Although I have never been a big fan of modeling studies, viewing their appropriate role as hypothesis-generating rather than clinical decision-supporting, a study published in the Annals of Internal Medicine deserves kudos for trying to do what neither the American College of Cardiology/American Heart Association nor the U.S. Preventive Services Task Force did in their respective guidelines on primary prevention of cardiovascular disease for adults ...

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I’ve just discharged a kid with a cough, and there are no patients waiting to be seen. “I’ll be back,” I tell the nurse, as I slip away to the hospital kitchen and unlock the door. I steal two frozen grilled cheese sandwiches from the freezer and throw them into the microwave. Minutes later, I’m in the call room. I take a couple of bites and can already feel acid rising ...

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During a day of shadowing during my first year of medical school, the physician I was following had been running behind schedule and instructed me to keep the final patient company until he caught up. I knocked on the door and found myself facing a wide-eyed, middle-aged man staring down apprehensively at his severely bloated stomach. As I asked the patient what was going on, he suddenly looked up at me and ...

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Everything in life starts as a dream. Big or small. My dream was to become a physician since I was quite young — the first one in my family to walk the path. I wanted to understand the science of the human body and help the sick. Heal with my skills, knowledge, and empathy. Hold my patients’ hands with care and confidence. My work was to be like none other. ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 59-year-old man is evaluated during a routine examination. He feels well and has no symptoms. Medical history is significant for hypertension. He does not smoke, and he does not have diabetes mellitus. He is active, performing aerobic exercise for 20 to 30 minutes four times per ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 60-year-old man is evaluated for a 5-month history of exertional chest discomfort that improves with rest. His symptoms have progressively worsened such that he has reduced his activity to a minimum. Medical history is significant for hypertension and hyperlipidemia. Medications are low-dose aspirin, losartan, hydrochlorothiazide, and atorvastatin. On physical ...

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One of the advantages of practicing clinical medicine, and seeing patients daily for many years, is you develop your own long-term study regarding certain medical health issues. In the area of hypertension, I have been taught by the best since my internship with pioneers such as Eliseo Perez Stable and Barry Materson at the University of Miami affiliated hospitals, Jackson Memorial Program, ensuring that their trainees were up to the ...

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I scribbled my signature on a pharmaceutical rep’s iPad today for some samples of Jardiance, a diabetes drug that now has expanded indications, according to the Food and Drug Administration. This drug lowers blood sugar (reduces HbA1c by less than 1 point) but also reduces diabetes-related kidney damage, heart attacks, strokes and now also admission rates for heart failure (from 4.1% to 2.7% if I remember correctly – a significant ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 67-year-old man is evaluated for a carotid bruit detected on routine medical examination. He reports no history of previous focal neurologic symptoms or visual loss. He has type 2 diabetes mellitus and hyperlipidemia treated with metformin, moderate-intensity pravastatin, and aspirin. On physical examination, blood pressure is 128/64 mm Hg, ...

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What is the unspoken fatal epidemic of our time? And the greatest predictor of overall health, happiness, job satisfaction, and resiliency? Loneliness. As a clinical cardiologist, I am committed to the health and well-being of my patients. As a recovering burned-out physician who suffered in silence for years while hiding this so well from others, I am committed to finding solutions to help my partners suffering so often in silence. As a husband, ...

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Being a cardiologist, the most frequent question coming my way for the last few years is “Doc what do you think about the “keto” [ketogenic] diet.” All foods contain both micronutrients and macronutrients that are essential for the body to function optimally. The human body requires macronutrients in large amounts, which include carbohydrates, proteins, and fats. These nutrients provide energy for your body in the form of calories. Micronutrients are nutrients ...

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My 83-year-old patient had outlived peoples' expectations on several occasions. Faced with a critical illness three years ago, she underwent emergency surgery and spent several months in the hospital with a series of complications, including septic shock, renal failure, and hospital-acquired pneumonia. I'd seen her in the office for a new visit soon after she was discharged. It took nearly 20 minutes to go through her history before walking into the ...

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I woke up to him, pacing the bedroom. Within an hour, I was pacing the ER at his bedside. Our experience at one of the country's best-ranked hospitals lasted only three days before we were discharged home. What led us there will last a lifetime in our minds. When faced with your own mortality (or that of your husband's), you are forever changed. We are grateful for his continued recovery from myopericarditis. ...

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An excerpt from Heart To Beat: A Cardiac Surgeon’s Inspiring Story of Success and Overcoming Adversity―The Heart Way. What if we approached life’s challenges and setbacks like our own hearts continuously strive to meet the demands of our body—unrelenting, constant effort, and action even in dire circumstances? Rather than shying ...

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The health challenge recently faced by Sen. Bernie Sanders has brought two issues to the forefront of the 2020 presidential election. Should there be a disqualifying upper age limit to become president, and should an existing health issue preclude a candidate from running for president? As scientists in the field of aging, we cannot tell the voting public how to answer these questions. What we can do is inform you about ...

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A professor recently romanticized my idea of clinical reasoning as he began our session by saying, "When you're a physician, you're a detective." He elaborated: "Every fact you have, every piece of evidence you have, must be consistent with your leading diagnosis." As he said this, my eyes narrowed, and I sat up a little taller. My fellow first-year medical students and I have begun our official training in clinical reasoning, ...

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Smoking was cool. And he started smoking at the age of 15. Two packs a day — every day. When he was 32 years old, we had our first-born son. And he decided to quit cold turkey. But the damage was done. Somehow, someway, it would catch up with him in devastating ways. By the time my husband was 66 years old, he developed shortness of breath and chest pain. With exertion and without ...

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The Skeptical Cardiologist was recently greeted by headlines announcing that an international panel of 14 unbiased researchers had concluded that it was OK for humans to continue eating red meat and processed meat at current levels. The startling news was a reversal of what the Dietary Guidelines for Americans, the American Heart Association, and the American Cancer Society have ...

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On Saturday morning at the breakfast table surrounded by my husband and kids, I suddenly felt chest pain, palpitations, and was about to collapse. Being an internist, I knew it: arrhythmia. Paramedics at arrival confirmed it. I was running ventricular tachycardia. Out of the chaos surrounding me at that moment, my physician's brain assessed the situation: "VT. Serious arrhythmia." After that, I lost it. I became a scared-to-death patient who has a ...

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Dr. Ryme had been retired at least thirty years from medicine when he met me, his last pupil. I was a freshly minted doctor, and he became the first teacher of a new course at my new school called “Life as an Independent Doctor.” At our first office visit, after telling me his life story, he quizzed me, “And furthermore, Dr. Braun, you’re an attending physician now. You are no longer ...

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