A new cardiac imaging paradigm for acute chest pain?

Posted on by Kurt Jensen

In the "high-sensitivity cardiac troponin era," will the role of cardiac imaging in the ED change?

As high-sensitivity cardiac troponin (hs-cTn) assays become more and more common, cardiac imaging becomes less necessary for ruling out acute myocardial infarction (AMI) in ED patients with acute chest pain, but might be useful to prevent unnecessary or aggressive treatments write experts in July's volume of the American Heart Journal.

ACVP blog has covered the groundbreaking research on the high-sensitivity cardiac troponin tests since early last year, when we reported a new strategy that could rule out acute myocardial infarction within one hour, and rule it in with 75 percent accuracy. In June, two studies publishes in JAMA Cardiology lent further support to one-hour algorithms.

The speed and safe, accurate "rule out" of acute myocardial infarction through these cardiac biomarker tests "challenges [the] need" for noninvasive imaging prior to patient discharge when troponin values are normal, write the authors of the American Heart Journal article.

Continue reading A new cardiac imaging paradigm for acute chest pain?

Medical Mystery Monday: Why is Heart Disease In Decline? Part Two

Posted on by Kurt Jensen

Last week, ACVP blog's analysis of heart disease as a medical mystery left our readers with a few big questions.

Despite all the research and measurement into heart disease on a national and global scale - are we any closer to satisfying answers about how best to continue to decrease heart disease mortality rates?

The history of the heart disease decline - and all the research that came out of it - still might leave us (surprisingly) lost for hard answers.

Attribution of causes, historically, a murky process

In 2013, medical historians David S. Jones, MD, PhD of Harvard Medical School and Jeremy A. Greene, MD, PhD of Johns Hopkins School of Medicine published a history of the decline of heart disease mortality in the American Journal of Public Health.

Following their peak in the early 1960s, heart disease mortality rates shockingly declined 20 percent between 1968 and 1978---a decline so large and without simple explanation that a conference was called to determine whether the decline was "real." (It was.)

"Quite simply, the problem was that too many things had changed," write Jones and Greene.

Continue reading Medical Mystery Monday: Why is Heart Disease In Decline? Part Two

Medical Mystery Monday: Why is Heart Disease In Decline? Part One

Posted on by Kurt Jensen

"Something strange is going on in medicine," writes the New York Times's Gina Kolata - major diseases are are on the wane, and in some cases, it's a mystery as to why.

A decline in mortality from colon cancer is "especially perplexing," writes Kolata - a decline by nearly 50 percent since its peak in the 1980s has left researchers searching for an answer, since more screening couldn't possibly indicate such a large decline.

Heart disease mortality still declining, but slowing

Despite still being the number one cause of death in the world and the United States, death rates from cardiovascular disease and stroke have been steadily and significantly declining since the 1970s.

From 2000 to 2010, age-adjusted mortality decreased 30 percent for heart disease and 36 percent for stoke. And with cancer mortality declining by only 13 percent over that time period, it looked as if heart disease might lose its status as leading cause of death in the United States for the first time since 1910.

Not so fast.

Continue reading Medical Mystery Monday: Why is Heart Disease In Decline? Part One

Is heart failure over-diagnosed? and other stories

Posted on by Kurt Jensen

Is heart failure over-diagnosed?

A common problem in elderly men, obstructive uropathy, can look a lot like heart failure.

When pulmonary edema is present, heart failure is often the "scapegoat" says Melissa Walton-Shirley, MD in a commentary on Medscape. Approaching heart failure with "an air of skepticism" might help.

I've seen a handful of obstructive uropathy cases masquerading as heart failure in elderly men in recent years. I shudder to think how many times I've missed it. I suspect that it's not just men who suffer. Some of our female patients with "diastolic dysfunction" and overflow incontinence seem to suffer from backpressure that finds its way into the pulmonary vasculature.

Melissa Walton-Shirley, MD
Read more on Medscape.

NYU Langone tests new transcatheter device.

Continue reading Is heart failure over-diagnosed? and other stories