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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Meet the courageous doctor who shoved a catheter all the way up his arm and into his own heart to prove that cardiac catheterization in a live human being was possible.  Produced by Fusion.

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 33-year-old woman is evaluated as an outpatient following an episode of atrial fibrillation. The episode resolved shortly after she arrived at the emergency department. She has a history of tetralogy of Fallot with repair performed at the age of 4 years. On physical examination, blood pressure is 110/70 mm Hg, pulse rate ...

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The doctor sprinted to the side of the bed and slapped her interlaced hands over the man’s heart.  What made his heart stop remained a mystery, but she knew she had to get it beating again. She pushed her hands into his chest, an internal metronome pacing her efforts. After every few pumps, she glanced up at the cardiac monitor. Still no pulse. “Well, it’s obvious why he’s dying, isn’t it?” ...

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Mr. J was as close to a typical sixty-year-old patient as possible, wary of doctors and selective in when he took his blood pressure medications. On a sunny Thursday, he woke up nauseated and called an ambulance. During evaluation in the emergency room, his blood pressures reached atmospheric levels (nearly 300 systolic). He began seizing, which soon stopped and was transferred to the ICU. As the admitting resident, I dutifully ...

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There were several news stories recently that reported that Pfizer had abandoned its efforts to have its Lipitor brand of atorvastatin made available over the counter (OTC), without a prescription. I was never a big fan of OTC statins, but I was struck by the reason that Pfizer put out:

The study did not meet its primary objectives of demonstrating patient compliance with the direction to check their low-density lipoprotein cholesterol ...

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shutterstock_180109973 There has been concern for several years about commonly prescribed antacid drugs called proton pump inhibitors (PPIs) and the heart.  PPIs are used to treat gastroesophageal reflux disease (GERD), peptic ulcer disease, and other acid-related diseases.  Common drugs in the PPI class are omeprazole (Prilosec), esomeprazole (Nexium), pantoprazole (Protonix), lansoprazole (Prevacid), and dexlansoprazole (Dexilant), among others. Specifically, there is a potential interaction ...

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