There has been debate whether high school students participating in organized sports should be screened for cardiac conditions before they participate in sports. Those who favor screening advocate use of an electrocardiography (ECG) while others recommend only a thorough history and physical examination. The Clinical Decisions series presented a case of whether to initiate screening in high school athletes and a panel of physician experts presented their views. Readers were allowed to join the debate by voting and posting comments on NEJM.org. The case was also presented by the same four physicians at the American Heart Association (AHA) in November 2013. Online polls received 1,266 votes from 86 countries. 18% opposed cardiac screening, 24% favored screening with history and physical examination only and 58% favored screening with ECG, history and physical examination. U.S. voters preferred screening with only a history and physical exam. Many of the comments pointed to the lack of evidence that screening prevents death, the unfavorable cost-benefit of screening, who would be paid to read and interpret millions of ECGs, as well as what recommendations should be given to children with abnormal ECG readings. Europe is recommending ECG screening for all young athletes while currently the AHA and American Academy of Family Physicians recommend screening with only a history and physical examination. What are your thoughts regarding whether screening for cardiac conditions should be expanded to include ECG along with a history and physical examination?
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In the United States more than 70 million people are diagnosed with high blood pressure, a major risk factor to cardiovascular events such as myocardial infarctions and strokes. The American Heart Association (AHA) journal, Hypertension, published the results of a small trial which assessed the clinical effects of drinking one cup of beetroot juice a day. Each serving contains about 0.2g of nitrate, which promotes vasodilation and therefore reduces blood pressure. The study subjects drank 250mL of beetroot juice and were monitored over a 24 hour period. Results show that the subject’s blood pressure readings had decreased about 10mmHg. The AHA and USDA are trying to encourage the public to increase their daily intake of vegetables in order to incorporate healthy amounts of nitrate in their diets. What other vegetables and/or foods do you recommend for their ability to reduce blood pressure?
The American Heart Association (AHA) Presidential Advisory just released its report on sodium use in patients with cardiovascular disease. The report was based on experimental and laboratory studies, US population surveys, observational and clinical trials and nutritional adequacy analysis. The evaluation of data was instigated by a recent controversial evidence suggesting removal of previous AHA sodium reduction recommendations. Based on all the currently available evidence, AHA Presidential Advisory recommends reducing dietary sodium intake to <1500 mg/day in US population. How do you encourage your patients to reduce their dietary sodium intake?
New research published in Arteriosclerosis, Thrombosis and Vascular Biology, a journal from American Heart Association looked at two large studies where close to 90 thousand adults were followed for 20 years. Participants with blood type A, B or AB appeared to have a higher risk of cardiac disease – by 5%, 11% and 23%, respectively. Lifestyle was a significant factor in decreasing the risk. How do you encourage your patients to modify their lifestyle to protect their heart? How often do you ask your patients about their blood type?
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