“How much teaching about diet did you get at medical school?” asked Professor dietitian her indoors…she’s not actually a Professor! “Not much that I can remember, but you are pushing my memory a bit, why?” “Well this blog in the BMJ from a couple of medical students suggests you doctors need to have a lot more. Maybe they don’t appreciate there is a whole profession specially trained to do this, I thought it was a team approach nowadays?!  Are they saying that patients are going to listen more to doctors than dietitians?” I detected more than a bit of annoyance and some professional ..read more

Have you had to use an antidote for one of the novel anticoagulants yet? I thankfully haven’t. I very rarely see bleeding complications bar those immediate or very close to our invasive procedures, and the vast majority are with antithrombotic and/or dual anti-platelet therapy. Any bleeding away from this time goes directly to someone else, and I don’t often hear about it. This probably isn’t a good thing. Not seeing the potential complications of your therapies can make you under-appreciate their incidence and the risks to your patient. It wasn’t always like this. I asked this question of my ..read more

I find one of the more difficult conversations with patients about their cardiac disease is when we have to advise them to stop driving. This enforced change in lifestyle markedly affects everyone, especially the elderly. In my practice in a rural city, the impact is that bit greater as there are fewer avenues to maintain individual mobility. Even a cursory look at my children’s grandparents shows many potential limitations to their lives if they weren’t allowed to drive, and to ours, if we have no child-sitting for evenings out! Last week one of my EP colleagues told me he’d just seen a pati ..read more

Technological advances in healthcare have been amazing in my lifetime. In cardiology, this year it’s the 40th anniversary of PCI and the 50th of heart transplant. These techniques have been progressively refined and were the launch pad for further advances. Medical progress continues exponentially. Now in-depth collaboration between medics and experts from other sciences is the key to success, moving far beyond the garages of the early PCI pioneers. The integration of new technologies into daily practice can at times be more or less helpful. It remains important to evaluate and prove a positi ..read more

Just before I went off on summer break a now stable paroxysmal atrial fibrillation (PAF) patient shared that he was taking Dr John Mandrola’s The Haywire Heart to read on his cycling holiday. He’ll definitely find resonance in Dr John’s recount of his AF episode whilst cycling, which is almost the same as my patient recalled. It’s a great read and discusses many sports cardiology questions beyond AF pertinent to the middle-aged athlete, and now in that group myself, there is a good bit to be concerned about! I’m especially thoughtful about how I would feel in a similar situation to my patient ..read more

Last I week I got my first query from a GP about prescribing Repatha (Evolocumab by Amgen), the monoclonal antibody that inhibits PCSK9, for a patient with atherosclerotic cardiovascular disease (ASCVD). This new group of medications are a fantastic piece of translational science, but in our financially pressured healthcare system are they a therapeutic step too far for our patients? The referral detailed that the patient had a previous CABG, had been intolerant of statins and now had a modestly unfavourable lipid profile. More often in recent years I’ve found myself in clinic ..read more

Acute aortic dissection is one of a number of conditions in medicine that carries the moniker of “the great mimicker“. But there is no doubt that it is the one with the highest jeopardy. Acute aortic dissection (AAD) has a very high mortality, even with surgical intervention, and the time to diagnosis and then to operation is critical for patient survival. Unfortunately, because it is both rare and often atypical in its presentation, it is well recognised that delays or failure to diagnose it are common. And these can result in a poor outcome for a patient. I remember one of the first times I ..read more

Even experienced general cardiologists find cardiovascular disease in pregnancy can give you sleepless nights. Most of the time we simply need to reassure, but a small percentage of cases need intense support, often with a complex clinical path. A good outcome is not guaranteed, which as always in young previously healthy individuals, raises your anxiety.     I’ve been involved in a broad range of challenging cases of cardiovascular disease in pregnancy. I’d rather not see another partially thrombosed mechanical mitral valve in a pregnant woman; thankfully she survived, and qui ..read more

This is not a new debate I know, but further persuasive data on the use of pressure wires made me revisit the thought that diagnostic coronary angiograms should optimally only be done by interventionists; I would be interested to hear your views. For many years now we have known that an intra-coronary lumenogram often doesn’t give us the information we need to optimally look after our patients. Pressure wire and IVUS has proven that obstructive coronary disease may not be definable by pictures alone. At last month’s ACC DEFINE-FLAIR and iFR-SWEDEHEART further reinforced the use  ..read more

What’s your cath lab’s normal/non-actionable coronaries rate?  I don’t know what ours is, so we’ve sent a registrar to gather some of our data to discuss in the department. Are you like me, disappointed when you see an out-patient whose invasive angio finds minimal CAD, where even a pressure wire doesn’t seem justified?  It really isn’t the proceduralist that simply sees that the patient doesn’t need a PCI, but the physician that thinks “this must be a failing in our diagnostic testing, and did we just subject this patient to an invasive test, with a very small ..read more