Zulfiqar Rana, MD, MPH, FACP

Board Certified in Internal Medicine

Category Archives: Cardiology


Edema evaluation

Attendance requirements:

Please see the “Guidelines” section.


  • Know the differential for this condition
  • Know how to approach a patient with this condition.
  • Know basic signs, symptoms, and treatment of other medical conditions in the differential.

Required reading:

  • Harrison’s chapter on Edema.
  • Also, review other “student slides” below. Know the differential and work-up algorithm!

Suggested reading:

Please use the text of your choice, e.g., UpToDate, Step-up to Medicine, Harrison’s, etc.

  • Pathophysiology of Edema

Student Slides:


Chest Pain

Prescribing of Fibrates

Comment: In large trials published in 2005 and 2010, fenofibrate did not improve cardiovascular outcomes significantly in patients with type 2 diabetes (JW Cardiol Jan 5 2006 and Mar 14 2010). Although gemfibrozil lowered rates of cardiovascular endpoints in older trials involving high-risk nondiabetic patients conducted largely before the statin era — for example, the Helsinki Heart Study (JW Gen Med Nov 17 1987) and VA-HIT Trial (JAMA 2001; 285:1585) — most such patients would now receive statins as first-line therapy. Thus, the recent rapid expansion of fenofibrate prescribing is unwarranted. One reason for this phenomenon is aggressive marketing of fibrates; another is confusion among clinicians about the lack of hard evidence to support add-on triglyceride-lowering therapies in patients receiving statins.

Prescribing of Fibrates Is Booming in the U.S. – General Medicine.

Extracranial Carotid and Vertebral Artery Disease – Cardiology

From J Watch: These recommendations concur with recently released guidelines on primary and secondary stroke prevention. The main message about revascularization for symptomatic carotid stenosis is that stenting should be avoided in older patients (e.g., aged ≥70) but might be as safe as endarterectomy in younger patients. However, a more important question is how either revascularization technique compares with intensive contemporary medical therapy, particularly in asymptomatic patients. As evidenced by the number of recommendations that are based on consensus in the absence of definitive evidence, opportunities for further research abound (e.g., the “imperfect correlation” between severity of carotid stenosis and ischemic events, methods to improve diagnostic accuracy, the effectiveness of carotid surgery in women). Large gaps in knowledge about vertebral arterial disease will be difficult to fill because of its relative infrequency compared with carotid artery disease.

Guidelines: Extracranial Carotid and Vertebral Artery Disease – Cardiology.

Updated Guidelines on Secondary Stroke Prevention – Neurology

About one in four strokes that occur annually are recurrent events. The American Heart Association/American Stroke Association has now updated its 2006 evidence-based recommendations for the prevention of stroke among survivors of ischemic stroke or transient ischemic attack (TIA). The guidelines include recommendations, rated by class (degree of treatment effect) and evidence level, for risk-factor control, antithrombotic therapies, interventional approaches for atherosclerotic disease, and treatment of unusual stroke mechanisms.

via Updated Guidelines on Secondary Stroke Prevention – Neurology.

Pacemaker, 1933

FIRST MENTION: Pacemaker, 1933

The Times reported on a demonstration of the “artificial pacemaker,” but the device and various successors were not ready for prime time until decades later.