ProCor: Managing CVD

Lown RCTs (Random Clinical Thoughts): Medical technology—A deadly encounter

"Even after Ed's passing he continued to hone my skill as a doctor. Because of that experience, I spared numerous patients with slow heart rates the implantation of pacemakers. I was reluctant to send asymptomatic patients to be operated on unless the evidence was compelling that their survival was otherwise in jeopardy. Scientific evidence is all important but should not trump common sense"... Clinical Encounter

Spontaneous reversion to normal sinus rhythm in chronic atrial fibrillation

We have been taught that only recent-onset atrial fibrillation may revert spontaneously, and the longer the duration of atrial fibrillation, the more difficult it is to revert... Clinical Pearl

"F" waves and atrial fibrillation

Cardiologists have paid scant attention to "f" waves. It is generally taught that "f" wave amplitude reflects left atrial size... Clinical Pearl

Prolonged A-V conduction a factor in atrial fibrillation

Commonplace bedside observations frequently provide profound clinical insights. They may seem trivial, but searching for them hones diagnostic skills... Clinical Pearl

Atrial fibrillation and ischemic heart disease

Atrial fibrillation is deemed a serious arrhythmia and presumed to be associated with advanced coronary artery disease... Clinical Pearl

Pulmonary hypertension simulating angina pectoris

Angina pectoris is a stereotypical discomfort with a uniquely distinguishable pattern comprehended only by a carefully taken history... Clinical Pearl

How physicians should introduce patients to the use of nitroglycerin

I encourage patients with angina to take nitroglycerin freely. This is contrary to the prevailing culture in medicine... Clinical Pearl

Psychological conditioning of angina pectoris

It is a widely held view that angina pectoris results from a mismatch between restricted coronary artery blood flow and an increased myocardial workload... Clinical Pearl

Risk and long-term prevention of stent thrombosis in drug-eluting stents

Recent studies have validated the benefit and safety of drug-eluting stents. Clinical experience with DES and recommendations are summarized below... In Practice

Cardiac care in an ambulatory setting

The patient, a 75-year-old woman seen for the first time, was in severe congestive heart failure (CHF). She was so short of breath she could not lie down on the examining table. Her neck veins were distended, the legs edematous up to her knees, the liver palpated 10 cm below the coastal margin, and the chest examination was consistent with pleural effusions and congestion... Clinical Encounter

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