Aortic aneurysm and dissection
Dr. Timothy Fleming presented an update on aortic aneurysm and dissection focusing on genetics, molecular mechanisms and underappreciated etiologies. A few pearls:
There is a strong association with congenital bicuspid aortic valve (it’s a disease of the aorta, not just the valvular apparatus; listen for that ejection click!).
A very strong and underappreciated association exists between giant cell arteritis (GCA) and thoracic aortic aneurysm/dissection. This is not new information (I first mentioned it here) but it’s underappreciated and seldom mentioned. Screening of patients with GCA for aneurysms, at baseline and periodically thereafter, was discussed.
Aortic dissection is temporally related to cocaine use.
The presentation was relevant and useful for internists, family physicians, hospitalists and cardiologists. It provided ample citations to primary sources and was free of commercial bias (the only two drugs mentioned were generic drugs).
To stent or not to stent---EBM to the rescue
Dr. J. Jeffrey Marshall presented data on the bewildering array of potential uses for cardiac stents, focusing on the new ACC guidelines. Fortunately the new guidelines take away much of the guesswork. Familiarity with the guidelines among hospitalists, general internists and family physicians will lead to a more appropriate and selective approach to referral of patients to cardiologists. The presentation was balanced, free of commercial bias and in conformity with recent evidence and guidelines.
Controversies in lipid management
There were two presentations on controversies surrounding the importance of lowering LDL, the use of medications to block LDL absorption (the Vytorin controversy) and the raising of HDL cholesterol. These incredibly complex topics were given the much needed nuanced treatment NOT provided by recent popular debate. I plan to blog about the issues when time permits.
More soon as time and Internet access permit! (My wife wants to take me shopping in Jackson after tomorrow afternoon’s sessions!).
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