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Atrial Fibrillation: When The Questions Outnumber The Answers

You may have heard that AF is a tough disease to understand. Questions far outnumber answers.

What causes AF?

Why do some not feel it at all, while others are incapacitated?

What’s the best treatment? Drugs? Ablation? Surgery? No treatment?

Should I take a blood thinner…and which one?

Where should one go for the best AF care?

This short email from a reader captures the essence of AF support group mayhem: Read more »

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

Following The Rules: Is The Patient Really Yours?

I had a patient with non-valvular atrial flutter denied dabigatran (Pradaxa®) by their insurer recently. The patient had diabetes, hypertension and has had a heck of a time maintaining therapeutic blood thinning levels (prothrombin times).

But those are the rules, you see. Only patients with non-rheumatic atrial fibrillation can get dabigatran, I was told. Dabigatran was never approved for atrial flutter, only atrial fibrillation. Never mind the stroke risk in non-rheumatic atrial flutter, like atrial fibrillation, has been found to be significant.

For my patient, dabigatran would have been the perfect solution.

But increasingly I’m finding the patient is not mine, they’re Read more »

*This blog post was originally published at Dr. Wes*

Multaq Simply Does Not Work To Control AF, So Why Is It Still So Over-Hyped?

Did you know September is AFib awareness month?

As a believer in education as the first, and best treatment of AF, I think it’s great to enhance the public knowledge of this highly-misunderstood disease.

By all means…

Tell people about AF’s risks: stroke and heart failure.

Tell them that their fatigue, poor exercise tolerance and breathlessness might not be old age; it might be AF.

Tell them about the importance of early intervention.

Tell them that obesity, inactivity, sleep disturbances, alcohol, and incessantly worrying about everything makes AF more likely to occur, and to stay.

Tell them that Read more »

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

Articles Give An In-Depth Analysis Of Multaq

As a patient, you probably see lots of hype-filled reports about various drugs. After a drug is approved, there’s an inevitable blitz of negative publicity which often scares people away from important new solutions that could help them.

There has been so much news lately about Multaq (dronedarone), the drug designed to provide the benefits of amiodarone but with fewer risks. This drug is important to people with afib, especially those with heart disease whose choices are limited, so it’s time to put into context for patients what has transpired in the two years since FDA approval.

These two companion articles provide an in-depth analysis into issues that have been reported about Multaq, including whether it can cause: Read more »

*This blog post was originally published at Atrial Fibrillation Blog*

New Blood-Thinner Shifts Responsibility To Patients

I recently came across a very important blog post on the use of the novel new blood-thinner, dabigatran (Pradaxa).

Fellow Kentucky cardiologist, and frequent contributor, Dr. Melissa Walton-Shirley wrote this very detailed case presentation involving a cantankerous non-compliant rural patient with AF (atrial fibrillation) that sustained a stroke while “taking” dabigatran.

Dr. Walton-Shirley details the very commonly done procedure of cardioversion (shock) for AF. As she clearly points out, the most important safety feature of shocking AF back to regular rhythm entails adequate blood thinning before and after the procedure. Thin blood prevents the possibility of clots dislodging after restoring normal contraction to the top chambers of the heart (atria).

Herein lies the rub with dabigatran, and the two soon-to-be-approved non-warfarin blood-thinning agents, apixaban and rivaroxaban. In the past, 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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