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Media, News & Topics on prevention, diagnosis & treatment of cardiovascular disease
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Impact of Delay to Reperfusion on Mortality in ST-Segment Elevation Heart Attacks

Impact of Delay to Reperfusion on Mortality in ST-Segment Elevation Heart Attacks | Heart and Vascular Health | Scoop.it

In patients with large anterior myocardial infarction undergoing relatively early reperfusion, longer delays to reperfusion were associated with larger IS and 1-year mortality, but not with reduced reperfusion success.

Seth Bilazarian, MD's insight:

In this trial that made an effort to evaluate the effect delay in treatment has on death in anterior STEMI's (the most serious & deadly of the heart attacks) there was a large difference in survival at 1 year between those that were treated within 3 hours and those that were not.  

The absolute risk reduction for death at 1 year was 5.2%.  That means that every 20 patients that come to the hospital and are treated within 3 hours of their heart attack symptoms there will be one life saved.  Early heart attack education, awareness and action are critical.  

If you have chest pain lasting more than 5 minutes call 911 for the earliest and most effective treatment.

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Influenza Vaccine

Influenza Vaccine | Heart and Vascular Health | Scoop.it
WHAT IS INFLUENZA?

Influenza, also called “the flu,” is caused by the influenza virus. It affects the lungs and can cause symptoms such as fever and trouble breathing. Most people recover from the flu on their own. But, in some people who are older or have long-term medical problems, the flu can be a serious or even deadly illness.

Influenza is a seasonal illness and affects most people during the winter months. In the United States, January and February tend to be the worst months for flu, but people can get the flu as early as October and as late as May. Each year the virus changes slightly, and the resulting different types of viruses are called strains. Some strains cause more serious illness than others. These strains are sometimes given special names, such as “swine flu” (H1N1) or “avian flu” (H5N1 and H7N9).

Seth Bilazarian, MD's insight:

The season for influenza vaccine is upon us.  Its never been easier to get a "flu shot" - available at pharmacies, senior & community centers and docotr's offices.  Get one today (if your over 6 months old).

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Consumer Updates > Blood Pressure Monitoring Kiosks Aren't for Everyone

Consumer Updates > Blood Pressure Monitoring Kiosks Aren't for Everyone | Heart and Vascular Health | Scoop.it
Correct cuff size is critical in measuring blood pressure. FDA is advising consumers that the cuffs on blood pressure kiosks in stores, pharmacies, gyms and other locations don't fit everyone and might not be accurate for all users.
Seth Bilazarian, MD's insight:

Measurement by a trained professional  (doctor, nurse or other trained person) is the best approach with blood pressure measurement in both arms. The cuff size is critical.  A cuff too large will cause blood pressure to be measured artificially lower than is accurate.  A cuff too small will give a falsely elevated reading.  Good quality home machines are an excellent option.  Added confidence is gained by validating the results on a home machine.   Bringing your device  to the physicin's office to confirm that the equipment and your use of the machine results in an accurate blood pressure measurement is easy and effective.

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Donovan Baldwin's curator insight, October 5, 2014 1:57 PM

I do not have huge arms, but, they are larger than the recommended size for most blood pressure cuffs. I have found that asking for a larger cuff brings my blood pressure readings down. Kiosks that measure blood pressure automatically raise my readings dramatically.

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What We Don't Know About Heart Disease Can Kill Us

What We Don't Know About Heart Disease Can Kill Us | Heart and Vascular Health | Scoop.it
People in the United Kingdom failed big time when they took a poll on risk factors for heart disease. Think you're more up to speed? Try our quickie quiz and find out.
Seth Bilazarian, MD's insight:

Are you smarter than a Brit?

Four simple questions to test your knowledge about risk factors and their relation to stroke and heart disease.

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Donovan Baldwin's curator insight, September 30, 2014 11:15 AM

Heart disease is a major killer in the U.S. and the UK. Heart health starts with knowledge, followed by action...in more ways than one. Regular, moderate exercise is one of our major defenses against heart disease.

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My Life Check - Life's Simple 7 Success Plan

My Life Check - Life's Simple 7 Success Plan | Heart and Vascular Health | Scoop.it

No matter where you stand, it’s never too late to make better choices for your health and we invite you to start a new life resolution now. All you need is a goal, a plan and the desire to live better. That’s why we created My Life Check and the Simple Seven. Thanks to the science and research volunteers of the American Heart Association, we have created a simple tool so you know where you stand on your road to good health. All of us need to practice these seven steps to live a heart-healthy life, and no one achieves heart health by accident.

To find out where you stand with the Simple Seven goals, just take the My Life Check assessment. In a few minutes, you will know how you’re doing with each one of Life’s Simple Seven. You will also get your own personal heart score and life plan. Your results will show you where you stand on the seven recommended areas of focus and will create an action plan that is customized to your lifestyle and health outlook. Your last step is a promise to yourself: a resolution to start making healthy, positive changes for a long, healthy future.

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The Ways to Avoid Feeling Off During Workouts

The Ways to Avoid Feeling Off During Workouts | Heart and Vascular Health | Scoop.it
How to explain a slow day of exercising? It's in how you eat, drink, sleep and think.
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Donovan Baldwin's curator insight, September 3, 2014 10:10 AM

 You always don't feel like you are getting your best from your workout...or doing your best. There can be many reasons for this. One of these might just be a lack of motivation. Check out these Reasons to Exercise, to remind yourself of the many benefits of exercise and have a better workout.

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Testing for “Silent” Coronary Heart Disease

Testing for “Silent” Coronary Heart Disease | Heart and Vascular Health | Scoop.it

Heart disease is the leading cause of death in the United States. Coronary heart disease refers to heart disease resulting from the buildup of plaque (collection of cholesterol, calcium, and other materials) in the coronary arteries (blood vessels) that supply blood to the heart.

Common symptoms of coronary heart disease include chest pain and trouble breathing, especially with activity. Many people who have coronary heart disease do not have any symptoms and therefore do not know they have problems with their heart. 

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Novel Wireless Devices for Cardiac Monitoring

Novel Wireless Devices for Cardiac Monitoring | Heart and Vascular Health | Scoop.it
It is likely that the cardiac patient of the future, “wired” with a personalized network of biosensors, will be extremely different from the usual patient today. These biosensors will transmit a wealth of data about the patient’s genomic, metabolomics, and clinical responses to daily stimuli to the patient’s smartphone peripheral brain. Once that information is received, the smartphone will process it using sophisticated and personalized modeling software and will direct the patient to take action, for example, to contact his or her physician, to adjust a medication, or to alert emergency medical services of an impending myocardial infarction. These devices have the potential to revolutionize medicine. The eventual integration and study of these devices in the coming years must carefully examine not only the relative safety and efficacy of this technology relative to conventional care but also the impact of this technology on changing the costs of health care by preventing rehospitalization and empowering patients.
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Lyme Disease with cardiac involvement

Lyme Disease with cardiac involvement | Heart and Vascular Health | Scoop.it

Lyme carditis occurs when Lyme disease bacteria enter the tissues of the heart. This can interfere with the normal movement of electrical signals from the heart's upper to lower chambers, a process that coordinates the beating of the heart. The result is something physicians call "heart block," which can be mild, moderate, or severe.

Heart block from Lyme carditis can progress rapidly.

The cases of three patient who had sudden death has been reported byCDC

 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6249a1.htm?s_cid=mm6249a1_w

Seth Bilazarian, MD's insight:

Lyme carditis is infrequent but probably under recognized.  I have seen this only once in my career despite living in the part of the country with the highest prevalence.


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Reducing the Risk of Heart Attack and Stroke

Reducing the Risk of Heart Attack and Stroke | Heart and Vascular Health | Scoop.it
Reducing the Risk of Heart Attack and Stroke using The American Heart Association/American College of Cardiology Prevention Guidelines

The authors review use of the ASCVD risk calculator repeatedly over several months to assess risk in a patient and provide positive feedback on the improving risk parameters and lowering of risk through a combination of both lifetstyle changes (diet with weight loss and exercise) and statin therapy.

Seth Bilazarian, MD's insight:

The point is well made that we see with patients who begin to have positive effects on blood pressure, lipids and glucose parameters when they have initial success with weight loss and exercise.  Before patient begin these lifestyle changes they have great skepticism but once patients see the positive impact (especially in fasting glucose) the efforts often intensify and continue.

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Obesity 'linked to 10 cancers'

Obesity 'linked to 10 cancers' | Heart and Vascular Health | Scoop.it

Being overweight and obese puts people at greater risk of developing 10 of the most common cancers, according to research in the Lancet medical journal. Scientists calculated individuals carrying this extra weight could contribute to more than 12,000 cases of cancer in the UK population every year. They warn if obesity levels continue to rise there may be an additional 3,700 cancers diagnosed annually.The study of five million people is the largest to date to confirm the link.

Seth Bilazarian, MD's insight:

Many patients know  the link between obesity and diabetes & heart disease, but the link to cancer is not as well known. This is another reason for urgency to address obesity and overweight for individuals and from a public health standpoint.

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Olivia Perez's curator insight, November 14, 2014 1:06 PM
If obesity keeps going on arise there will be an additional 3700 cancers diagnosed each year. Scientist and doctors say that tumor can start to develop on your Kinsey, uterus, cervix, thyroid, and ect. People with more body mass are more likely to develop liver, colon, ovaries, and breast cancer. But scientists she haven't connected of you BMI level is even associated on getting cancer.
Leeza Trainor's comment, November 17, 2014 9:25 AM
That is a whole lot of cancer
Lexie Ruscheinski's comment, November 17, 2014 11:01 PM
This is a huge wake up call and also scary. It shows how big of a problem obesity can be in our country!
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Choosing Wisely for Syncope: Low‐Value Carotid Ultrasound Use

Choosing Wisely for Syncope: Low‐Value Carotid Ultrasound Use | Heart and Vascular Health | Scoop.it
 

The US spends more than $750 billion/ yr  on tests and procedures that do not benefit patients. Although there is no physiological indication for carotid ultrasound in “simple” syncope in the absence of focal neurological signs or symptoms suggestive of stroke, there is concern that this practice remains common for routine syncope workups.

We found that 16.5% of all Medicare beneficiaries with simple syncope underwent carotid imaging and 6.5% of all carotid ultrasounds ordered in 2009 were for this low‐value indication.

For the 15.4% patients with stenosis ≥50%, carotid ultrasound did not yield a causal diagnosis. Only 2% of patients imaged experienced a change in medications after a positive study, and <1% of patients underwent a carotid revascularization procedure.

Seth Bilazarian, MD's insight:

The ultrasound of the carotid artery is often part of the "package" of inappropriate testing that happens with syncope or worse lightheadedness without syncope.  Other commonly ordered tests for syncope are Head CT and echocardiography without signs and symptoms indicating their utility.  Much of the problem comes from emergency room evaluation and hospital admission which leads to accelerated testing to limit patient's length of stay. Most of this would be done better (more effectively and wit greater value)  in the office based assessment by the patient's internist or cardiologist.

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Banning the Handshake From the Healthcare Setting

Banning the Handshake From the Healthcare Setting | Heart and Vascular Health | Scoop.it

Banning the handshake from the health care environment may require further study to confirm and better describe the link between handshake-related transmission of pathogens and disease. Moreover, given the profound social role of the handshake, a suitable replacement gesture may need to be adopted and then promoted with widespread media and educational programs. Nevertheless, removing the handshake from the health care setting may ultimately become recognized as an important way to protect the health of patients and caregivers, rather than as a personal insult to whoever refuses another’s hand. Given the tremendous social and economic burden of hospital-acquired infections and antimicrobial resistance, and the variable success of current approaches to hand hygiene in the health care environment, it would be a mistake to dismiss, out of hand, such a promising, intuitive, and affordable ban.

Seth Bilazarian, MD's insight:

The fist bump although a challenge for the older generation may be the best alternative, if it became socially accepted and widely adopted.

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Pig or Metal? Aortic Valve Choice for Patients 50 to 69 Years

Pig or Metal? Aortic Valve Choice for Patients 50 to 69 Years | Heart and Vascular Health | Scoop.it

The choice between bioprosthetic and mechanical aortic valve replacement in younger patients is controversial because long-term survival and major morbidity are poorly characterized.

Results  No differences in survival or stroke rates were observed in patients with bioprosthetic compared with mechanical valves.

Actuarial 15-year survival was 60.6% in bioprosthesis vs 62.1% in the mechanical prosthesis group

The 15-year cumulative incidence of stroke was 7.7% vs. 8.6%.

The 15-year cumulative incidence of reoperation was higher in the bioprosthesis group 12.1%  vs. 6.9%

The 15-year cumulative incidence of major bleeding was higher in the mechanical prosthesis group 13.0% vs 6.6%

The 30-day mortality rate was 18.7% after stroke, 9.0% after reoperation, and 13.2% after major bleeding.

Conclusions and Relevance  Among propensity-matched patients aged 50 to 69 years who underwent aortic valve replacement with bioprosthetic compared with mechanical valves, there was no significant difference in 15-year survival or stroke. 

Seth Bilazarian, MD's insight:

The answer to the pig vs. metal question has been easy in patients over 70 years old since life expectancy of the valve was considered to be greater than the patient's life expectancy.  For those younger patients the option of a bioprosthetic valve that does not require life long oral anticoagulation with warfarin(Coumadin) is a very good option.

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Self-monitoring and Self-titration for Hypertension

Self-monitoring and Self-titration for Hypertension | Heart and Vascular Health | Scoop.it

Importance  Self-monitoring of blood pressure with self-titration of antihypertensives (self-management) results in lower blood pressure in patients with hypertension, but there are no data about patients in high-risk groups.

Design, Setting, and Patients  A primary care, unblinded, randomized clinical trial involving 552 patients who were aged at least 35 years with a history of stroke, coronary heart disease, diabetes, or chronic kidney disease and with baseline blood pressure of at least 130/80 mm Hg being treated at 59 UK primary care practices in 2011-13.

Interventions  Self-monitoring of blood pressure combined with an individualized self-titration algorithm. During the study period, the office visit blood pressure measurement target was 130/80 mm Hg and the home measurement target was 120/75 mm Hg. Control patients received usual care consisting of seeing their health care clinician for routine blood pressure measurement and adjustment of medication if necessary.

Results .The mean baseline blood pressure was 143.1/80.5 mm Hg in the intervention group and 143.6/79.5 mm Hg in the control group. After 12 months, the mean blood pressure had decreased to 128.2/73.8 mm Hg in the intervention group and to 137.8/76.3 mm Hg in the control group, a difference of 9.2 mm Hg (95% CI, 5.7-12.7) in systolic and 3.4 mm Hg (95% CI, 1.8-5.0) in diastolic blood pressure following correction for baseline blood pressure. These results were comparable in all subgroups, without excessive adverse events.

Seth Bilazarian, MD's insight:

The illustration is Consumer Reports top rated BP monitors.  Home blood pressure monitoring is extremely valuable in management of hypertension.  From the accompanying editorial:

This trial went beyond monitoring and had patients actively adjust medications based on an algorithm. The patients in the intervention group showed no increase in adverse events compared with patients in the control group.  This trial is an important step toward adaptation of treatment for patients who want to actively take part in their own risk-factor control.  Based on these findings, a “bring it home” blood pressure–lowering strategy appears suitable for patients with hypertension and comorbidities.

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Replacement valves save lives

Replacement valves save lives | Heart and Vascular Health | Scoop.it
The silent nature of heart valve disease presents a major challenge to health services in the UK where the number of people aged over 65 is expected to almost double to 19 million in the next 30 years
Seth Bilazarian, MD's insight:
See my blog: TAVR: A Plea to Refer Patients for Consideration

http://www.medscape.com/viewarticle/831946

 

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Epidemic of the 20th Century: Coronary Heart Disease

Epidemic of the 20th Century: Coronary Heart Disease | Heart and Vascular Health | Scoop.it

1. The increase in coronary heart disease deaths in the 1930s, 1940s and 1950s was due to an increase in coronary atherosclerosis.

2.  A decline in coronary atherosclerosis that began in the late 20th century was associated with decreased smoking and a decrease in cholesterol levels.

3.  Primary and secondary prevention has decreased the incidence of acute myocardial infarction and sudden cardiac deaths from the mid-1960s to the present.

4.  More effective treatment of acute myocardial infarction has  decreased the number of deaths.

Seth Bilazarian, MD's insight:

Most of the decline in coronary heart disease deaths is due to a decrease in deaths due to acute myocardial infarction and to a reduction in sudden cardiac deaths. These deaths have been reduced by primary prevention, which has decreased the incidence of coronary atherosclerosis, and primary and secondary prevention, which have reduced the progression of coronary atherosclerosis to obstructive coronary heart disease. In addition, the remarkable reduction in the case fatality rate of acute myocardial infarction is almost certainly due to more effective emergency treatment and transport of patients who then receive more rapid and effective in-hospital treatment.
The multiple factors that have led to the remarkable decline in coronary heart disease deaths in the US over the
last 50 years less atherosclerosis and better heart attack care 

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Healthy Weight Loss

Healthy Weight Loss | Heart and Vascular Health | Scoop.it

There are no magic diets, pills, or operations for long-term, healthy weight loss. A useful approach is to select the best diet that works for you. This is the eating plan you can live with.  A total of 3500 calories equals 1 pound of body weight. This means if you decrease (or increase) your intake by 500 calories daily, you will lose (or gain) 1 pound per week. (500 calories per day × 7 days = 3500 calories.) All foods have carbohydrate, protein, and fat. Carbohydrates provide 4 calories per gram. Proteins provide 4 calories per gram. Fats provide 9 calories per gram. Carbohydrates are either simple or complex. Simple carbohydrates cause more weight gain than complex carbohydrates. Simple carbohydrates include sugar and starches (potatoes, pasta, and rice). Complex carbohydrates include fruits, vegetables, and whole grains.

Seth Bilazarian, MD's insight:

Most useful (and most difficult) line from this JAMA patient page:

To lose weight, you must change your habits. This will happen slowly. Losing 1 to 2 pounds each week is great progress.

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Olivia Perez's curator insight, November 14, 2014 11:21 PM
the best way to lose the weight you want is to do it the right healthy way. For losing weight you don't want to eat more than 3500 calories but you don't want to eat less than 1100. To lose weight way try to eat healthy and work out to 30 minutes to an hour a day.
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Fish Oil Supplements

Fish Oil Supplements | Heart and Vascular Health | Scoop.it

Omega-3 polyunsaturated fatty acids can lower high plasma triglycerides, but they have not been shown to decrease the risk of pancreatitis. The results of recent studies do not offer any convincing evidence that fish oil supplements prevent cardiovascular disease.

Seth Bilazarian, MD's insight:

The Medical Letter gives the "bottom line" on fish oil.  It doesn't reduce cardiovascular risk.

Eat fish, don't take fish oil. 

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Wine only protects against CVD in people who exercise

Wine only protects against CVD in people who exercise | Heart and Vascular Health | Scoop.it

Wine only protects against cardiovascular disease (CVD) in people who exercise, according to results from the In Vino Veritas (IVV) study presented at ESC Congress 2014.

IVV is the first long-term, prospective randomised trial comparing the effect of red and white wine on markers of atherosclerosis. The study included 146 people with mild to moderate risk of cardiovascular disease. Participants were randomised to one year of moderate consumption of red (Pinot Noir) or white wine (Chardonnay-Pinot) from the same year and wine region of the Czech Republic.

Moderate consumption was the World Health Organization definition of 0.2 L for women and 0.3 L for men, a maximum of five times a week. The primary endpoint was the level of HDL cholesterol at one year. Participants consumed their usual diet.

The researchers found that there was no difference between HDL cholesterol levels at the beginning of the study compared to one year in either the red or white wine groups. LDL cholesterol was lower in both groups at one year while total cholesterol was lower only in the red wine group.: "The only positive and continuous result was in the subgroup of patients who took more exercise, which means regular exercise at least twice a week, plus the wine consumption. In this group HDL cholesterol increased and LDL and total cholesterol decreased in the

red and white wine groups. There may be some synergy between the low dose of ethyl alcohol in wine and exercise which is protective against CVD."

Seth Bilazarian, MD's insight:

American patients often seize the results of population based dietary studies and often take them out of context.  French populations drink more red wine and have lower rates of cardiovascular events so Americans may add wine to their diet without considering the many other potential contributors to the good outcome.  The French ,in addition to consuming more red wine. also exercise more, eat less processed foods, have lower rates of obesity and eat less fast foods and snack less.  False conclusions are often made also made about fish eating populations such as Eskimos.

The IVV study brings to light these other important added contributors to health.

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Donovan Baldwin's curator insight, September 1, 2014 11:43 AM

Interesting article. I have always said that most of these things, supplements, red wine, massage, weight loss products, diet pills, whatever...would probably only have a significant effect if they were a part of a healthy lifestyle, which includes exercise, nutrition, and rest.

Ellen Diane's curator insight, September 4, 2014 11:00 AM

thank you Seth:)

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High Blood Pressure Control Infographic

High Blood Pressure Control Infographic | Heart and Vascular Health | Scoop.it
High Blood Pressure Infographic: Make Control Your Goal
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Donovan Baldwin's curator insight, August 25, 2014 9:16 AM

Lowering your blood pressure is good for you. Learn more about your blood pressure at http://nodiet4me.com/health_products/blood_pressure/articles/index.html

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Donating.vs.Death from CDC

Donating.vs.Death from CDC | Heart and Vascular Health | Scoop.it

Where we donate vs. what kill us. 

Seth Bilazarian, MD's insight:

Many inferences can be made about this disparity but one contributor is clearly the notion (incorrectly) that heart disease is a disease of the elderly and therefore inevitable.  A contributor to this was former surgeon general Jocelyn Elders comment the "you have to die of something".   Much of the public has a dim view of the strides that have been made in cardiovascular disease, but its persistence as a problem in young and old alike requires continued research funding.

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When Patients Read What Their Doctors Write

When Patients Read What Their Doctors Write | Heart and Vascular Health | Scoop.it
Patients are more satisfied with their care when doctors share their medical notes. But letting patients see what doctors put in medical records has long been taboo. That's starting to change.
Seth Bilazarian, MD's insight:

The "open notes" enthusiasts often tout that patients have great benefit going from NO access to compete access.  As a clinician, I have no objection to patients having access to any and all their records but without guidance most of the records are unintelligible and patients often grasp on to abnormal testing results which have no clinical significance ("Why was my ALT or BUN 1 point above the upper limit of normal?" .  

After patients are discharged from the hospital I review all the lab and imaging results, page by page, to ensue that they have heard the results and understand the implications of the results.  

Giving patients copies of these reports in addition to all the other (now mandated) discharge paper works is completely useless and almost never reviewed.

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Global Sodium Consumption & Death from Cardiovascular Causes

Global Sodium Consumption & Death from Cardiovascular Causes | Heart and Vascular Health | Scoop.it

High sodium intake increases blood pressure, a risk factor for cardiovascular disease, but the effects of sodium intake on global cardiovascular mortality are uncertain.

In 2010, the estimated mean level of global sodium consumption was 3.95 g/ day, and regional mean levels ranged from 2.18 to 5.51 g/day. Globally, 1.65 million annual deaths from cardiovascular causes were attributed to sodium intake above the reference level; 61.9% of these deaths occurred in men and 38.1% occurred in women. These deaths accounted for nearly 1 of every 10 deaths from cardiovascular causes (9.5%). Four of every 5 deaths (84.3%) occurred in low- and middle-income countries, and 2 of every 5 deaths (40.4%) were premature (before 70 years of age). 

In this modeling study, 1.65 million deaths from cardiovascular causes that occurred in 2010 were attributed to sodium consumption above a reference level of 2.0 g per day.

Seth Bilazarian, MD's insight:

Nice multimedia presentation of the current data on salt and cardiovascular disease from NEJM editors.

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Varicose Veins

Varicose Veins | Heart and Vascular Health | Scoop.it

Varicose veins are superficial veins that have become abnormally enlarged and cause symptoms or are cosmetically distressing. Types of varicose veins include spider veins, which are reddish-bluish and thread-like; reticular veins, which are bluish and string-like; and true varicose veins, which are large rope- or worm-like veins that feel spongy to the touch and bulge out from the skin surface.

Seth Bilazarian, MD's insight:

Great review on what varicose veins are, how they occur and strategies for prevention and treatment.

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