Category: Blog

Should telling patients they can no longer drive be straightforward?

05 Oct 2017 2 Comments

I find one of the more difficult conversations with patients about their cardiac disease is when we have to advise them to stop driving. This enforced change in lifestyle markedly affects everyone, especially the elderly. In my practice in a rural city, the impact is that bit greater as there...

Sports cardiology: questions from the heart

03 Aug 2017 33 Comments

Just before I went off on summer break a now stable paroxysmal atrial fibrillation (PAF) patient shared that he was taking Dr John Mandrola's The Haywire Heart to read on his cycling holiday. He'll definitely find resonance in Dr John's recount of his AF episode whilst cycling, which is almost...

Too many normal coronaries in the cath lab

02 Mar 2017 12 Comments

What's your cath lab's normal/non-actionable coronaries rate?  I don't know what ours is, so we've sent a registrar to gather some of our data to discuss in the department. Are you like me, disappointed when you see an out-patient whose invasive angio finds minimal CAD, where even a pressure wire doesn't seem justified?  It...

Always follow-up asymptomatic LBBB with a good LV?

05 Jan 2017 37 Comments

I expect you are the same, I find it quite reassuring when there is no clear agreement amongst my Consultant colleagues to a clinical question because it’s then most likely that there is no scientific right or wrong. Last month, I mentioned asymptomatic left bundle branch block (LBBB) with a good...

Anomalous coursing LCA: always go into the valley of death?

01 Dec 2016 5 Comments

“Which way round do you think it goes, anterior or posterior to the aorta?”, said the interventional fellow. My staff replied: “Well, you could do more views whilst I consult the textbook...then you could do more views with a PA catheter in-situ...then take a few more views....but really you need...

Commotio Cordis: post Olympics reflections

06 Oct 2016 17 Comments

“Why do the Taekwondo players have protective gear and the boxers don’t?”, said my daughter watching the Olympics. One of those great “why?” questions that parents hope to answer with authority, but for which they often fall short of knowing the exact answer. Let’s keep it heart-related I thought: “Well,...

Are you maintaining your skeletal integrity at work?

19 Aug 2016 0 Comments

“I needed a seat, my sciatica is really bad today,” said my EP colleague as I walked into his office at lunchtime, “it’s bad enough being sore with tingling down my leg, and then I get eyelid scissors that don’t cut...I never get sharp bloody scissors anymore!!” There are many...