Cardiology

I remember the exact moment as clearly as if it happened yesterday and not twenty years ago, when I was a medical student. It was during ward rounds on the Cardiology service, when one of my attendings said very bluntly, "stenting causes myocardial infarctions, so never do an angiogram for coronary artery disease unless you absolutely have to."

Chest pain is the second most common reason people come to the emergency department (ED) (behind stomach and abdominal complaints), accounting for more than 7 million ED visits in the United States each year according to the latest data from the National Hospital Ambulatory Medical Care Survey.1

At the time of our ECG trends forecast in December 2020, a confluence of factors had been taking shape that would set the scene for predictions about the future of ECG in 2021. As we look at the trends a year later, where were we right, and where were we off? And what might current trends indicate about ECG in 2022?

It's well documented that left ventricular hypertrophy (LVH) is seen more frequently among Black patients than any other racial or ethnic group. In combination with disparities in care that marginalized populations experience, increased risk of LVH can contribute to heart failure, worsening outcomes, and mortality.

My four-year-old nephew from New York City came to visit me a few weeks ago in Denver, and we spent a weekend catching up on all his favorite Batman episodes. In one particularly engaging adventure, the Joker and the Penguin joined forces to plot Batman's demise, and that got me thinking about how two formidable powers, each mighty in its own right, can combine to make matters worse.

It was my last new patient after a long clinic day: a 32-year-old young man with bicuspid aortic valve and mild aortic stenosis. I walked in expecting a quick visit but saw an anxious young couple. After a quick introduction and some pleasantries, I got the question, "Can I get a vaccine exemption signed due to my heart condition?"

When COVID-19 emerged as a global health crisis, many healthcare entities turned to telehealth as a way to continue patient care without increasing exposure risk. According to the Centers for Disease Control and Prevention, slightly over 30% of weekly health center visits occurred via telehealth between late June and early November 2020.1

Many common medications, despite being effective for the targeted condition, come with concerns about cardiotoxicity. These toxic effects commonly manifest as arrhythmias (especially QT prolongation with the potential to lead to torsades de pointes) but also as bradyarrhythmias, Afib/atrial flutter, atrial tachycardia, atrioventricular nodal reentrant tachycardia, monomorphic ventricular tachycardia (VT), and Brugada syndrome.