Causes and Evaluation of Mildly Elevated Liver Transaminase Levels – American Family Physician.
Nice article on the subject of mildly elevated liver enzymes.
Understanding lab tests
Hand-grip Dynamometry Predicts Future Outcomes in Aging Adults
Causes and Evaluation of Mildly Elevated Liver Transaminase Levels – American Family Physician
LUQ Pain: Another Use for Ultrasound
Cardiac Catheterization: A New Route – Johns Hopkins Health Alerts
Cardiac Catheterization: A New Route: Johns Hopkins Health Alerts.
Cardiac Catheterization: A New Route
Doctors use cardiac catheterization to diagnose and treat heart conditions. The technique involves threading a thin tube called a catheter through an artery (usually the femoral artery in the upper thigh or groin) to the heart. Serious complications during cardiac catheterization are rare. But the procedure comes with risks of bleeding and damage to arteries.
Increasingly, cardiologists perform cardiac catheterization from an alternate site — the radial artery in the wrist — an equally effective tactic that’s linked to fewer bleeding and vascular complications, according to a review published in Circulation.
Why the wrist? After patients undergo cardiac catheterization through the femoral artery, they must remain flat on their back with their leg immobile for two to six hours to allow the artery to heal and help prevent both internal and external bleeding. Because the radial artery is smaller and closer to the skin’s surface, there’s no risk of internal bleeding, and external bleeding is easier to stop or prevent, an advantage for obese patients or those taking blood thinners.
Patients who undergo cardiac catheterization through the wrist can sit up, walk and eat immediately after the procedure — good news for people with back problems who find it difficult to lie still. A compression device is worn around the wrist for two hours. Patients must refrain from heavy lifting with the hand for a few days.
Radial cardiac catheterization most benefits patients in the highest risk groups — women, patients 75 and older and people with acute coronary syndrome. Yet doctors have been less likely to use the wrist site for these groups.
The decision to use radial versus femoral artery cardiac catheterization is largely based on the abilities and the experience of the cardiologist who’ll perform the procedure. The radial procedure is more technically challenging, and a greater number of U.S. doctors have more experience with the femoral approach — something that’s likely to change in the near future.
Cardiologists Should Mind Radiation Doses, ESC Says
Because radiation used in imaging tests is proven to cause cancer, they wrote, “cardiologists should make every effort to give ‘the right imaging exam, with the right dose, to the right patient.’
via Cardiologists Should Mind Radiation Doses, ESC Says.
We are seeing more applicant/patient initiated cardiac scans. I recently became aware of a life insurance application where the underwriter requested a repeat cardiac CT scan. The applicant’s cardiologist flatly rejected this course of action in an a asymptomatic patient with a correspondingly low CHD risk score.
Now you understand the cardiologist’s thinking.
Did I hear someone say “litigation risk”?
Nipple Aspirate Test Is Not An Alternative To Mammography
BACKGROUND: A nipple aspirate device is a type of pump used to collect fluid from a woman\’s breast. A nipple aspirate test can determine whether the fluid collected from the breast contains any abnormal cells.
RECOMMENDATION: Do not use a nipple aspirate test as a substitute for mammography or by itself for breast cancer screening or diagnosis.
Lexiscan (regadenoson) and Adenoscan (adenosine): Drug Safety Communication – Rare but Serious Risk of Heart Attack and Death
BACKGROUND: Lexiscan and Adenoscan are FDA approved for use during cardiac nuclear stress tests in patients who cannot exercise adequately. Lexiscan and Adenoscan help identify coronary artery disease. They do this by dilating the arteries of the heart and increasing blood flow to help identify blocks or obstructions in the heart’s arteries. Lexiscan and Adenoscan cause blood to flow preferentially to the healthier, unblocked or unobstructed arteries, which can reduce blood flow in the obstructed artery. In some cases, this reduced blood flow can lead to a heart attack, which can be fatal. RECOMMENDATIONS: Screen all nuclear stress test candidates for their suitability to receive Lexiscan or Adenoscan. Avoid using these drugs in patients with signs or symptoms of unstable angina or cardiovascular instability, as these patients may be at greater risk for serious cardiovascular adverse reactions. Cardiac resuscitation equipment and trained staff should be available before administering Lexiscan or Adenoscan.
Calcium Score Beats Lipids for Telling CVD Risk
Measurement of coronary artery calcium stratified patient risk for cardiovascular disease regardless of dyslipidemia burden or definition, researchers found.
When measured across lipid abnormality categories, patients with a coronary artery calcium score of 100 or more had a 22.2 to 29.2 incidents of cardiovascular disease per 1,000 person-years versus 2.4 to 6.2 events per 1,000 person-years among those with arterial calcium scores of 0, according to Khurram Nasir, MD, MPH, of Baptist Health South Florida in Miami Beach, and colleagues.
N-Terminal Probrain Natriuretic Peptide Is a Stronger Predictor of Cardiovascular Mortality Than C-Reactive Protein and Albumin Excretion Rate in Elderly Patients With Type 2 Diabetes
NT-proBNP is a strong independent predictor of short-term CV mortality risk in elderly people with type 2 diabetes, including those without preexisting CVD. This association is evident even in people with slightly increased values, is not modified by CRP, and is additive to that provided by AER.
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