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Cardiomyopathy: When the Heart Muscle is Sick

Several months ago, I devoted a couple blogs to the subject of CHF (congestive heart failure).  At the time, I discussed the differences between heart failure from systolic dysfunction (problems with the heart contracting/pumping) and that caused by diastolic dysfunction (problems during the relaxation phase of the cardiac cycle).  These are clinical syndromes and are brought on by a variety…

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Why Are My Ankles Swollen?

Hardly a day goes by that I am not asked that question by a patient.  The causes are numerous, but most people’s biggest fear is that they have CHF (congestive heart failure).  Indeed, peripheral edema (edema fluid causing swelling of the extremities, usually the legs) is certainly seen with CHF, and probably is its most visible manifestation.  There, it is…

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When “Negative” Is Not Reassuring

Last week I described a patient who had an abnormal nuclear stress test, but turned out to have no significant blockage in his coronary arteries.  This week I saw a patient in follow-up who had had a normal nuclear stress test, but ended up having significant blockages in his coronary vessels. He is a 68-year old man who has had…

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When “Positive” Turns Out To Be Negative

This past week I had a conversation with a patient that surprised him.  His test result had been incorrect.  He is a 76-year old gentleman who had been having shortness of breath for the last several months, though the symptoms weren’t necessarily with exertion.  I had ordered a nuclear stress test (see “Services” section of this website for a description…

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PFOs: What To Do?

Last week, we talked about PFO’s—what they are and how we find them.  This week we’ll turn to a discussion of what we do when we find one. Because PFO’s are fairly common and the vast majority of people have no consequences from their presence, we don’t generally close them.  It is controversial whether patients with an asymptomatic PFO should…

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PFOs: The Most Common Hole in the Heart

What does it mean to have a “hole” in your heart? Is blood leaking out? How can you have this without knowing about it? A hole in the heart means that there is a connection between two chambers that shouldn’t be there. A patent foramen ovale (PFO) is a connection between the right and left atria. Blood normally passes from…

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Aortic Aneurysms: The Danger of Dilation

We’ve spent the last several weeks discussing valvular heart disease.  Today I’ll turn our attention to a problem outside the heart—aortic aneurysms.  An aneurysm is a focal enlargement or bulging of a blood vessel.  It comes from the Greek word meaning “dilation.”  In fact, radiology reports will often use the term “dilated” to refer to a vessel that is larger…

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Gregory Koshkarian, MD, FACC