Women and Heart Disease: A Pro-Per™ Approach

It is important to be aware of 'non-classical' symptoms of heart disease . It is also important that awareness of these ‘non-classical’ symptoms does not get you perpetually worried about heart disease- turning you into a nervous wreck. Many of these symptoms can be due to tens of reasons other than heart.
Read More

A Call to the Medical Journals

Times, they are achangin’. Many of us- medical professionals or not- are getting our medical news through Associated Press or Reuters rather than our conventional medical journals. The popular journals like New England Journal of Medicine and the Journal of American Medical Association have long issued press releases (a few days prior to availability of hard copy) about the research articles that they thought will be of interest to the general public. This leads to articles published in newspapers, magazines and Internet sites.

Times, they are achangin’. The blogosphere is responsible for some of these changes. There are several physicians and other medical professionals- including yours truly- who write their opinions on the new medical research. Several of us like to peruse these articles and write about their strengths and weaknesses. We will like to offer our opinions on recent research to our readers at the same time that it is written about in the press.

Most of the time, I get the news about the research from the press. Sometimes I can get my hands on the full article through the journal’s website. Sometimes I wait for the hard copy to get to my mailbox. Many times, it is too late- it is old news.

I think it is important that everybody get the details of the articles released to the press at the same time. This can be done in several ways. One of the ways is for the popular journals like the Journal of American Medical Association and New England Journal of Medicine to offer sign-up for the ‘press release’ through their websites. (Most of the journals already offer sign-up for table of contents.) That way, the subscribers to the press release alerts can get the full text article at the same time that the press does. It will help several writers give their viewpoint to their readers in a timely fashion.
Home Page

Heart Disease: Why Are We Not Talking Enough About Non-surgical Treatments?

A Feb 25, 2007 The New York Times article discusses two treatment options for blocked heart arteries- stents and bypass surgery (CABG). Some of the points made are:
- The number of bypass surgeries has gone down while the number of stent procedures has gone up over the years.
- One of the possible reasons cited for lower number of bypass surgeries is cardiologists not consulting surgeons before treating blockages with stents.
- The recognition of previously unknown complication of new stents-late stent thrombosis- may make bypass surgery an attractive option for more patients.
- The cardiologists say that some surgeons refuse to operate on sicker patients for the fear of adverse effect on their performance statistics. The performance statistics for individual surgeons are made public in some states.

In this article, Barnaby J. Feder writes about an issue that is commonly discussed- and argued about- among cardiothoracic surgeons and cardiologists. There are heart blockages that are clearly suitable for stent placement (performed by a cardiologist), and there are those clearly suitable for bypass surgery (performed by a surgeon). In addition, there is a gray area that is source of discussion between cardiologists and cardiothoracic surgeons. Of late, the cardiologists have taken over more of this gray territory.
At times, the argument between bypass surgery and stents can relegate non-surgical treatment measures to the background.

Pro-Per™ Points

A. Whenever blockage of heart arteries is diagnosed, some patients feel let down if they are told that their blockage will not and should not be fixed with stents or bypass surgery. The physicians at times also feel nervous about not fixing the blockage that they see. This happens despite the fact that research supports non-surgical management in many of these cases. This happens because we do not talk enough about the following:

- Whenever we notice any heart artery blockages, we are afraid that these blockages may cause heart attack. We used to think that blockages turn form 50 to 60 to 70%...eventually turning into 100%- causing a heart attack. The studies now suggest that majority of heart attacks happen at locations in the heart arteries that have less than 50% blockage- the extent of blockage that can easily be missed or deemed unimportant on a stress test or an angiogram. So while the tighter blockages may scare us more, the minor blockages are the ones that make us more vulnerable to dreaded heart attacks. This brings us to the next point.
- The heart artery blockage is the presenting symptom of body’s diseased plumbing system. It needs to be seen and treated as a systemic disease. Not all blockages need to be fixed surgically. Without regards to how these blockages are tackled (with or without surgery), attention to whole plumbing system of the body is most important aspect of the management. This includes medications and management of risk factors. These measures decrease the chances of various diseases of plumbing system: stroke, heart attack, peripheral arterial disease (P.A.D.). A person with heart attack is at a high risk for stroke and vice versa.

B. Anytime we discuss the treatment of heart artery blockages, non-surgical treatment methods including medicines, exercise etc. need to be given well-deserved place of pride along with other treatments.
Home Page