Cardiology

Unraveling The Mysteries of Prinzmetal’s Angina: What Is It And How Do We Diagnose It?

October 8, 2014
Unraveling The Mysteries of Prinzmetal’s Angina: What Is It And How Do We Diagnose It?

By Anjali Varma Desai, MD

Peer Reviewed

Mr. Q is a 55-year-old male smoker who presents with recurrent chest pain in the mornings over the past several months. The patient reports being awakened from sleep at approximately 5:00 a.m. each morning with the same diffuse chest “pressure.” The pain typically lasts on the order of minutes, resolves, and then recurs at five-minute intervals in the same fashion for a total duration of two hours. The pain always occurs at rest and is never precipitated…

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From the Bellevue Wards: Wellens’ Syndrome Revisited

September 18, 2014
From the Bellevue Wards: Wellens’ Syndrome Revisited

By Matthew Shou Lun Lee, MD

Peer Reviewed

Clinical Questions

-How common are elevated cardiac enzymes during Wellens’ syndrome?

-Can the EKG changes in Wellens’ syndrome be found with other causes?

Background

This post represents a follow-up to the 2009 article in Clinical Correlations by Dr. Erin Ducharme .

Wellens’ syndrome refers to a distinctive combination of clinical and EKG findings in unstable angina associated with high-grade lesions of the left anterior descending artery (LAD) . Initially described in 1982, the criteria has undergone…

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Caffeine and the Risk of Atrial Fibrillation

June 6, 2014
Caffeine and the Risk of Atrial Fibrillation

By Joshua Michael Lader, MD

Peer Reviewed

As physicians, we are frequently asked to weigh-in on dinnertime discussions about topics that, despite their relevance to everyday life, were never formally addressed in our medical training. For example, at a recent family gathering the conversation turned to a 78 year-old uncle who was recently diagnosed with atrial fibrillation. While this uncle had longstanding and likely poorly controlled hypertension, he would also typically drink 4 to 5 cups of coffee between breakfast and lunch. The debate then…

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New Cholesterol Guidelines: How Safe Are High-Potency Statins?

May 14, 2014
New Cholesterol Guidelines: How Safe Are High-Potency Statins?

By Molly Anderson

Peer Reviewed

Managing hyperlipidemia is a mainstay of cardiovascular risk reduction. The 2013 ACC/AHA guidelines no longer target specific low-density lipoprotein (LDL)-cholesterol levels, but recommend lipid-lowering therapies of varying intensity based on the predicted risk of cardiovascular events . Adoption of the new guidelines would result in millions more Americans receiving high-potency statins; it is therefore important to investigate potential dangers associated with aggressive therapy and the long-term implications for patients.

Many studies have shown that strict adherence to lipid-lowering medications improves…

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The Yolk Or The Egg

February 27, 2014
The Yolk Or The Egg

By Nicole A. Lamparello, MD and Molly Somberg, MD, MPA

Peer Reviewed

You hear it wherever you eat, whether at the deli ordering a breakfast sandwich or at the diner for Sunday brunch, “Egg whites only, please.” For the last decade, there has been a strong movement toward avoiding egg yolks; instead people are opting for only the ‘healthier’ egg white when ordering or cooking their breakfast.

However, are egg whites truly ‘healthier’ than eating whole eggs? What is the basis for this decision being…

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Should Beta-Blockers Be Used In The Setting Of Cocaine-Related Chest Pain?

February 5, 2014
Should Beta-Blockers Be Used In The Setting Of Cocaine-Related Chest Pain?

By Matthew A. Haber

Peer Reviewed

The following is a hypothetical example of a classic exam question that one might come across as a medical student:

A 50-year-old male presents to the emergency department with severe chest pain. His past medical history is significant for congestive heart failure and stent placement. His vitals are significant for a blood pressure of 220/110 and a heart rate of 170. On physical exam he appears to be profusely sweating, and his pupils are markedly dilated. Troponin I is…

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How Much Do We Know About HDL Cholesterol?

January 29, 2014
How Much Do We Know About HDL Cholesterol?

By Gregory Katz, MD

Peer Reviewed

As levels of HDL cholesterol increase, rates of heart disease go down. It’s this fact that has given HDL its reputation as the “good cholesterol,” serving a crucial role in reverse cholesterol transport. According to our models, HDL ferries cholesterol away from our arteries – where its buildup leads to heart disease and stroke – and back towards our liver, safely out of harm’s way. The epidemiology backs this up: people with higher levels of HDL tend to…

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From The Archives: Fast Hearts and Funny Currents, Part 2: Is Tachycardia Part of the Problem in Heart Failure?

January 9, 2014
From The Archives: Fast Hearts and Funny Currents, Part 2: Is Tachycardia Part of the Problem in Heart Failure?

Please enjoy this post from the archives dated May 25, 2011

By Santosh Vardhana

Faculty Peer Reviewed

Please review Part 1 of this article here.

Mr. M is a 63-year old man with a history of coronary artery disease and systolic congestive heart failure (ejection fraction 32%) on lisinopril, metoprolol, and spironolactone who presents to the Adult Primary Care Center complaining of persistent dyspnea with exertion, two-pillow orthopnea, and severely limited exercise tolerance. His vital signs on presentation are T 98.0˚F, P…

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From The Archives: Fast Hearts and Funny Currents: Is Tachycardia Part of the Problem in Heart Failure? Part 1

December 12, 2013
From The Archives: Fast Hearts and Funny Currents: Is Tachycardia Part of the Problem in Heart Failure? Part 1

Please enjoy this post from the archives dated May 18, 2011

By Santosh Vardhana

Faculty Peer Reviewed

Mr. M is a 63-year-old man with a history of coronary artery disease and systolic CHF (ejection fraction 32%) on lisinopril, metoprolol, and spironolactone who presents to Primary Care Clinic complaining of persistent dyspnea with exertion, two-pillow orthopnea, and severely limited exercise tolerance. His vital signs on presentation are T 98.0º F, BP 122/76, HR 84 bpm. What are his therapeutic options?

A Race Against…

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BREAKING NEWS: New ACC/AHA Guidelines on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults

November 13, 2013
BREAKING NEWS: New ACC/AHA Guidelines on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults

By Sherif Shoucri, MD

Yesterday, the American College of Cardiology and American Heart Association released new groundbreaking guidelines on the treatment of blood cholesterol. These recommendations, which officially drop LDL target levels for patients on statin therapy, will fundamentally alter the way most primary care physicians and cardiologists treat hyperlipidemia. After reviewing the available data on statins, the authors concluded that there was no evidence to support an LDL target of either 70 or 100. Rather, patients should be placed on either moderate-intensity (lowers…

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The Complicated Story of Saturated Fat

November 8, 2013
The Complicated Story of Saturated Fat

By Gregory Katz, MD

Faculty Peer Reviewed

Everyday in clinic, we tell our patients to choose foods low in saturated fat. Because these foods raise plasma cholesterol, the thinking goes, they cause heart disease. Today, every major medical organization – from the American Heart Association to the Harvard School of Public Health to the USDA – recommends a diet low in saturated fat to prevent and treat heart disease. The fat-cholesterol-heart disease connection is so thoroughly integrated into both medicine and popular culture…

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To Stent or Not to Stent?

November 6, 2013
To Stent or Not to Stent?

By Anish Vani

Faculty Peer Reviewed

According to the 2010 Heart Disease and Stroke Statistics update of the American Heart Association, there are 17.6 million Americans living with coronary heart disease (CHD) . Fortunately, mortality from heart disease is on the decline in the United States and in countries with advanced health care, likely due to better management of acute coronary syndrome (ACS) and a reduction in lifestyle risk factors such as smoking. However, for the millions of Americans with stable ischemic heart disease (SIHD),…

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