A middle aged patient whom I have seen in the past for benign palpitations called today because of atypical chest pain. Although I have criticized the overuse of nuclear imaging studies, and probably order the fewest of any cardiologist in the city, there are times when they are appropriate --this was one of those occasions. Symptoms did not rise to the level of an invasive angiogram, but could not be ...

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He is 93 and has numerous medical problems, most of which involved aging blood vessels, as well as multiple orthopedic issues, including compression fractures and diffuse arthritis. The bony issues have resulted in a severely compromised mobility of late. Despite ongoing treatment with both aspirin and clopidogrel, he presents after numerous hours of focal neurologic symptoms. A CT scan shows no evidence of bleeding and the diagnosis is a major stroke ...

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Dysrhythmias like atrial fibrillation (AF), more often than not, require medical therapy. The dreaded blood thinner, warfarin (Coumadin) comes to the fore often. In aggregate, I have likely spent months of my life discussing the risks and benefits of this much maligned drug. Common rat poison is made from the same ingredients as warfarin -- only rats keep eating it and die days later of bleeding, while humans have the blood ...

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While typing words, the advertisement for yet another hospital is overheard from the TV. "Ignore it John," I think to myself, but, it is impossible to not look up and see. The head shakes with a smirk, like my grandfather did and without words displeasure was easily conveyed. Do people really think the graphical professionalism of a TV spot is even remotely an accurate metric of quality of medical care? At work, ...

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Middle age introduces itself in many ways; one is atrial fibrillation. Youth, vigor and a medically-problem free life was seemingly right there in the recent past. A rhythm doctor often hears this suddenness of onset described as "Doc, yesterday, I was fine." As is always the case for a first episode of an arrhythmia, yesterday, you were fine, but today is indeed a new day. It happened during a bike ride. ...

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During residency, there was always a case of misdiagnosed chest pain to discuss in conference.  Incorrectly sending a patient home and missing the diagnosis of cardiac chest pain was an infrequent, but repetitively observed, phenomenon. So as to tread carefully with words, it is sufficient to say that even now, chest pain triage remains a vexing problem. Chest pain diagnosis is like appendicitis; there are always small numbers of unusual cases in ...

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Conflicted am I on reading of the strategy of a group of South Miami cardiologists who have written their patients complaining of the cuts to reimbursement, primarily cuts in imaging procedures. A tension emerges from within upon reading the following quote from a "healthcare expert." "I'm not at all sympathetic with the cardiologists,'' said Robert Berenson, a doctor who was once in charge of Medicare payment policy and now is a ...

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Here are two vignettes illustrating the failure of doctors to master the obvious and maybe a window onto the future struggles to control medical costs. A 90-year old is referred for care due to "end stage dementia." End-stage dementia is medical speak and as such does not really convey the appropriate imagery. It means a skeletal man, in a wheelchair or mostly in bed, with diapers, who has does not know ...

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