Tag Archives: coronary artery disease

Is My Stent Open?


Here’s a scenario that we cardiologists occasionally see. A patient comes into the hospital with chest pain. He goes to the cath lab where he’s seen to have 90% narrowing of one of his critical vessels, which his cardiologist opens with a small metal coil called a stent (see previous post for more information on how this is done). Several months later, the man begins having discomfort that is similar to his previous episode.  He immediately wonders about his stent and heads straight to the ER.  Another angiogram follows and the diagnosis is made: “In-stent restenosis.”  The stent has closed down (“stenosis” is Latin for “narrowing”).  Technically, the configuration of the stent remains the same; it’s just that the cells … Continue reading

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Sometimes Less is More


I saw a patient in my office this week who had received a stent from one of my partners last month.  The man was highly satisfied with his experience—the procedure was tolerable, the recovery short, and the nurses were pretty (he specifically made a point of this, presumably because the post-hospitalization customer surveys don’t include what seemed to him to be the most important feedback metric)—but his wife had a different opinion.  She was upset (and not about the nurses). “Why did he get only one stent?” The cardiac catheterization had apparently revealed the presence of at least a couple of blockages.  The 99% narrowing—the one that was stented—was the clear cause of his chest tightness, and fixing this one … Continue reading

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Can’t Win For Losing


This morning while eating breakfast I came across a story in the newspaper announcing that an occasional glass of wine can increase a woman’s chance of developing breast cancer by 15%. I immediately rushed across the room to where my wife was standing and swatted the Cabernet Sauvignon Napa Valley 2007 out of her hand before she had a chance to take her first deadly sip. Her mouth dropped open and her eyes gleamed with what I’m sure was gratitude for my quick thinking and decisive action. The next moment, though, the fact that I’m a heart doctor popped into my head and I recalled that we cardiologists have been promoting the heart-friendly attributes of regular wine ingestion for years. … Continue reading

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Bypass Surgery vs Stents: The Rematch


There’s been a lot in the news lately about the relative benefits of coronary artery bypass surgery (CABG) and angioplasty/stenting (for the purpose of this blog post I’ll use the abbreviation PCI for percutaneous coronary intervention, the term we use to encompass all the fancy plumbing procedures my interventional colleagues perform).  I say “a lot in the news” with the acknowledgment that any story about cardiac health represents no more than a blip on the radar of the overall news cycle—on the same day that two articles about the heart appear there are probably a hundred reporting on the latest attire of the pop-diva-of-the-week. The latest headlines to which I refer raised questions about the value of PCI in patients … Continue reading

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Heart Attacks


There’s a point of confusion I often encounter that I’d like to clarify.  It’s not uncommon for patients conclude a lengthy hospital stay for a cardiac condition in utter confusion about whether they had a heart attack or not.  We have changed the definition of heart attack so dramatically over the years that doctors and nurses are just as confused as the patient. A few years ago this was all very simple.  A heart attack meant only one thing—your uncle Herb is out shoveling the snow one winter morning when he stumbles into the house clutching his breast and moaning as if an elephant decided to use his chest as a foot stool.  He is pale, sweaty, and clammy, and … Continue reading

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