Friday, September 7, 2012


Provide clear, easy to understand information of complex genetic techniques and normal anatomic changes in pregnancy is a physician literacy skill. Despite the challenge of learning the jargon and concepts, consider how you would discuss this with someone who is a physicist, an engineer or an administrative aide. Getting at the right place where you and the patient are on the same page is an incredibly important skill to work on. This right place might feel too reductionistic or be too 'cartoony' - so it is not the 'right place' for you, rather it is the 'right place' for you patient.

Below is an example of a clear, user friendly tool that is called a decision support instrument. Click on the caption to see the whole tool at the site.

Click on the picture above to enlarge
CVS, AMNIO FISH and PCR  - For more visuals
Here's a picture of a chorionic villus (which when sampling becomes the 'S' of CVS)

Here's a nice example of the use of FISH and PCR (you may have to register your name to watch the short video, but it's worth it!)  click here 

Here's a patient information sheet on CVS from Medline

And here is an interactive tutorial on AMNIOCENTESIS

I mentioned in class, the image of the nuchal translucency (you can get to it from here)

Thursday, September 6, 2012

Ischemic Heart Disease and Women
One of the many amazing (and distinguished) cardiologist I am fortunate to know is Dr. Noel Bairey Merz. Read more about her here. She and her colleagues in their 2009 article (see here) posit that the female presentation of disease may be due, in part to ischemia presenting differently in women (as compared to men)
In a rudimentary perspective, ischemia is often viewed as obstruction (due to atheromatous plaques and sticky platelets.)

 As the diameter of the vessel becomes more compromised and when demand for blood flow goes up (e.g. exercise), the mismatch of needed blood to tissues and that delivered results in pressure, pain or symptoms.
The clogged vessel approach may be true for some people (men and women) but it does not explain why women (with cardiovascular risks and normal catheterizations) respond better to treatment similar to those with obstructive disease.
The endothelial response of illness in ischemia, may be in part a reason why women, vs men experience a)no symptoms (yet have disease); b) 'different' symptoms - fast heart rate, GI upset, profound fatigue and c) die at higher numbers than their male counterparts.

So here again, we have the opportunity that sex and gender medicine can present inroads to the pathophysiology of ischemic heart disease that is accurate for both women and men - but we are still early in the game. Read more in the article link above and search the blog for other useful resources and stats.

For the latest guidelines check out Effectiveness-Based Guidelines for the Prevention of Cardiovascular Disease in Women—2011 Update overseen by Lori Mosca, MD, MPH, PhD and Professor of Medicine and Preventive Cardiology at Columbia.

Two of our Drexel Heart Health Medicine experts contributed to this - Dr Katherine Sherif Associate Professor of Medicine and Director of the Center for Women's Health and Dr Ellie Kelepouris, Professor of Medicine, Section Chief of Nephrology and Vice Chair for Medical Education

Check out more info at :