April 2012 references and further reading

Qaseem A, Alguire P, Dallas P, Feinberg LE, Fitzgerald FT, Horwitch C, Humphrey L, LeBlond R, Moyer D, Wiese JG, Weinberger S. Appropriate use of screening and diagnostic tests to foster high-value, cost-conscious care. Annals of Internal Medicine 2012; 156:147-49. Cooper PN, Westby M, Pitcher DW, Bullock I. Synopsis of the National Institute for Health and Clinical Excellence Guideline for management of transient loss of consciousness. Annals of Internal Medicine 2011; 155:543-49. Chen J, Normand SL, Wang Y, Krumholz HM. National and regional trends in heart failure hospitalization and mortality rates for Medicare beneficiaries, 1998-2008. Journal of the American Medical Association 2011; 306:1669-78. (Locked) More »

Overuse, underuse, and valuable use

Most doctors do not misuse the resources available to them, but the potential for overuse exists. Informed patients should be aware of this and be prepared to question the necessity of tests or treatments. Sometimes raising such issues motivates a physician to consider alternative — perhaps even better — approaches. More »

What's at the heart of fainting?

About 15% of fainting episodes are related to heart rhythm problems, including the abnormally slow heartbeat known as bradycardia. Blockages in arteries supplying the heart and heart muscle malfunctions can also temporarily disrupt the flow of blood to the brain and cause fainting. Treatment options might include medications to control abnormal heart rhythms, a pacemaker if your fainting is caused by an abnormally slow heartbeat, or an implantable cardioverter-defibrillator if a more serious rhythm problem exists. (Locked) More »

Tales of two heart failures

Incidence of heart failure is split about evenly between two types. One is a problem with the pumping phase of each contraction. It is called systolic heart failure. The other is a problem during the refilling phase, called diastolic heart failure. In systolic heart failure, the heart muscle stretches out and weakens so that when the heart contracts, the proportion of blood pushed out is lower than it should be. People with diastolic heart failure have the opposite problem — the heart muscle is too rigid. It doesn't completely relax when at rest and so can't refill completely with blood.  (Locked) More »

Blood clots: The good, the bad, and the deadly

Blood clots inside the body can be dangerous, especially if a clot blocks an artery supplying the heart, or forms in one location and then is carried through the bloodstream to a lung or the brain. Researchers are constantly looking for ways to prevent platelets from sticking together and to interrupt the clotting cascade at one or several of its stages. Two classes of drugs that accomplish those objectives — termed antiplatelets and anticoagulants, respectively — are frequently called blood thinners. If you already have cardiovascular disease or compelling risk factors for it, you may already be taking one or more of these anticlotting drugs. If you're not, ask your doctor whether you should be. (Locked) More »

Gut microbes may affect heart disease risk

Researchers are exploring a possible link between gut microbes that live in the digestive system and the development of atherosclerotic plaque. Researchers from the Cleveland Clinic first took blood samples from two groups of people, those who had recently had a heart attack or stroke and those who hadn't. Blood from those with cardiovascular disease carried higher levels of choline, betaine, and trimethylamine N-oxide (TMAO). All three are breakdown products of lecithin, a dietary fat. In step two, the researchers determined that the body converts dietary lecithin and choline into TMAO. They also determined that feeding mice lecithin or choline promotes the development of atherosclerotic plaque. To identify the source of TMAO production, the researchers gave mice a course of antibiotics, which wipes out many gut bacteria. When these mice were fed a diet rich in lecithin, they didn't make TMAO, and there was no increase in atherosclerosis. (Locked) More »

No beef with beef if it's lean

Red meat can be an acceptable part of a healthy diet, as long as it is very lean and is eaten in small amounts along with fruits, vegetables, and whole grains. (Locked) More »