Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 62-year-old man is evaluated during a routine visit. He is asymptomatic and walks 1 mile most days of the week. Medical history is significant for aortic stenosis, type 2 diabetes mellitus, hypertension, and hyperlipidemia. Medications are aspirin, metformin, lisinopril, metoprolol, and rosuvastatin. On physical examination, the patient is afebrile, blood pressure is ...

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It would appear that I was a much more efficient cardiologist 20 years ago at age 50.  I had my share of the “worried well” -- patients with non-cardiac chest pains, benign palpitations, innocent murmurs and normal variation EKGs.  In most cases, a focused cardiac history and physical followed by some words of reassurance resolved the problem. For those with more serious cardiac problems, a battery of tests such as echocardiograms, ...

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It has occurred to me that this is a terrible idea. In fact, it’s possibly the least beneficial thing for the general health of a population to have gained momentum in recent years. I’m not discussing cigarettes or e-cigarettes or low-yield cancer screening procedures. I’m not talking about diet drinks or sugary drinks. I’m talking about home blood pressure monitoring. It’s a terrible idea. OK, I get it. The idea sounds benign. Buy your own ...

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My father recently visited his internist with complaints of vague chest symptoms and was referred to a cardiologist who recommended coronary CT, ultrasonography, and angiography.  A cardiac workup would seem to be a reasonable course of action given that he has a history of coronary artery disease (CAD) with prior angioplasty. However, upon further exploration, I felt that his chest symptoms were due to stress and were not of cardiac origin.  ...

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After having an echocardiogram recently, I saw a cardiologist, which seemed the prudent thing to do.  I was not symptomatic, and I think the echo was pretty much unremarkable -- to use a bit of doctor's lingo.  I saw the word "mild" here and there in the report describing processes of my heart's functions.  When you're over seventy-three, "mild" sounds pretty all right.  Better than the word "acute," I figure.  ...

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ZDoggMD has company.  Another physician rapper is in our midst: emergency medicine resident Christopher Hahn, over at the EMC.   Here's one about diagnosing cardiac tamponade by ultrasound.   I heart the rhymes!

I have previously written about a patient on this site: “How elderly patients can be stubborn to their own detriment.” In that post, I discussed how the patient repeatedly turned down appropriate therapy for her hypertension, saying she didn’t need the help.  Now I’m writing an update. Due to the patient’s refusal to accept treatment for her hypertension, despite counseling on the part of her cardiologist and primary care physician that ...

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It’s been over a year since my older sister Anna died, so I choke up less readily while speaking about it.  The raw anger is less, but the frustration of losing someone to a preventable medical mistake will always remain with me.   Anna was five years older than me, my only sister, and the one I often turned to for advice. We were close despite living 600+ miles apart.  She ...

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Recently, two significant pharmaceutical breakthroughs have resulted in a renewed debate about the costs of drug therapy. In the last year, a new drug class for the treatment of hepatitis C has been released by two different manufacturers and has been found to cure a once incurable chronic liver disease for nearly 90 percent of patients who are treated with a full course of therapy. The drug appears to be ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 58-year-old man is evaluated during a routine appointment. He is asymptomatic. He was diagnosed with type 2 diabetes mellitus 4 years ago and has hypertension, dyslipidemia, and obesity. His medications are enteric-coated low-dose aspirin, lisinopril, fluvastatin (20 mg/d), and metformin. His calculated 10-year risk of atherosclerotic cardiovascular disease (ASCVD) using the Pooled ...

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