therapy for coronary artery disease over medical therapy have not been a consistent result in clinical trials.”

A five year trial published in 2005 comparing stenting to CABG for multivessel disease shows no difference in mortality.

Conventional drugs used for medical treatment of heart disease include: Beta Blockers such as Inderal, calcium channel blockers include Cardizem, Procardia, and Norvasc. Nitrates such as Isordil, Sorbitrate, Cardilate, Dilatrate, and Peritrate. Nitroglycerine skin patches include Minitran, Nitro-Dur and Transderm-Nitro. Diuretics and ACE inhibitors are used.

Why does medical therapy work?

Medical therapy reduces the oxygen demand of the heart muscle and allows time for the heart to develop microscopic collateral vessels which provides blood flow around the blocked arteries.

To read more:
Cardiac Bypass, Angioplasty and Stenting by Jeffrey Dach MD

Jeffrey Dach MD
4700 Sheridan Suite T
Hollywood Florida 33021
954-983-1443

]]> By: Anonymous http://www.kevinmd.com/blog/2009/01/angioplasty-in-healthy-patient-and-why.html/comment-page-1#comment-89155 Anonymous Sat, 10 Jan 2009 23:41:00 +0000 http://clients.emmense.com/kevinmd/2009/01/angioplasty-in-a-healthy-patient-and-why-preventive-heart-care-is-dismissed.html#comment-89155 In light of recent reports, elective c-sections might be a good area to look at WRT cost control. Pregnant women who wish to schedule their child's birth for their own convenience ought to have to pony up for the privilege. In light of recent reports, elective c-sections might be a good area to look at WRT cost control. Pregnant women who wish to schedule their child’s birth for their own convenience ought to have to pony up for the privilege.

]]> By: Anonymous http://www.kevinmd.com/blog/2009/01/angioplasty-in-healthy-patient-and-why.html/comment-page-1#comment-89153 Anonymous Sat, 10 Jan 2009 20:05:00 +0000 http://clients.emmense.com/kevinmd/2009/01/angioplasty-in-a-healthy-patient-and-why-preventive-heart-care-is-dismissed.html#comment-89153 Thank-you for pointing out this article. <br/><br/>there must be countless overtreatments and "risk-reducing" invasive procedures that are taken for granted by medical institutions even while risking negative outcomes on the patient victims. Other such unnecessary procedures still unquestioned in medical establishments are the castrations and hysterectomies performed on healthy women. Sadly, at worst, these are often performed without prior permission, and at best, under coercion. <br/><br/>What are some of the other unquestioningly performed but often unnecessary procedures to be watchful for? Thank-you for pointing out this article.

there must be countless overtreatments and “risk-reducing” invasive procedures that are taken for granted by medical institutions even while risking negative outcomes on the patient victims. Other such unnecessary procedures still unquestioned in medical establishments are the castrations and hysterectomies performed on healthy women. Sadly, at worst, these are often performed without prior permission, and at best, under coercion.

What are some of the other unquestioningly performed but often unnecessary procedures to be watchful for?

]]> By: thecountrydocreport http://www.kevinmd.com/blog/2009/01/angioplasty-in-healthy-patient-and-why.html/comment-page-1#comment-89147 thecountrydocreport Sat, 10 Jan 2009 15:26:00 +0000 http://clients.emmense.com/kevinmd/2009/01/angioplasty-in-a-healthy-patient-and-why-preventive-heart-care-is-dismissed.html#comment-89147 The other dirty secret of cardiology is that half of people with acute myocardial infarction do not have any significant narrowing of their coronaries prior to the event.<br/><br/>The old attage from Watergate holds, "Follow the money." The other dirty secret of cardiology is that half of people with acute myocardial infarction do not have any significant narrowing of their coronaries prior to the event.

The old attage from Watergate holds, “Follow the money.”

]]> By: Gingerb http://www.kevinmd.com/blog/2009/01/angioplasty-in-healthy-patient-and-why.html/comment-page-1#comment-89143 Gingerb Sat, 10 Jan 2009 12:43:00 +0000 http://clients.emmense.com/kevinmd/2009/01/angioplasty-in-a-healthy-patient-and-why-preventive-heart-care-is-dismissed.html#comment-89143 I would be interested to know if in these trials comparing lifestyle mod to stent placement whether the "lifestyle" group receives a lot of coaching and encouragement. <br/><br/>Often in trial situations the participants are followed up frequently and make a lot of effort to change. As you point out, in real life you get a couple of peices of paper shoved at you and sent on your way -- with predictable results.<br/><br/>So my question would be, is the interventionist procedure more effective when compared to the miserable level of compliance you'd see in real life, as compared to compliance in a group of closely coached patients. I would be interested to know if in these trials comparing lifestyle mod to stent placement whether the “lifestyle” group receives a lot of coaching and encouragement.

Often in trial situations the participants are followed up frequently and make a lot of effort to change. As you point out, in real life you get a couple of peices of paper shoved at you and sent on your way — with predictable results.

So my question would be, is the interventionist procedure more effective when compared to the miserable level of compliance you’d see in real life, as compared to compliance in a group of closely coached patients.

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