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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Lying in a hospital bed while awaiting heart surgery, I looked at my teen daughter and my parents, then smugly pointed out the irregular slashes on the cardiac monitor. "See these?" I said. "They're called PVCs. My doctor is going to fix them. Make them all go away." The asymmetrical rhythm, a frequent and annoying pattern of multiple skipped heartbeats, had plagued me for the last three years, despite my swearing off ...

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The use of artificial intelligence in medicine is generating great excitement and hope for treatment advances. AI generally refers to computers’ ability to mimic human intelligence and to learn. For example, by using machine learning, scientists are working to develop algorithms that will help them make decisions about cancer treatment. They hope that computers will be able to analyze radiological images and ...

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Artificial intelligence is incredibly buzzy in health care right now, and for a good reason. Other industries are already experiencing AI-enabled radical transformations, like real-time fraud monitoring and detection in banking and finance and instantaneous image recognition across the web and social media. Health care now stands similarly positioned to capitalize on the transformative power of machine learning, and the massive potential is driving levels of investment expected to
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The storage capacity of the human mind is amazing. One estimate of the size of the brain’s “RAM” is as high as  2.5 petabytes (a million gigabytes). The number is based on the total number of neurons in the brain and the total number of possible connections per neuron. I suspect it is an overestimate, given the vagaries and innate inefficiency of biological systems. Nevertheless, the true figure is ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 52-year-old woman is evaluated for a 6-week history of chest pressure. The symptom occurs when she walks up an incline on her daily 2-mile walk and is relieved with rest. She also had chest pressure during a stressful meeting at work last week. She reports no associated symptoms. ...

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A 67-year-old woman with a high-stress job had a vigorous disagreement with her neighbors last week. She developed severe substernal chest pain and called 911 fearing a heart attack. She is thin, has never smoked, has normal blood pressure and normal cholesterol. She is not a diabetic and runs on a treadmill for two hours at five miles per hour with an elevation for two hours four times a week. ...

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Prevention of heart disease has centered on smoking cessation, controlling blood pressure, achieving an appropriate weight, regular exercise, control of blood sugar, and control of your cholesterol.  Despite addressing and controlling these items, individuals still have heart attacks and strokes and vascular events. Researchers are now directing their attention to a dietary metabolite of red meat called trimethlamine N-oxide or TMAO. Recent peer-reviewed and published studies have shown ...

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