MKSAP: 62-year-old man is evaluated during a routine visit
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 62-year-old man is evaluated during a routine visit. He is asymptomatic and walks 1 mile most days of the week. Medical history is significant for aortic stenosis, type 2 diabetes mellitus, hypertension, and hyperlipidemia. Medications are aspirin, metformin, lisinopril, metoprolol, and rosuvastatin.
On physical examination, the patient is afebrile, blood pressure is 130/66 mm Hg, pulse rate is 68/min, and respiration rate is 14/min. BMI is 29. Cardiac examination reveals a grade 2/6 early-peaking systolic mur...
Source: Kevin, M.D. - Medical Weblog - April 21, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Cardiology Diabetes Source Type: blogs
MKSAP: 26-year-old woman with a mechanical mitral valve prosthesis
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 26-year-old woman with a mechanical mitral valve prosthesis visits to discuss anticoagulation management during pregnancy. Her last menstrual period was 6 weeks ago and her pregnancy was confirmed by laboratory testing in the office. Her mitral valve was replaced 5 years ago. Her medications are low-dose aspirin, metoprolol, and warfarin (4 mg/d).
On physical examination, vital signs are normal. Cardiac auscultation demonstrates a normal mechanical S1. There are no murmurs or added sounds. Her INR is 2.6.
Whic...
Source: Kevin, M.D. - Medical Weblog - February 24, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Cardiology OB/GYN Source Type: blogs
Altered Mental Status, Bradycardia
911 was called for an elderly woman who fell and was confused. Medics found her unresponsive, with " convulsive " movements. They could not find a pulse. They performed CPR, gave epinephrine, and intubated the patient and regained a pulse, at which time she became responsive and had this prehospital ECG:On arrival, heart rate was 87 and she was hypotensive at 52/21, with a palpable pulse and cardiac function present on echo. She was intubated (by medics), but awake and alert and nodding to questions, shaking her head " no " to chest pain, headache, or SOB. Repeat pulse was slow and irregular.&...
Source: Dr. Smith's ECG Blog - February 19, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs
A fire, thick socks, and prebiotics to keep you warm
Here’s an interesting speculation: The microbes in bowel flora are metabolically active, generating heat. There are so many microbes inhabiting the human intestine that it is estimated that up to 70% of human heat (at rest) is generated by bowel flora.
In support of this argument, antibiotics have been found to reduce body temperature. Animals raised to have sterile intestines free of microorganisms also have lower body temperature. The pound or so of human bowel flora is therefore a virtual heat factory.
We know that feelings of being cold can be produced by common health conditions such as iodine deficiency, hypoth...
Source: Wheat Belly Blog - December 11, 2017 Category: Cardiology Authors: Dr. Davis Tags: Undoctored Wheat Belly Lifestyle bowel flora cold feeling cold Inflammation microbiota prebiotic probiotic Weight Loss Wheat Belly Total Health Source Type: blogs
Are there any good doctors?
Are doctors who follow “consensus guidelines,” rank high on quality standards set by hospitals, and adhere to rules set by the drug and medical device industries really providing “health”? Would you call a regimen of Lipitor, hydrochlorothiazide, aspirin, metoprolol, Prilosec, and Naprosyn “healthy” because it was prescribed by a “good” doctor?
Health is not provided by doctors; revenue-generating healthcare is provided by doctors–there’s a difference, a big difference.
Health is something you achieve on your own with results that are SUPERIOR to the results doc...
Source: Wheat Belly Blog - June 1, 2017 Category: Cardiology Authors: Dr. Davis Tags: Undoctored Wheat Belly Lifestyle diy healthcare prescriptions sick care Source Type: blogs
Chest Pain Diagnosed as Gastroesophageal Reflux
p.p1 {margin: 0.0px 0.0px 0.0px 0.0px; font: 11.0px Helvetica; background-color: #fefefe}A 50-something male presented to a clinic for one day of intermittent substernal chest and jaw pain. He had had several episodes of pain since onset; it was described as pressure-like and lasts about 5-15 minutes and resolves spontaneously. He had been pain free for about an hour. He had some " pre-diabetes, " but no h/o hypertension, no known family history of heart disease, and he smokes about 1-2 cigarettes per day. An ECG was recorded:The computer read:Normal ECGWhat do you think?Smith Comment:Th...
Source: Dr. Smith's ECG Blog - May 29, 2017 Category: Cardiology Authors: Steve Smith Source Type: blogs
MKSAP: 57-year-old man is seen after results of a carotid ultrasound
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 57-year-old man is seen for follow-up evaluation after results of a carotid ultrasound obtained to investigate a left neck bruit show a mixed density plaque at the origin of the left internal carotid artery. Stenosis is estimated to be 60% to 80%. He has had no focal neurologic symptoms or visual loss. The patient has coronary artery disease (CAD) with stable angina, hypertension, dyslipidemia, type 2 diabetes mellitus, and mild kidney failure. He has a 30-pack-year smoking history but stopped smoking 7 years ...
Source: Kevin, M.D. - Medical Weblog - May 6, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Heart Source Type: blogs
MKSAP: 68-year-old man with new-onset ascites
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 68-year-old man is evaluated for new-onset ascites with lower-extremity edema. Symptoms have increased gradually over the past 4 weeks. He has consumed three alcoholic beverages per day for many years. His medical history is notable for coronary artery bypass graft surgery 8 months ago and dyslipidemia. His medications are low-dose aspirin, atorvastatin, and metoprolol.
On physical examination, temperature is 36.8 °C (98.2 °F), blood pressure is 122/84 mm Hg, pulse rate is 64/min, and respiration rate is 16/...
Source: Kevin, M.D. - Medical Weblog - April 22, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions GI Source Type: blogs
An unstable wide complex tachycardia resistant to electrical cardioversion
CONCLUSIONS:p.p1 {margin: 0.0px 0.0px 0.0px 0.0px; font: 11.9px Arial; -webkit-text-stroke: #000000; background-color: #ffffff} p.p2 {margin: 0.0px 0.0px 0.0px 0.0px; font: 17.2px Arial; -webkit-text-stroke: #000000; background-color: #ffffff} p.p3 {margin: 0.0px 0.0px 0.0px 0.0px; font: 12.9px Arial; color: #660066; -webkit-text-stroke: #660066; background-color: #ffffff} p.p4 {margin: 0.0px 0.0px 0.0px 0.0px; font: 14.0px Arial; color: #660066; -webkit-text-stroke: #660066} p.p5 {margin: 0.0px 0.0px 0.0px 0.0px; font: 14.0px Arial; color: #660066; -webkit-text-stroke: #660066; min-height: 16.0px} p.p6 {margin: 0.0px 0.0p...
Source: Dr. Smith's ECG Blog - February 22, 2017 Category: Cardiology Authors: Steve Smith Source Type: blogs
A Young Man with Recurrent Chest Pain and Dyspnea with Exertion
CaseThis is a young man who has had chest pain and dyspnea with exertion for years. He presented to the ED with these symptoms again. On this occasion, the CP was associated with stress and accompanied by some SOB, 7/10 at it ' s worse and made worse with activity, with radiation up into the left side of his neck and face.No h/o hypertension.Here is the ECG:Probable Diagnosis?I was shown this ECG and gave my opinion, as below.Here is an ED bedside echo, parasternal long axis:Look at the small the end-systolic LV chamber sizeParasternal short axis:Again, look at the end-systolic chamber size!What is the Diagnosis?...
Source: Dr. Smith's ECG Blog - November 29, 2016 Category: Cardiology Authors: Steve Smith Source Type: blogs
Drug names need to be simplified for our patients ’ safety
The patient’s heart was beating dangerously slowly, and his EKG showed third-degree AV block: His heart’s electrical system had completely shut down in the middle. If this were TV, the doctors would have started shouting “Epi!” and “Get the pads!” immediately. This was real life, though, so his team decided to briefly sit down with him to try to determine why his heartbeat had slowed so dramatically. Was it something that could be reversed without the need to surgically implant a pacemaker?
Yes, as it turns out, the patient had been taking metoprolol for years, a blood-pressure pill with the potential to ...
Source: Kevin, M.D. - Medical Weblog - November 29, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/rahul-banerjee" rel="tag" > Rahul Banerjee, MD < /a > Tags: Meds Medications Source Type: blogs
Are these prescription drugs preventing your weight loss?
A number of drugs prescribed to treat common conditions, such as hypertension, allergies, depression, inflammation, and diabetes, block your ability to lose weight. Several of these drugs actually cause weight gain, and most doctors fail to inform their patients of such side effects. Among the drugs that block weight loss are:
Beta-blockers: metoprolol, atenolol, carvedilol, and propranolol
Antidepressants: amitriptyline (Elavil), nortriptyline (Pamelor), doxepin, paroxetine (Paxil), trazodone, and others
Steroids: prednisone and hydrocortisone (but not inhaled or nasal steroids for allergies)
Antihistamines: diphenhydr...
Source: Wheat Belly Blog - September 13, 2016 Category: Cardiology Authors: Dr. Davis Tags: Depression Dr. Davis Drugs and wheat Nutritional supplements Weight loss Wheat Belly Wheat Belly Lifestyle Wheat Belly Total Health Wheat-Free Lifestyle anxiety Source Type: blogs
Oh So Quietly, Evidence of Bad Health Care Corporate Leadership Accumulates - Three AstraZeneca Settlements
While the news media is distracted by seemingly more spectacular issues, we hear the steady drip, drip, drip oflegal cases suggesting just how systemically bad the leadership of big health care organizations is. From February 2015 to now, for example, there have been three cases involving multinational pharmaceutical giant AstraZeneca.Settlement of Allegations of Kickbacks to Give AZ Drugs Preferred Status in FormulariesFirst, in February 2015, reported in most detail by Ed Silvermanin the Wall Street Journal,AstraZeneca has agreed to pay the federal government $7.9 million to settle allegations the drug maker paid k...
Source: Health Care Renewal - September 8, 2016 Category: Health Management Tags: AstraZeneca bribery deception impunity kickbacks legal settlements Source Type: blogs
MKSAP: 57-year-old man with substernal chest pain
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 57-year-old man is admitted to the hospital for evaluation of substernal chest pain. His medical history is significant for type 2 diabetes mellitus, coronary artery disease, hypertension, and hyperlipidemia. He manages his diabetes as an outpatient with diet, exercise, and metformin. His other medications are aspirin, metoprolol, atorvastatin, and sublingual nitroglycerin as needed. His inpatient plasma glucose values are 170 to 210 mg/dL (9.4-11.6 mmol/L). Results of all other laboratory studies are normal.
...
Source: Kevin, M.D. - Medical Weblog - August 27, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Diabetes Endocrinology Source Type: blogs
An Unusual Tachycardia
This Case was sent by Atif Farooq and Scott Weingart, from Stony Brook.This is a 70-something with history of CABG who presented with 30 minutes of SOB and palpitations.Here is his ECG:What is it?Atif wrote this:" My first thought was perhaps a bidirectional V Tach, though the pt is not on digoxin and otherwise has no discernable reason to be in BVT. Scott was considering maybe an intermittent aberrant conduction, though we thought it odd for it to be strictly alternating beats.Here is my answer:Atif,Interesting EKG!I think it is SVT with every-other-beat-aberrancy. --Every QRS comes right on time, perfectly regu...
Source: Dr. Smith's ECG Blog - August 24, 2016 Category: Cardiology Authors: Steve Smith Source Type: blogs
