Question: I am a 46 yr old female. My problem is pvc and pac’s. I have had a stress test, persantine stress thallium, echo, and holtor monitor. All normal except holtor, doc say benign pvc and pac. 48 hr holtor showed 0.2 % pvc and 0.2 % pac. My question is why is it that some days are worst then …
Stenting for stable coronary artery disease is wrong!
In a January 4th, 2012 JAMA editorial, the authors describe that patients were not being helped by a variety of well-established procedures including stenting for stable coronary artery disease: “Percutaneous coronary intervention (stenting) performed for stable coronary artery disease… cost(s) billions of dollars and (has supported) the existence of (an) entire specialty for many years. Stable coronary artery disease accounted for …
Is HbA1c the gold standard for diagnosis of Diabetes?
HbA1c is not a sure-fire tool for Diabetes diagnosis.At the European Association for the Study of Diabetes meeting on HbA1c for diagnosis, many physicians did not trust glycated hemoglobin levels alone to diagnose diabetes, despite ADA guidelines. High-risk, pre-diabetic patients could be left untreated with an HbA1c of less than 6.5%, and a fasting Glucose or a Glucose tolerance test …
An Approach to Hypertension Treatment In The Elderly
Question: Is there a difference in the treatment of hypertension in the elderly? Answer: In clinic today, I saw an 85 year old woman with Parkinson’s disease for follow-up of her high blood pressure. Her pressures have been difficult to control. Today her BP is 170/80 with a heart rate of 62 bpm. She is taking an ACEi and a …
Medical therapy often superior than stenting
There is more and more evidence of the superiority of medical therapy over stenting, not only with coronary artery disease, but also with stenotic arteries in your brain: The 30-day rate of stroke or death associated with stenting (14.7%) is nearly 2.5 times as high as the 6% rate associated with stenting in high-risk patients with a 70 – 90 …
Left-main PCI is only appropriate for a minority of patients
An atricle published in Cardiovascular Business on November 8, 2011 is very much in-line with our previous publications on this website about optimal treatment of Coronary Artery Disease that includes a Left Main Stenosis and/or three vessel disease: SAN FRANCISCO—CABG is the preferred treatment strategy for patients with left main disease, according to Michael J. Mack, MD, president of the Society for Thoracic Surgeons …
Weight Gains After Dieting
As is well known, although restriction of diet often results in initial weight loss, more than 80 per cent of obese dieters fail to maintain their reduced weight. A new study from Australia involved 50 overweight or obese patients without diabetes in a 10-week weight-loss program using a very-low-energy diet. Levels of appetite-regulating hormones were measured at baseline, at the end of …
Physical Activity and Weight Gain Prevention
In a paper, published in JAMA in 2010, the association of different amounts of physical activity with long-term weight changes among women consuming a usual diet was examined. The amount of physical activity needed to prevent long-term weight gain is unclear. In 2008, federal guidelines recommended at least 150 minutes per week (7.5 metabolic equivalent [MET] hours per week) of …
Treatment of Chronic Kidney Disease (CKD) and multi-vessel CAD
CABG is associated with better survival than PCI with DES in patients with non Hemodialysis Dependent (HD) Chronic Kidney Disease (CKD) and multivessel CAD, but CABG patients have a greater short-term risk of needing permanent hemodialysis. A new study, published in the American Journal of Cardiology, compared the short- and long-term outcomes of coronary artery bypass grafting (CABG) and percutaneous …
Computed Tomography Coronary Angiography (CTCA) screening for Coronary Artery Disease
The major risk factors of inappropriate diet, physical inactivity, high cholestreol (> 250 mg%), high BMI (>26) and hypertension (>155 mmHg) and smoking, explain at least 75% of new cases of Coronary Artery Disease (CAD). In the absence of these risk factors, CAD is a rare cause of death. Two studies have addressed the issue of predicting the risk of …