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Latest Posts

Is The Prescription Of Real Exercise Underused?

I recently wrote about the incredible sensations that come with vigorous exercise. Perhaps it was the post ride cannabinoid flurry, but it’s possible that I went too far in suggesting that ‘we’ (doctors, patients, the whole of Western Society) default first to pills before healthy living.

Two commentors called me out on this snark. They wrote about valid points.

One comment focused on the fact that her AF medicines were causing side effects that made vigorous exercise difficult. The second objected to my inference that exercise alone could substitute for the many benefits of modern medicine.

To the idea that medicine Read more »

*This blog post was originally published at Dr John M*

Heart Rate: What’s Normal?

The “normal” number of heartbeats per minute is very much a frequently asked question. People, especially medical people, like well-defined lows and highs. Parameters which can be assigned an ‘L’ or ‘H’ makes life easier.

2009 National Championship Masters (45-49) Road Race

As a modern-day competitive cyclist, I am immersed in a sea of information. In our quest for weekend glory, minutia like speed, wattage outputs, RPMs, torque, elevation gain and of course, heart rates (highs, lows, and averages) get recorded, downloaded, and then studied intensively.

As a heart rhythm specialist, it is a frequent occurrence to see patients referred for low or high heart rates. More often than not, heart doctors are called upon to adjudicate patients who fall outside the “normal” values.

The old school teaching holds that the normal resting heart rate is greater than 55 and less than 100 beats per minute (bpm). Maximal heart rates are estimated by the Read more »

*This blog post was originally published at Dr John M*

Is Turbulence Good For The Heart?

It’s hard to believe that turbulence could be a good thing for the heart. Consider how the word turbulent is defined: “Characterized by conflict, disorder, or confusion; not controlled or calm.” Those traits don’t sound very heart-healthy. But when it comes to heart rhythm, it turns out that a turbulent response — to a premature beat — is better than a blunted one. The more turbulent the better.

No, you haven’t missed anything, and turbulence isn’t another of my typos. Until [recently], heart rate turbulence was an obscure phenomenon buried in the bowels of heart rhythm journals.

What Is Heart Rate Turbulence (HRT)?

When you listen to the heart of a young physically-fit patient, you are struck not just by the slowness of the heartbeat, but also by the variability of the rhythm. It isn’t perfectly regular, nor is it chaotic like atrial fibrillation (AF). Doctors describe this — in typical medical speak — as regularly irregular: The heart rate increases as the patient inhales and slows as he or she exhales. This variability occurs as a result of the heart’s responsiveness to its environment. The more robustly and quickly the heart responds, the healthier it is.

HRT seeks to measure how quickly and vigorously the heart rate reacts in response to a single premature beat from the ventricle — a premature ventricular contraction (PVC).  Normally after a PVC, the heart rate speeds for a few beats, and then slows back to baseline over the next 10 beats. The healthy heart responds with a more intense rise in heart rate and a quicker return to baseline. Using simple measurements of heart rate from a standard 24-hour electrocardiogram (ECG) monitor, a propriety software program averages many of these responses and comes up with a measurement of turbulence onset and turbulence slope. Read more »

*This blog post was originally published at Dr John M*

The Heart And The Holidays

The human heart resides in a lighltless 98.6-degree chest cavity. Its contracting muscles are further cushioned by the well-lubricated glistening smooth pericardial sac. One wouldn’t think that the heart could sense the time of year. The heart’s rhythm should remain independent of the holiday season. But then there is December in the EP lab. They are as busy as the malls.

Is it the depressing weather? Or the short days? Or a post-Thanksgiving hangover? It’s hard to say, but every year for as many as I can remember, the EP lab rocks in November and December. And with the advent of deductible health plans, this holiday phenomenon has only intensified.

The I-90 of the heart, the AV node, seems to give out more in the holidays. I’ll never forget the Saturday in December many years ago when I did five “urgent” pacemakers — and neither will the pacemaker rep. Read more »

*This blog post was originally published at Dr John M*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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