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An Update on Fibromuscular Dysplasia

An Update on Fibromuscular Dysplasia

Fibromuscular dysplasia (FMD) has been defined as a non-atherosclerotic, non-inflammatory vascular disease that can result in arterial stenosis, occlusions, aneurysms, or dissections. Although the cause of FMD and its prevalence in the general population are unknown, research has shown that it has been reported in virtually every arterial bed. Most commonly, FMD affects the renal and extracranial carotid and vertebral arteries. When the renal artery is involved, the most frequent finding is hypertension. Carotid or vertebral artery FMD may lead to dizziness, pulsatile tinnitus, transient ischemic attack (TIA), or stroke. According to Jeffrey W. Olin, DO, FACC, FAHA, there is an average delay of 4 to 9 years from the time of the first symptom or sign to a diagnosis of FMD. “Many consider this disease rare, but in reality, the diagnosis is often overlooked,” he says. “Thus, it’s not considered in a differential diagnosis. In addition, FMD is poorly understood by many healthcare providers. Many of the signs and symptoms are non-specific, which in turn can lead clinicians down the wrong diagnostic pathway.” He notes that a delayed diagnosis can impair quality of life and result in poor outcomes. In 2014, the American Heart Association (AHA) released a scientific statement on FMD that addressed the state of the science and critical unanswered questions. “Over the last several years, we have learned that FMD is more common than previously thought,” says Dr. Olin, who chaired the AHA writing committee that developed the scientific statement. “FMD is frequently being discovered incidentally while imaging is performed for other reasons in asymptomatic patients without classic risk factors for atherosclerosis. The clinical manifestations...

What’s the Point of Medical Licensing?

A surgeon emailed me the following:. OK, I know this is radical but consider my argument… Medical licensing protects no one and costs physicians hundreds to thousands of dollars each year. If a physician is negligent, can the injured party sue the state that licensed him? I’m guessing not. When I moved to my current location, I had to send lots of documentation to the state medical board so they could verify that I was a true and competent surgeon. I provided my employer with the same info so they could also verify my credentials. Now my employer can and will get sued if I commit a negligent act and absolutely should verify my credentials prior to handing me a scalpel. But the state? Its license is useless. Most people choose a surgeon based on recommendations and word-of-mouth reputation, and these are by far better indicators of quality than any credentialing board. Nobody asks to see my license, and, even if they did, it would not protect them any more than their trust in the health system in which I work. If I was in private practice and had my license displayed on my wall, it may give some reassurance to my patients, but it does not say anything about the quality of my work. Most doctors who really screw up due to negligence are licensed by the state. I contend again, that word of mouth and reputation are the best indicators of a surgeon’s ability, anything beyond that is useless. Caveat emptor, “let the buyer beware” remains the mantra of the informed consumer. Thanks for letting me vent....
ESC 2014

ESC 2014

Research is being presented at ESC 2014, the European Society of Cardiology’s 2014 Congress, from August 30 to September 3 in Barcelona, Spain.   Meeting Highlights Fractional Flow Reserve for Managing NSTEMI Real-World Success With Retrievable & Repositionable Valve Renal Denervation, AF, & Hypertension   News From ESC 2014 Best of ESC Congress 2014 STICS – Short-term peri-operative statin treatment does not reduce complications after cardiac surgery X-VErT – Pre-treatment with rivaroxaban may expedite cardioversion AMIO CAT – Medication Improves Short-Term Recovery after Ablation for Atrial Fibrillation IBIS 4 – High-Dose Rosuvastatin Shrinks Coronary Plaque in Heart Attack Patients IMPI – Steroids Raise Cancer Risk in TB-associated HIV Simple awareness campaign in general practice identifies new cases of AF ROCKET AF trial suggests that digoxin increases risk of death in AF patients Coffee increases prediabetes risk in susceptible young adults Mechanical heart valves increase pregnancy risk Health structures explain nearly 20% of non-adherence to heart failure guidelines BIOSCIENCE – Experimental coronary stent combines ultrathin structure with biodegradable material ANTHEM-HF study shows significant improvement in cardiac function with left or right vagus nerve stimulation Biventricular pacing disappoints in BIOPACE trial SEPTAL CRT – Study finds alternative lead position is safe in cardiac resynchronisation therapy   STAR AF 2 – In Ablation for Persistent Atrial Fibrillation, “Less May be More”  EUROECO – ICD Home Monitoring: Cost Compares, but Reimbursement Lags CvL PRIT – Complete Revascularisation Improves Outcome in Heart Attack Patients  ATLANTIC – Ambulance administration of anti-clot drug may benefit heart attack patients NOMI – Nitric oxide inhalation in heart attack patients sends mixed messages, but may offer benefit MITOCARE – Hopes dashed...
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