The purpose of this post is to introduce my most recent column over at theHeart.org | Medscape Cardiology in which I address recent concerns about the drug rivaroxaban (Xarelto). — In 2014, Rivaroxaban (Xarelto) was the most prescribed new oral anticoagulant (NOAC). Millions of patients have atrial fibrillation, so it’s fair to call it a […]
Category: General Cardiology
Three academic physicians, writing in an editorial in the Journal of the American Medical Association, raised serious (but theoretical) concerns about the risk of Alzheimer’s disease and macular degeneration with long-term use of the new heart failure drug, valsartan/sacubitril (Entresto, Novartis). Here is the translation: Sacubitril is a drug that inhibits neprilysin, which is an […]
Here is my most recent column on theHeart.org | Medscape Cardiology: Mandrola’s Top 10 Cardiology Stories 2015 What follows below is a short-writing summary of my ten picks. The hyperlinks go to earlier columns I wrote on the topic. 1. The FDA approved two new (injectable) cholesterol drugs. The problem with the PCSK9-inhibitors: the study […]
A frail elderly women has a leaky heart valve. It caused her legs to swell and increased her work of breathing when she pushed her walker around the house. One doctor wanted to relieve her suffering. She suggested palliative care; she wanted to make her disease less severe but without removing the cause. Other doctors […]
I wrote yesterday about how a broken healthcare system favors overuse of procedures. Today I will discuss rational care. Remember the goals of the Lown Institute: We think healthcare should be affordable, effective, rational and available to all. Rational means in accordance with reason or logic. Hardly a day goes by that I don’t see […]
The next frontier in cardiology is the replacement of cardiac valves via catheters rather than open-chest surgery. This new branch of cardiology is called “structural” cardiology. Trainees do entire “structural” fellowships in which they learn to do things with catheters that surgeons once did with open chest techniques. You may have heard about TAVR–or transcatheter […]
I’ve never been more convinced that the ease with which knowledge is shared in the digital age is a force for good. I loved the video below. These two guys read conclusions of medical studies for humor. That’s a good one. James McCormack is a pharmacist, professor, medication mythbuster, and healthy skeptic at the Faculty […]
Hundreds of thousands of people have undergone surgery or stents to “fix” blockages in their carotid arteries. (The left and right carotids are the main arteries to the brain.) Most of the these people (about 90%) reported no complaints. We say they are asymptomatic. The blockages were discovered on exam or by ultrasound of the […]
One of the most common reasons people require medical care is their medical care. This is a distinctly modern problem. In times past, doctors treated disease. Patients saw their doctor when they were sick. They had a problem; doctors offered help. The doctor of today often improves health by removing healthcare. It’s one of my […]
It’s time to write an update on AF ablation. Things have changed. The major change is that I am doing many fewer ablations for AF. The reason is we have a better understanding of the disease, or should I say, condition? In the last 2-3 years, good science has changed the way specialists see AF. […]
Premature ventricular complexes (PVCs) remain a common and vexing problem in cardiology. PVCs deserve attention because they often induce fear in both patient and doctor. In US healthcare, fear is bad. Fear sets the stage for over-treatment. The approach to the funny-looking beats has not changed much in the last two decades. That may be […]