Joseph S Alpert

Interests

Teaching

I teach both internal medicine and cardiovascular disease. I am also very frequently used as a mentor for students, residents, and junior and senior faculty. I give lectures to undergraduates, medical students, residents, and faculty throughout the year.

Research

I serve on a number of Data Monitoring Committees (DMC) for large and small, randomized, double-blind controlled trials. This committee oversees the unblinded data from these trials to make sure nothing importantly good or bad is happening that might lead the committee to stop the trial. I am frequently the chairman of the DMC. My areas of interest include acute ischemic heart disease, cardiovascular pharmacology, and cardiovascular epidemiology.

Courses

Scholarly Contributions

Books

• Alpert, J. S., Fletcher, B. J., & Fletcher, G. (2017). Volume 4: Acute Coronary Syndrome—Urgent and Follow-up Care. Minneapolis, MN: Cardiotext Publishing.
• Alpert, J. S., Braun, L. T., Fletcher, B. J., Fletcher, G., & Waldo, A. L. (2015). Atrial Fibrillation--A multidisciplinary Approach to Improving Patient Outcomes. Minneapolis, Minnesota: Cardiotext Publishing.
• Alpert, J. S., Braun, L. T., Fletcher, B. J., Fletcher, G., Escabar, E., & Barbagelata, A. (2015). Volume 2 : Prehospital Management of acute STEMI--Practical Approaches and International Strategies for Early Intervention. Minneapolis, Minnesota: Cardiotext Publishing.
• Alpert, J. S., Braun, L. T., & Fletcher, B. J. (2013). The Cardiovascular Team Approach, Volume 1: Heart Failure - Strategies to Improve Outcomes. Minneapolis, Minnesota: Cardiotext.
• Alpert, J. S., & Bettman, M. (2008). Mentoring Handbook, Second Edition. Dallas, Texas: American Heart Association.
• Alpert, J. S., Pollack, C. V., & Becker, D. L. (2008). Antithrombotic Therapy in ACS - A Sybthesis. New York, New York: The Exeter Group.
• Nixon, I., & Alpert, J. S. (2007). American Heart Association Clinical Cardiology Consult, Lippincott, Williams and Wilkins. Philadelphia: American Heart Association.
• Alpert, J. S. (2005). Cardiology for the Primary Care Physician. Philadelphia: Current Medicine Group.
• Alpert, J. S., & Rippe, J. M. (1986). Manual of Cardiovascular Diagnosis and Therapy--Second Edition. Boston, MA: Little, Brown & Co..
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  Translation: Japanese.
• Gore, J. M., Alpert, J. S., Benotti, J. R., Kotilainen, P. W., & Haffajee, C. I. (1985). Handbook of Hemodynamic Monitoring. Boston, MA: Little, Brown an Co.
• Alpert, J. S. (1984). Physiopathology of the Cardiovascular System. Boston, MA: Little, Brown & Co..
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  Translations: Japanese.
• Alpert, J. S., & Francis, G. S. (1984). Manual of Coronary Care-- Third Edition. Boston, CO: Little, Brown & Co.
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  Translations: Japanese and Spanish
• Alpert, J. S., & Mull, J. D. (1984). Part One: Guide To Anticoagulant Therapy--Management of Herparin and Warfarin. Wilmington, Delaware: Los Angeles and E.I. dupont de Nemours and Co, Inc.
• Alpert, J. S., & Mull, J. D. (1984). Part Two: Guide to Anticoagulant Therapy-- Counseling and Follow-up. Wilmington, Delaware: Los Angeles and E.I. duPont De Nemours and Co, Inc.
• Alpert, J. S., & Rippe, J. M. (1980). Manuel of Cardiovascular Diagnosis and Therapy. Boston, MA: Little, Brown & Co..
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  Translations: French and Spanish.
• Dalen, J. E., & Alpert, J. S. (1981). Valvular Heart Diease. Boston, MA: Little, Brown & Co.
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  Translations: Italian and Japanese.
• Alpert, J. S., & Francis, G. S. (1980). Manuel of Coronary Care, Second Edition. Boston, MA: Little, Brown & Co.
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  Translations: German.
• Alpert, J. S. (1978). The Heart Attack Handbook-- A Commonsense Guide to Treatment, Recovery and Prevention.. Boston, MA: Little, Brown & Co.
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  Translations: Swedish and Spanish.
• Alpert, J. S., & S, F. G. (1977). Manuel of Coronary Care. Boston, MA: Little, Brown & Co.
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  Translations: German, Japanese, and Spanish.

Chapters

• Alpert, J. S., & Klotz, S. A. (2017). Infective endocarditis. In Hurst’s The Heart,14th edition,(pp 1621-1648). New York, NY: McGraw Hill.
• Alpert, J. S., & Jaffe, A. S. (2016). What Is a Type 2 Myocardial Infarction: How Is It Recognized and What Should One Do to Establish That Diagnosis?. In Cardiac Biomarkers. Springer International Publishing. doi:10.1007/978-3-319-42982-3_6
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  In the 2007 Task Force for the Universal Definition of Myocardial Infarction document, published simultaneously in the Journal of the American College of Cardiology, the European Heart Journal, and Circulation, five subcategories of myocardial infarction (MI) were established (Thygesen et al., J Am Coll Cardiol 50:2173–2195, 2007). The 2007 document was an updated revision of the original document from this group that had first been published in 2000 (Alpert et al., J Am Coll Cardiol 36:959–969, 2000). As noted above, in this second communication the task force defined five subtypes of MI which were retained with modest changes in the 2012 revision (Thygesen et al., Eur Heart J 33:2551–2567, 2012).
• Thygesen, k., Alpert, J. S., Jaffe, A. S., & White, H. D. (2015). The Universal definition of myocardial infarction. In The ESC Textbook of Intensive and Acute Cardiovascular Care(pp 356-364). Oxford, Great Britain: Oxford Press.
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  Second Edition; Tubaro M, Vranckx P, Price S, Vrints C, Editors.
• Alpert, J. S., Jaffe, A. S., Thygesen, K., & White, H. D. (2011). Biomarkers in Acute Ischemic Heart Disease. In Acute Coronary Syndromes: A Companion to Braunwald's Heart Disease (Second Edition). Elsevier. doi:10.1016/B978-1-4160-4927-2.00012-8
• Alpert, J. S., Thygesen, K., Jaffe, A. S., & White, H. D. (2011). Terminology of acute coronary syndromes and definition of myocardial infarction. In Coronary Care Manual. Elsevier. doi:10.1016/B978-0-7295-3927-2.10004-1

Journals/Publications

• Alpert, J. S. (2024). Aristotle's Golden Mean in the Clinic. The American journal of medicine, 137(1), 1-2.
• Alpert, J. (2023). Twelve Interesting Biological Tidbits. The American journal of medicine.
• Alpert, J. S. (2023). Bicuspid Aortic Valve Disease - Evolving Concepts with Clinical Relevance. The American journal of medicine, 136(11), 1053-1054.
• Alpert, J. S. (2023). Face-to-Face Versus Digital Encounters in the Clinic. The American journal of medicine.
• Alpert, J. S. (2023). Hey, Doc, Should I be Taking Vitamin D Capsules Just Like My Neighbor?. The American journal of medicine.
• Alpert, J. S. (2023). Leprosy in Literature and Art: The Covenant of Water. The American journal of medicine.
• Alpert, J. S. (2023). Medical Jeopardy Quiz: Zoonoses - What Disease Is Related to These Animals?. The American journal of medicine.
• Alpert, J. S. (2023). Remarkable Advances in Clinical Medicine that Have Occurred Since I Was an Intern. The American journal of medicine, 136(6), 499-500.
• Alpert, J. S., & Chen, Q. M. (2023). Pharmacogenomics of Statins: A View from ChatGPT. The American journal of medicine.
• Frishman, W. H., & Alpert, J. S. (2023). Greens Replacing Whites: The Death of the White Hospital Uniform?. The American journal of medicine.
• Šerpytis, R., Lizaitis, M., Majauskienė, E., Navickas, P., Glaveckaitė, S., Petrulionienė, ., Valevičienė, N., Laucevičius, A., Chen, Q. M., Alpert, J. S., & Šerpytis, P. (2023). Type 2 Myocardial Infarction and Long-Term Mortality Risk Factors: A Retrospective Cohort Study. Advances in therapy, 40(5), 2471-2480.
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  In-hospital risk factors for type 1 myocardial infarction (MI) have been extensively investigated, but risk factors for type 2 MI are still emerging. Moreover, type 2 MI remains an underdiagnosed and under-researched condition. Our aim was to assess survival rates after type 2 MI and to analyze the risk factors for patient prognosis after hospitalization.
• Alpert, J. S., Jaffe, A. S., White, H. D., & Thygesen, K. A. (2022). Type 1, Type 2 Myocardial Infarction and Non-Ischemic Myocardial Injury-Opinion from the Front Lines. The American journal of medicine.
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  Differentiating patients with type 1 and type 2 myocardial infarction (MI) and acute non-ischemic myocardial injury continues to be a problem for many clinicians. Type 1 MI is the most easily defined. It involves the rise and fall of blood troponin measurements (only falling values if the patient arrives late) with an appropriate clinical observation consistent with myocardial ischemia. Diagnosis and therapy of type 1 MI are well understood and usually present no problem to the physician. The clinical scenarios leading to type 2 MI and non-ischemic myocardial injury are, however, often fraught with greater degrees of uncertainty. In addition, therapy for these latter 2 entities is poorly defined. This review will present 3 patient scenarios that should help clinicians understand the difference between these 3 entities as well as possible therapeutic interventions.
• Devereaux, P. J., Lamy, A., Chan, M. T., Allard, R. V., Lomivorotov, V. V., Landoni, G., Zheng, H., Paparella, D., McGillion, M. H., Belley-Côté, E. P., Parlow, J. L., Underwood, M. J., Wang, C. Y., Dvirnik, N., Abubakirov, M., Fominskiy, E., Choi, S., Fremes, S., Monaco, F., , Urrútia, G., et al. (2022). High-Sensitivity Troponin I after Cardiac Surgery and 30-Day Mortality. The New England journal of medicine, 386(9), 827-836.
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  Consensus recommendations regarding the threshold levels of cardiac troponin elevations for the definition of perioperative myocardial infarction and clinically important periprocedural myocardial injury in patients undergoing cardiac surgery range widely (from >10 times to ≥70 times the upper reference limit for the assay). Limited evidence is available to support these recommendations.
• Frishman, W. H., & Alpert, J. S. (2022). New Clinical Guidelines for the Diagnosis and Treatment of Heart Failure: Snatching Life from the Jaws of Death. The American journal of medicine.
• Alpert, J. S. (2021). A Philosophical Thought Experiment in Medical Ethics. The American journal of medicine.
• Alpert, J. S. (2021). Autism: A Spectrum Disorder.. The American journal of medicine, 134(6), 701-702. doi:10.1016/j.amjmed.2020.10.022
• Alpert, J. S. (2021). Homeless in America.. The American journal of medicine, 134(3), 295-296. doi:10.1016/j.amjmed.2020.10.002
• Alpert, J. S. (2021). Is Digitalis Therapy Still Viable? Foxglove Therapy Makes a Comeback.. The American journal of medicine, 134(1), 1-2. doi:10.1016/j.amjmed.2020.09.001
• Alpert, J. S. (2021). Lying to Patients - Is It Ever Ethical?. The American journal of medicine, 134(12), 1435-1436.
• Alpert, J. S. (2021). Mortality from Fear.. The American journal of medicine, 134(5), 557-558. doi:10.1016/j.amjmed.2021.02.003
• Alpert, J. S. (2021). Strange Bedfellows: Migraine Headache and Patent Foramen Ovale.. The American journal of medicine. doi:10.1016/j.amjmed.2021.04.002
• Alpert, J. S. (2021). The Reluctant Patient and the Insistent Doctor. The American journal of medicine.
• Alpert, J. S. (2021). When Will the Chaos End?. The American journal of medicine, 134(2), 149-150. doi:10.1016/j.amjmed.2020.11.004
• Alpert, J. S. (2022). Recent Thoughts Concerning Atrial Fibrillation. The American journal of medicine, 135(1), 1-2.
• Alpert, J. S., Skinner, D. P., & Goel, H. V. (2017). Personalized medicine: Digital electrocardiography. Digital Med, 3(3), 120-122. doi:10.4103/digm.digm_38_17
• Boylston, A. W., & Alpert, J. S. (2021). A Call to Arms: The War of the COVID.. The American journal of medicine, 134(4), 413-414. doi:10.1016/j.amjmed.2020.12.004
• Chen, Q., Serpytis, P., Serpytis, R., & Alpert, J. S. (2018). Myocardial infarction with non-obstructive coronary arteries (MINOCA). American Journal of Medicine.
• Chipkin, S. R., & Alpert, J. S. (2021). Don't React to Symptoms in Patients with Subclinical Hypothyroid Disease.. The American journal of medicine. doi:10.1016/j.amjmed.2021.05.001
• Frishman, W. H., & Alpert, J. S. (2021). The Most Important Qualities for the Good Doctor.. The American journal of medicine, 134(7), 825-826. doi:10.1016/j.amjmed.2020.11.002
• Frishman, W. H., & Alpert, J. S. (2021). Virtual Interviews During Internal Medicine Recruitments: An Unexpected Favorable Outcome of the COVID-19 Pandemic?. The American journal of medicine, 134(8), 935-936. doi:10.1016/j.amjmed.2021.03.002
• Khan, S. A., Campbell, A. M., Lu, Y., An, L., Alpert, J. S., & Chen, Q. M. (2021). N-Acetylcysteine for Cardiac Protection During Coronary Artery Reperfusion: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Frontiers in cardiovascular medicine, 8, 752939.
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  Coronary artery reperfusion is essential for the management of symptoms in the patients with myocardial ischemia. However, the benefit of reperfusion often comes at an expense of paradoxical injury, which contributes to the adverse events, and sometimes heart failure. Reperfusion is known to increase the production of reactive oxygen species (ROS). We address whether N-acetylcysteine (NAC) reduces the ROS and alleviates reperfusion injury by improving the clinical outcomes. A literature search for the randomized controlled trials (RCTs) was carried out in the five biomedical databases for testing the effects of NAC in patients undergoing coronary artery reperfusion by percutaneous coronary intervention, thrombolysis, or coronary artery bypass graft. Of 787 publications reviewed, 28 RCTs were identified, with a summary of 2,174 patients. A meta-analysis using the random effects model indicated that NAC administration during or prior to the reperfusion procedures resulted in a trend toward a reduction in the level of serum cardiac troponin (cTn) [95% , standardized mean difference (SMD) -0.80 (-1.75; 0.15), = 0.088, = 262 for control, 277 for NAC group], and in the incidence of postoperative atrial fibrillation [95% , relative risk (RR) 0.57 (0.30; 1.06), = 0.071, = 484 for control, 490 for NAC group]. The left ventricular ejection fraction or the measures of length of stay in intensive care unit (ICU) or in hospital displayed a positive trend that was not statistically significant. Among the nine trials that measured ROS, seven showed a correlation between the reduction of lipid peroxidation and improved clinical outcomes. These lines of evidence support the potential benefit of NAC as an adjuvant therapy for cardiac protection against reperfusion injury.
• Serpytis, R., Majauskiene, E., Navickas, P., Lizaitis, M., Glaveckaite, S., Rucinskas, K., Petrulioniene, Z., Valeviciene, N., Samalavicius, R. S., Berukstis, A., Baranauskas, A., Gargalskaite, U., Laucevicius, A., Chen, Q. M., Alpert, J. S., & Serpytis, P. (2022). Randomized Pilot Trial on Optimal Treatment Strategy, Myocardial Changes, and Prognosis of Patients with Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA). The American journal of medicine, 135(1), 103-109.
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  Myocardial infarction with nonobstructive coronary arteries (MINOCA) remains an unresolved challenge. Many different diagnostic approaches are often required to diagnose, confirm, and evaluate MINOCA. The prevalence can be as high as 13% of all acute myocardial infarction patients, indicating that this condition is not rare. At this time, there have been no completed randomized clinical trials involving MINOCA patients, and a better understanding of the mechanisms and management of these patients is important. This exploratory analysis seeks to find possible etiologic factors, the value of novel biomarkers, and the effect of different treatment strategies in patients with MINOCA.
• Simon, H. B., & Alpert, J. S. (2021). The American Journal of Medicine Responds.. The American journal of medicine, 134(4), 417. doi:10.1016/j.amjmed.2021.02.001
• Tavoian, D., Ramos-Barrera, L. E., Craighead, D. H., Seals, D. R., Bedrick, E. J., Alpert, J. S., Mashaqi, S., & Bailey, E. F. (2021). Six Months of Inspiratory Muscle Training to Lower Blood Pressure and Improve Endothelial Function in Middle-Aged and Older Adults With Above-Normal Blood Pressure and Obstructive Sleep Apnea: Protocol for the CHART Clinical Trial. Frontiers in cardiovascular medicine, 8, 760203.
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  Cardiovascular disease is a major global health concern and prevalence is high in adults with obstructive sleep apnea (OSA). Lowering blood pressure (BP) can greatly reduce cardiovascular disease risk and physical activity is routinely prescribed to achieve this goal. Unfortunately, many adults with OSA suffer from fatigue, daytime sleepiness, and exercise intolerance-due to poor sleep quality and nocturnal hypoxemia-and have difficulty initiating and maintaining an exercise program. High-resistance inspiratory muscle strength training (IMST) is a simple, time-efficient breathing exercise consistently reported to reduce BP in small, selective groups of both healthy and at-risk adults. Herein we present the study protocol for a randomized clinical trial to determine the long-term efficacy of IMST performed regularly for 24 weeks in middle-aged and older adults with OSA. The primary outcome is casual systolic BP. Secondary outcomes are 24-h systolic BP and circulating plasma norepinephrine concentration. Other outcomes include vascular endothelial function (endothelial-dependent and -independent dilation), aortic stiffness, casual and 24-h diastolic BP, and the influence of circulating factors on endothelial cell nitric oxide and reactive oxygen species production. Overall, this trial will establish efficacy of high-resistance IMST for lowering BP and improving cardiovascular health in middle-aged and older adults with OSA. This is a single-site, double-blind, randomized clinical trial. A minimum of 92 and maximum of 122 male and female adults aged 50-80 years with OSA and above-normal BP will be enrolled. After completion of baseline assessments, subjects will be randomized in a 1:1 ratio to participate in either high-resistance or sham (low-resistance) control IMST, performed at home, 5 min/day, 5 days/week, for 24 weeks. Repeat assessments will be taken after the 24-week intervention, and after 4 and 12 weeks of free living. This study is designed to assess the effects of 24 weeks of IMST on BP and vascular function. The results will characterize the extent to which IMST can reduce BP when performed over longer periods (i.e., 6 months) than have been assessed previously. Additionally, this study will help to determine underlying mechanisms driving IMST-induced BP reductions that have been reported previously. This trial is registered with ClinicalTrials.gov (Registration Number: NCT04932447; Date of registration June 21, 2021).
• Thygesen, K. A., Jaffe, A. S., & Alpert, J. S. (2021). Let the Buyer (Clinician) Beware.. Journal of the American College of Cardiology, 77(12), 1500-1502. doi:10.1016/j.jacc.2021.02.031
• Wylie, L. E., Waterbrook, A. L., Goldberg, R. J., Dalen, J. E., & Alpert, J. S. (2021). Should Senior Citizens Take Aspirin Daily to Prevent Heart Attacks or Strokes??. The American journal of medicine. doi:10.1016/j.amjmed.2021.04.001
• Alpert, J. S. (2020). 'A plague o' both your houses': Selected Quotations for Our Times.. The American journal of medicine, 133(6), 647. doi:10.1016/j.amjmed.2020.03.002
• Alpert, J. S. (2020). A Common Drug May Help Patients With Debilitating Migraine Headaches.. The American journal of medicine, 133(4), 397-398. doi:10.1016/j.amjmed.2019.11.002
• Alpert, J. S. (2020). A Possible and Simple Response to Physician Burnout.. The American journal of medicine, 133(2), 153-154. doi:10.1016/j.amjmed.2019.08.002
• Alpert, J. S. (2020). Bleeding Risk in Elderly Patients Receiving Anticoagulant Therapy: Should Dosage Be Reduced?. The American journal of medicine, 133(5), 523-524. doi:10.1016/j.amjmed.2019.11.003
• Alpert, J. S. (2020). Cardiac Rehabilitation: An Underutilized Class I Treatment for Cardiovascular Disease.. The American journal of medicine, 133(9), 1005-1006. doi:10.1016/j.amjmed.2020.01.008
• Alpert, J. S. (2020). Concerns About the Integrity of Ishida Y, Kawai S. Am J Med. 2004;117:549-555: The Reply.. The American journal of medicine, 133(6), e315. doi:10.1016/j.amjmed.2020.02.003
• Alpert, J. S. (2020). Further Insights into Type 2 Myocardial Infarction.. The American journal of medicine, 133(10), 1116-1117. doi:10.1016/j.amjmed.2020.05.006
• Alpert, J. S. (2020). Infection as a Trigger for Cardiovascular Disease. The American journal of medicine, 133(12), 1372-1373.
• Alpert, J. S. (2020). Life Imitates Art: The Physician in a Time of Plague.. The American journal of medicine, 133(6), 651. doi:10.1016/j.amjmed.2020.04.001
• Alpert, J. S. (2020). Something to Feel Good About in These Bad Times.. The American journal of medicine, 133(12), 1363-1364. doi:10.1016/j.amjmed.2020.08.003
• Alpert, J. S. (2020). The Great Meat Debate.. The American journal of medicine, 133(7), 769-770. doi:10.1016/j.amjmed.2020.02.002
• Alpert, J. S. (2020). The Reply.. The American journal of medicine, 133(2), e71. doi:10.1016/j.amjmed.2019.08.025
• Alpert, J. S. (2020). The Reply.. The American journal of medicine, 133(9), e531. doi:10.1016/j.amjmed.2020.05.008
• Alpert, J. S. (2020). The implantable cardioverter defibrillator was not as cost-effective as amiodarone for prolonging survival. ACP journal club.
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  Source Citation O’Brien BJ, Connolly SJ, Goeree R, et al., for the CIDS Investigators. Cost-effectiveness of the implantable cardioverter-defibrillator. Results from the Canadian Implantable Defibr...
• Alpert, J. S. (2020). Veterans' Day, 2020: Personal Reflections.. The American journal of medicine, 133(11), 1239-1240. doi:10.1016/j.amjmed.2020.05.001
• Alpert, J. S. (2020). Why Are Women Underrepresented in Cardiology?. The American journal of medicine, 133(3), 255-256. doi:10.1016/j.amjmed.2019.10.002
• Chen, Q. M., Alpert, J. S., Serpytis, R., Serpytis, P., Chen, Q. M., Alpert, J. S., & Alonderyte, A. (2020). MIOKARDO INFARKTO, NESANT VAINIKINIŲ ARTERIJŲ OBSTRUKCIJOS (MINOVA), DIAGNOSTIKOS IR GYDYMO YPATUMAI. Health Sciences, 30(2), 100-105. doi:10.35988/sm-hs.2020.051
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  Pirmasis miokardo infarktas aprašytas kone prieš 80 metų, tačiau miokardo infarktas, nesant vainikinių arterijų obstrukcijos (toliau – MINOVA), nustatytas dar neseniai. MINOVA pasireiškia 6-8 proc. pacientų, kuriems diagnozuotas ūmus miokardo infarktas (toliau – ŪMI). Šią pacientų grupę dažniau sudaro moterys (vidutiniškai apie 55 metų), tačiau, lyginant su ŪMI, šioje grupėje rečiau nustatoma hiperlipidemija. MINOVA pacientai reikalingi ypatingo dėmesio dėl skirtingų patofiziologinių reakcijų, kurios lemia skirtingą gydymą ir prognozę. Pagrindinės MINOVA sukeliančios priežastys yra vainikinių arterijų spazmas, vainikinių kraujagyslių aterominės plokštelės plyšimas ar erozija, mikrovaskulinė vainikinių arterijų disfunkcija, vainikinės kraujagyslės embolija (trombozė) bei spontaninė vainikinės arterijos disekacija. Pagrindinis tyrimas, padedantis atmesti kitaspriežastis, imituojančias ŪMI, yra širdies magnetinis rezonansas. Šiai pacientų grupei tikslinga atlikti acetilcholino provokacinį mėginį, optinės koherentinės tomografijos ar intravaskulinio ultragarso tyrimą bei hematologinį ištyrimą dėl trombofilijų. Klinikiniai tyrimai atskleidė, jog šiems pacientams skiriami angiotenziną konvertuojančio fermento inhibitoriai bei statinai yra naudingi tolimesnei prognozei. Nenustačius obstrukcijos kraujagyslėse, t.y. ūmų susirgimą sukėlusios priežasties, daugelis pacientų išrašomi į namus, nepaskiriant jokio arba paskiriant tik minimalų kardioprotekcinį medikamentinį gydymą.
• Dalen, J. E., & Alpert, J. S. (2020). Diagnosis and Treatment of Pulmonary Embolism: What Have We Learned in the Last 50 Years?. The American journal of medicine, 133(4), 404-406. doi:10.1016/j.amjmed.2019.08.049
• Dalen, J. E., Stein, P. D., Plitt, J. L., Jaswal, N., & Alpert, J. S. (2020). Extended Thromboprophylaxis for Medical Patients.. The American journal of medicine, 133(1), 9-11. doi:10.1016/j.amjmed.2019.05.050
• Frishman, W. H., & Alpert, J. S. (2020). Corrigendum to "Twenty Common Mistakes Made in Daily Clinical Practice" American Journal of Medicine 2020:133(01):1-3.. The American journal of medicine, 133(4), 522. doi:10.1016/j.amjmed.2020.01.005
• Frishman, W. H., & Alpert, J. S. (2020). Twenty Common Mistakes Made in Daily Clinical Practice.. The American journal of medicine, 133(1), 1-3. doi:10.1016/j.amjmed.2019.06.045
• Harhash, A. A., Cassuto, J., Hussein, A., Achu, E., Zucker, M. J., Goldschmidt, M., Alpert, J. S., & Baran, D. A. (2020). Safety of Outpatient Milrinone Infusion in End-Stage Heart Failure: ICD-Level Data on Atrial Fibrillation and Ventricular Tachyarrhythmias.. The American journal of medicine, 133(7), 857-864. doi:10.1016/j.amjmed.2019.11.023
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  Milrinone infusion is one of a few select "non-device" therapies for patients with New York Heart Association (NYHA) class IV, stage D heart failure, which has been associated with an increase in ventricular tachyarrhythmia and atrial fibrillation. Milrinone improves hemodynamics and provides symptomatic relief. Many patients with end-stage heart failure die from cardiac pump failure, and the impact of ventricular tachyarrhythmia and atrial fibrillation on their mortality is unclear..This is a retrospective study of 98 consecutive patients receiving outpatient milrinone in a single center from 2008 to 2016. The primary endpoint of the study was overall survival on milrinone. Secondary endpoints were incidence of post-milrinone implantable cardioverter defibrillator (ICD) shocks and development of ventricular tachyarrhythmia or atrial fibrillation..Median survival was 581 ± 96 days with no difference between those with prior ventricular tachyarrhythmia and those without at 1 month (92% vs 97%, P = 0.34), 6 months (67% vs 73%, P = 0.75), and 12 months (67% vs 61%, P = 0.88). Seven out of 12 (58%) patients with prior ventricular tachyarrhythmia had ICD shocks, as compared to 5 out of 78 (6.4%) (P
• Juneman, E. B., Alpert, J. S., Juneman, E. B., & Alpert, J. S. (2020). We Will Never Give Up.. The American journal of medicine, 133(10), 1111-1112. doi:10.1016/j.amjmed.2020.07.002
• Rieder, R. O., & Alpert, J. S. (2020). Do Long Hours at Work Increase One's Risk for Developing Coronary Heart Disease?. Journal of the American Heart Association, 9(12), e017010. doi:10.1161/jaha.120.017010
• Serpytis, R., Serpytis, P., Chen, Q. M., Alpert, J. S., & Alonderyte, A. (2020). MIOKARDO INFARKTO, NESANT VAINIKINIŲ ARTERIJŲ OBSTRUKCIJOS (MINOVA), DIAGNOSTIKOS IR GYDYMO YPATUMAI. HEALTH SCIENCES IN EASTERN EUROPE. doi:10.35988/SM-HS.2020.051
• Seward, P. N., & Alpert, J. S. (2020). Should We Have a Universal 1-Week Lockdown Every Year?. The American journal of medicine, 133(8), 879-880. doi:10.1016/j.amjmed.2020.05.002
• Alpert, J. S. (2019). A Common Drug May Help Patients With Debilitating Migraine Headaches. The American journal of medicine.
• Alpert, J. S. (2019). A Possible and Simple Response to Physician Burnout. The American journal of medicine.
• Alpert, J. S. (2019). Addendum to Dr. Robert Stern's Commentary Concerning an Herbal Product that Relieved Neuropathic Pain in Several Patients. The American journal of medicine, 132(10), 1128.
• Alpert, J. S. (2019). Animals in the Hospital. The American journal of medicine, 132(7), 779-780.
• Alpert, J. S. (2019). Bias in Medicine. The American journal of medicine, 132(8), 895-896.
• Alpert, J. S. (2019). Bleeding Risk in Elderly Patients Receiving Anticoagulant Therapy: Should Dosage Be Reduced?. The American journal of medicine.
• Alpert, J. S. (2019). Common Sense and Medical Practice. The American journal of medicine, 132(11), 1249-1250.
• Alpert, J. S. (2019). How Accurate Are the Findings Noted During a Physical Examination?: Will Physicians Stop Performing Physical Examinations? (Part 2). The American journal of medicine, 132(6), 663-664.
• Alpert, J. S. (2019). Placebo and Nocebo Effects, Medication Bias, and Hearsay. The American journal of medicine, 132(9), 1003-1004.
• Alpert, J. S. (2019). So, You Have to Give a Lecture-Are You Anxious?. The American journal of medicine, 132(5), 545-546. doi:10.1016/j.amjmed.2018.11.024
• Alpert, J. S. (2019). Syncope in the Elderly. The American journal of medicine, 132(10), 1115-1116.
• Alpert, J. S. (2019). Take-Home Messages From the Recently Updated AHA/ACC Guidelines for Atrial Fibrillation. The American journal of medicine.
• Alpert, J. S. (2019). The Racial Divide Here at Home.. The American journal of medicine, 132(1), 1-2. doi:10.1016/j.amjmed.2018.08.014
• Alpert, J. S., Chen, Q. M., Serpytis, R., Serpytis, P., Chen, Q. M., & Alpert, J. S. (2019). Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA).. The American journal of medicine, 132(3), 267-268. doi:10.1016/j.amjmed.2018.12.005
• Alpert, J. S., Dedic, A., & Arslan, M. (2019). Up-front non-invasive imaging in low-risk NSTEMI. An old keeper at a new gate.. J Am Coll Cardiol, 2478-2479.
• Dalen, J. E., & Alpert, J. S. (2019). Diagnosis and Treatment of Pulmonary Embolism; What Have We Learned in the Last 50 Years?. The American journal of medicine.
• Dalen, J. E., & Alpert, J. S. (2019). Medical Tourists: Incoming and Outgoing.. The American journal of medicine, 132(1), 9-10. doi:10.1016/j.amjmed.2018.06.022
• Dalen, J. E., Plitt, J. L., Jaswal, N., & Alpert, J. S. (2019). An Alternative to Medicare for All. The American journal of medicine, 132(6), 665-667.
• Dalen, J. E., Ryan, K. J., & Alpert, J. S. (2019). More Sub-Subs Are Coming!. The American journal of medicine, 132(2), 132-133. doi:10.1016/j.amjmed.2018.07.031
• Dalen, J. E., Stein, P. D., Plitt, J. L., Jaswal, N., & Alpert, J. S. (2019). Extended Thromboprophylaxis for Medical Patients. The American journal of medicine.
• Frishman, W. H., & Alpert, J. S. (2019). Class of 1969. The American journal of medicine.
• Frishman, W. H., & Alpert, J. S. (2019). Twenty Common Mistakes Made in Daily Clinical Practice. The American journal of medicine.
• Husain, M., Birkenfeld, A. L., Donsmark, M., Dungan, K., Eliaschewitz, F. G., Franco, D. R., Jeppesen, O. K., Lingvay, I., Mosenzon, O., Pedersen, S. D., Tack, C. J., Thomsen, M., Vilsbøll, T., Warren, M. L., & Bain, S. C. (2019). Oral Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes. The New England journal of medicine, 381(9), 841-851.
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  Establishing cardiovascular safety of new therapies for type 2 diabetes is important. Safety data are available for the subcutaneous form of the glucagon-like peptide-1 receptor agonist semaglutide but are needed for oral semaglutide.
• Thygesen, K., Alpert, J. S., Jaffe, A. S., Chaitman, B. R., Bax, J. J., Morrow, D. A., & White, H. D. (2019). Consenso ESC 2018 sobre la cuarta definición universal del infarto de miocardio. Revista Espanola De Cardiologia, 72(1), 72-72.
• Zavatta, M., Zamorano, J. L., Zakke, I., Yakovlev, A., Windecker, S., White, H. D., Werf, F. V., Weintraub, W. S., Wal, A. C., Vranckx, P., Virmani, R., Valgimigli, M., Underwood, S. R., Thygesen, K., Tendera, M., Tatu-chitoiu, G., Sujayeva, V., Steg, P. G., Smith, S. C., , Smajic, E., et al. (2019). Fourth universal definition of myocardial infarction (2018).. European heart journal, 40(3), 237-269. doi:10.1093/eurheartj/ehy462
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  Kristian Thygesen∗ (Denmark) Joseph S. Alpert∗ (USA) Allan S. Jaffe (USA) Bernard R. Chaitman (USA) Jeroen J. Bax (The Netherlands) David A. Morrow (USA) Harvey D. White∗ (New Zealand) Hans Mickley (Denmark) Filippo Crea (Italy) Frans Van de Werf (Belgium) Chiara Bucciarelli-Ducci (
• Alpert, J. S. (2018). Diet Redux: Which Food Type Leads to Heart Attacks?. The American journal of medicine, 131(9), 989-990.
• Alpert, J. S. (2018). Divisions, Departments, and the 2018 Red Sox Baseball Team: Qualities of Leadership That Lead to Success. The American journal of medicine.
• Alpert, J. S. (2018). Do We Learn More from Our Mistakes than from Our Successes?. The American journal of medicine, 131(4), 331-332.
• Alpert, J. S. (2018). Does Resting or Exercise Electrocardiography Assist Clinicians in Preventing Cardiovascular Events in Asymptomatic Adults?. JAMA cardiology, 3(8), 678-679.
• Alpert, J. S. (2018). Emotional States and Sudden Death. The American journal of medicine, 131(5), 455-456.
• Alpert, J. S. (2018). Is Science Important? A Recent Lecture.. The American journal of medicine, 131(3), 215. doi:10.1016/j.amjmed.2017.10.045
• Alpert, J. S. (2018). Medical Axioms: The Pithy Little Sayings That Reflect Deeper Knowledge. The American journal of medicine, 131(7), 719-720.
• Alpert, J. S. (2018). Please Say Thank You. The American journal of medicine, 131(6), 587-588.
• Alpert, J. S. (2018). Sloppy, Greedy, or Overworked?. The American journal of medicine, 131(12), 1397-1398.
• Alpert, J. S. (2018). So, You Have to Give a Lecture-Are You Anxious?. The American journal of medicine.
• Alpert, J. S. (2018). Socrates on Quality. The American journal of medicine, 131(8), 855-856.
• Alpert, J. S. (2018). Statement of Concern Regarding: Sato Y, Iwamoto J, Kanoko T, Satoh K. Homocysteine as a Predictive Factor for Hip Fracture in Elderly Women with Parkinson's Disease. Am J Med. 2005;118:1250-1255. The American journal of medicine, 131(3), e109.
• Alpert, J. S. (2018). The Digital Handheld Ultrasound Device: A New Portable Diagnostic Tool for Healthcare. Will it Replace the Stethoscope?. Digital Medicine, 4, 113-116.
• Alpert, J. S. (2018). The Fourth Edition of the Universal Definition of Myocardial Infarction. The American journal of medicine, 131(11), 1265-1266.
• Alpert, J. S. (2018). The Racial Divide Here at Home. The American journal of medicine.
• Alpert, J. S. (2018). The Reply. The American journal of medicine, 131(8), e341.
• Alpert, J. S. (2018). The Role of the Environment in Health Outcomes. The American journal of medicine, 131(10), 1137-1138.
• Alpert, J. S. (2018). The Seven Ages of the Physician. The American journal of medicine, 131(1), 1.
• Alpert, J. S., & Jaffe, A. S. (2018). 1-h High-Sensitivity Troponin Rule-Out and Rule-In Approach: Strengths and Potential Weaknesses. Journal of the American College of Cardiology, 72(6), 633-635.
• Dalen, J. E., & Alpert, J. S. (2018). Cardiac Cath Labs: Their Origins and Their Future. Chest, 154(3), 487-490.
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  More than 1 million diagnostic cardiac catheterizations (excluding percutaneous coronary intervention-only procedures) are performed each year in the nearly 2,000 cardiac catheterization laboratories in the United States..
• Dalen, J. E., & Alpert, J. S. (2018). Medical Tourists: Incoming and Outgoing. The American journal of medicine.
• Dalen, J. E., & Alpert, J. S. (2018). Which Patent Foramen Ovales Need Closure to Prevent Cryptogenic Strokes?. The American journal of medicine, 131(3), 222-225. doi:10.1016/j.amjmed.2017.10.052
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  Patients with cryptogenic strokes are more likely to have a patent foremen ovale than in the general population. It is speculated that these strokes are due to paradoxical embolism, that is, passage of a venous thrombus across the patent foremen ovale to enter the arterial circulation, resulting in an embolic stroke. Venous thromboembolism is rarely present in these cases of cryptogenic stroke. Thousands of patients with cryptogenic strokes have undergone transcatheter closure of their patent foremen ovale via a variety of devices. The first 3 randomized clinical trials comparing patent foremen ovale closure with medical therapy failed to show a significant advantage of patent foremen ovale closure. Three additional trials reported in 2017 had longer years of follow-up and demonstrated an advantage of patent foremen ovale closure versus medical therapy. Analysis of their data indicated that patent foremen ovale closure in patients with an atrial septal aneurysm in addition to a patent foremen ovale had a very significant decrease in cryptogenic strokes (P < .001). There was no decrease in strokes in patients without an aneurysm of the atrial septum who underwent patent foremen ovale closure (P = .37). Aneurysms of the atrial septum are easily recognized by echocardiography and are present in approximately one-third of patients with patent foremen ovales. These data suggest that closure of patent foremen ovales in patients with an atrial septal aneurysm is indicated. In patients with a patent foremen ovale without an aneurysm of the atrial septum, patent foremen ovale closure is not indicated.
• Dalen, J. E., Ryan, K. J., & Alpert, J. S. (2018). More Sub-subs Are Coming!. The American journal of medicine.
• Dalen, J. E., Ryan, K. J., & Alpert, J. S. (2018). The 2017 Match and the Future US Workforce. The American journal of medicine, 131(1), 2-4.
• Dalen, J. E., Ryan, K. J., Waterbrook, A. L., & Alpert, J. S. (2018). Hospitalists, Medical Education, and U.S. Health Care Costs. The American journal of medicine, 131(11), 1267-1269.
• Frishman, W. H., & Alpert, J. S. (2018). Medicine as a Meritocracy. The American journal of medicine.
• Frishman, W. H., & Alpert, J. S. (2018). Reform in House Staff Working Hours and Clinical Supervision: A 30-Year Reflection Following the Release of the Bell Commission Report. The American journal of medicine.
• Frishman, W. H., Alpert, J. S., & Killip, T. (2018). The Reply. The American journal of medicine, 131(3), e113.
• Huang, J. J., Reddy, S., Truong, T. H., Suryanarayana, P., & Alpert, J. S. (2018). Atrial Appendage Thrombosis Risk Is Lower for Atrial Flutter Compared with Atrial Fibrillation.. The American journal of medicine, 131(4), 442.e13-442.e17. doi:10.1016/j.amjmed.2017.10.041
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  The risk of stroke and thromboembolism in atrial fibrillation is established. However, the evidence surrounding the risk of thromboembolism in patients with atrial flutter is not as clear. We hypothesized that atrial flutter would have indicators of less risk for thromboembolism compared with atrial fibrillation on transesophageal echocardiography, thereby possibly leading to a lower stroke risk..A retrospective review of 2225 patients undergoing transesophageal echocardiography was performed. Those with atrial fibrillation or atrial flutter were screened. Exclusion criteria were patients being treated with chronic anticoagulation, the presence of a prosthetic valve, moderate to severe mitral regurgitation or stenosis, congenital heart disease, or a history of heart transplantation. A total of 114 patients with atrial fibrillation and 55 patients with atrial flutter met the criteria and were included in the analysis..Twelve patients (11%) in the atrial fibrillation group had left atrial appendage thrombus versus zero patients in the atrial flutter group (P < .05). The prevalence of spontaneous echocardiography contrast was significantly higher and left atrial appendage emptying velocity was significantly lower in the atrial fibrillation group compared with the atrial flutter group (P < .001). No spontaneous contrast was seen when the left atrial appendage emptying velocity was >60 cm/sec..Patients with atrial flutter have a lower incidence of left atrial appendage thrombi, higher left atrial appendage emptying velocity, and less left atrial spontaneous contrast compared with patients with atrial fibrillation, suggesting a lower risk for potential arterial thromboembolism.
• Janardhanan, R., Alpert, J. S., Alpert, J. S., & Janardhanan, R. (2018). The digital hand-held ultrasound device: A new portable diagnostic tool for healthcare. Will it replace the stethoscope?. American Journal of Medicine.
• Thygesen, K., Alpert, J. S., Jaffe, A. S., Chaitman, B. R., & White, H. D. (2018). Clarifying the Proper Definitions for Type 2 Myocardial Infarction. Journal of the American College of Cardiology, 71(11), 1291.
• Thygesen, K., Alpert, J. S., Jaffe, A. S., Chaitman, B. R., Bax, J. J., Morrow, D. A., & White, H. D. (2018). Fourth Universal Definition of Myocardial Infarction (2018).. Circulation, 138(20), e618-e651. doi:10.1161/cir.0000000000000617
• Thygesen, K., Alpert, J. S., Jaffe, A. S., Chaitman, B. R., Bax, J. J., Morrow, D. A., & White, H. D. (2018). Fourth Universal Definition of Myocardial Infarction (2018).. Global heart, 13(4), 305-338. doi:10.1016/j.gheart.2018.08.004
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  Kristian Thygesen∗ (Denmark) Joseph S. Alpert∗ (USA) Allan S. Jaffe (USA) Bernard R. Chaitman (USA) Jeroen J. Bax (The Netherlands) David A. Morrow (USA) Harvey D. White∗ (New Zealand) Hans Mickley (Denmark) Filippo Crea (Italy) Frans Van de Werf (Belgium) Chiara Bucciarelli-Ducci (
• Thygesen, K., Alpert, J. S., Jaffe, A. S., Chaitman, B. R., Bax, J. J., Morrow, D. A., White, H. D., Mickley, H., Crea, F., Bucciarelli-ducci, C., Katus, H. A., Pinto, F. J., Antman, E. M., Hamm, C. W., Januzzi, J. L., Apple, F. S., Alonso, M. A., Underwood, S. R., Canty, J. M., , Lyon, A. R., et al. (2018). [Fourth universal definition of myocardial infarction (2018)].. Kardiologia polska, 76(10), 1383-1415. doi:10.5603/kp.2018.0203
• Zhang, S., Liao, R., Kong, J., Spetzger, U., Milia, P., Thiriet, M., Wortley, D. J., & Alpert, J. S. (2018). Digital medicine: Emergence, definition, scope, and future. Digital Medicine, 4(1), 1. doi:10.4103/digm.digm_9_18
• Alpert, J. S. (2017). 'Lies, Damned Lies, and Statistics': Biostatistics and Prognostication for Patients. The American journal of medicine, 130(11), 1235.
• Alpert, J. S. (2017). Are You Planning to Sign Up for a Trip to Mars? Extreme Environmental Health Consequences of Space Travel. The American journal of medicine.
• Alpert, J. S. (2017). Challenging Patients. The American journal of medicine, 130(10), 1129-1130.
• Alpert, J. S. (2017). Is Science Important? A Recent Lecture. The American journal of medicine.
• Alpert, J. S. (2017). On Immigration: Welcome to America!. The American journal of medicine, 130(4), 383-384. doi:10.1016/j.amjmed.2016.11.032
• Alpert, J. S. (2017). Polypharmacy in Elderly Patients: The March Goes On and On. The American journal of medicine, 130(8), 875-876.
• Alpert, J. S. (2017). Statins and Diabetes: Wider Utilization Is Needed in Treatment and Prevention. The American journal of medicine, 130(5), 499-500.
• Alpert, J. S. (2017). The Reluctant Cardiac Patient. The American journal of medicine, 130(9), 1126-1127.
• Alpert, J. S. (2017). Will Physicians Stop Performing Physical Examinations?. The American journal of medicine, 130(7), 759-760.
• Alpert, J. S., & Chen, Q. M. (2017). Stem Cell Therapy: The Phoenix in Clinical Medicine?. The American journal of medicine, 130(9), 1003-1004.
• Alpert, J. S., Zhang, S., Liao, R., Thorsted Sorensen, J., & Zahger, D. (2017). Challenging Patients: An International Perspective. The American journal of medicine, 130(12), 1337-1339.
• Dalen, J. E., & Alpert, J. S. (2017). Concierge Medicine Is Here and Growing!!. The American journal of medicine, 130(8), 880-881.
• Dalen, J. E., & Alpert, J. S. (2017). The Reply. The American journal of medicine, 130(9), e405.
• Dalen, J. E., & Alpert, J. S. (2017). Which Patent Foramen Ovales Need Closure to Prevent Cryptogenic Strokes?. The American journal of medicine.
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  Patients with cryptogenic strokes are more likely to have a patent foremen ovale than in the general population. It is speculated that these strokes are due to paradoxical embolism, that is, passage of a venous thrombus across the patent foremen ovale to enter the arterial circulation, resulting in an embolic stroke. Venous thromboembolism is rarely present in these cases of cryptogenic stroke. Thousands of patients with cryptogenic strokes have undergone transcatheter closure of their patent foremen ovale via a variety of devices. The first 3 randomized clinical trials comparing patent foremen ovale closure with medical therapy failed to show a significant advantage of patent foremen ovale closure. Three additional trials reported in 2017 had longer years of follow-up and demonstrated an advantage of patent foremen ovale closure versus medical therapy. Analysis of their data indicated that patent foremen ovale closure in patients with an atrial septal aneurysm in addition to a patent foremen ovale had a very significant decrease in cryptogenic strokes (P 
• Dalen, J. E., Alpert, J. S., Dill, J., Desai, H., Dalen, J. E., Bime, C., Bhupinder, N., & Alpert, J. S. (2017). Pulmonary Embolism With Right Ventricular Dysfunction: Who Should Receive Thrombolytic Agents?. Journal of vascular surgery. Venous and lymphatic disorders, 5(2), 298. doi:10.1016/j.jvsv.2017.01.009
• Dalen, J. E., Ryan, K. J., & Alpert, J. S. (2017). Where Have the Generalists Gone? They Became Specialists, Then Subspecialists. The American journal of medicine, 130(7), 766-768.
• Frishman, W. H., Alpert, J. S., & Killip, T. (2017). The Coronary (Cardiac) Care Unit at 50 Years: A Major Advance in the Practice of Hospital Medicine. The American journal of medicine, 130(9), 1005-1006.
• Huang, J. J., Reddy, S., Truong, T. H., Suryanarayana, P., & Alpert, J. S. (2017). Atrial Appendage Thrombosis Risk Is Lower for Atrial Flutter Compared with Atrial Fibrillation. The American journal of medicine.
  More info

  The risk of stroke and thromboembolism in atrial fibrillation is established. However, the evidence surrounding the risk of thromboembolism in patients with atrial flutter is not as clear. We hypothesized that atrial flutter would have indicators of less risk for thromboembolism compared with atrial fibrillation on transesophageal echocardiography, thereby possibly leading to a lower stroke risk.
• Leelathanalerk, A., Dongtai, W., Huckleberry, Y., Kopp, B., Bloom, J., & Alpert, J. (2017). Evaluation of Deprescribing Amiodarone After New-Onset Atrial Fibrillation in Critical Illness. The American journal of medicine, 130(7), 864-866.
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  Recent studies have shed light on the continued prescription of inpatient medications upon hospital discharge, despite the original intent of short-term inpatient therapy. Amiodarone, an antiarrhythmic associated with significant adverse effects with long-term use, is commonly used for new-onset atrial fibrillation in critical illness (NAFCI). Although it is often preferred in this setting of hemodynamic instability, a prescription for long-term use should be carefully considered, preferably by a cardiologist. This study was conducted to evaluate the incidence of patients discharged on amiodarone without a cardiology consult or referral after being initiated on amiodarone for NAFCI.
• Natt, B., Dalen, J. E., Alpert, J. S., Natt, B., Dill, J., Desai, H., Dalen, J. E., Bime, C., & Alpert, J. S. (2017). Pulmonary Embolism with Right Ventricular Dysfunction: Who Should Receive Thrombolytic Agents?. The American journal of medicine, 130(1), 93.e29-93.e32. doi:10.1016/j.amjmed.2016.07.023
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  Appropriate management of pulmonary embolism patients with right ventricular dysfunction is uncertain. Recent guidelines have stressed the need for more data on the use of thrombolytic agents in the stable pulmonary embolism patient with right ventricular dysfunction. The objective of this study is to investigate the hypothesis that thrombolytic therapy in hemodynamically stable pulmonary embolism patients with right ventricular dysfunction is not associated with improved mortality..We did a retrospective analysis using multi-institutional observational data from the Nationwide Inpatient Sample database. International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes were used to identify the patients with pulmonary embolism and right ventricular dysfunction. In-hospital mortality was defined as the primary outcome of interest..Over the 4 years of the study period, 3668 patients with right ventricular dysfunction and pulmonary embolism were found, of which 3253 patients were identified as having hemodynamically stable right-sided heart failure with pulmonary embolism. There was no significant difference in mortality between hemodynamically stable pulmonary embolism patients with right ventricular dysfunction who received thrombolytic agents compared with those who did not. When outcomes were assessed for patients with right ventricular dysfunction and hemodynamic instability, a significant improvement in mortality was noted for patients with right ventricular dysfunction who received thrombolytic agents, which confirmed previous reports that thrombolytic therapy decreases mortality in pulmonary embolism patients who are hemodynamically unstable..Our data support the use of less aggressive treatment for stable pulmonary embolism patients with right ventricular dysfunction. These results argue against the reflexive use of thrombolytic agents in stable pulmonary embolism patients with right ventricular dysfunction.
• Natt, B., Desai, H., Bime, C., Dill, J., Dalen, J. E., & Alpert, J. S. (2017). The Reply. The American journal of medicine, 130(4), e165.
• Roever, L., Resende, E. S., & Alpert, J. S. (2017). Lipoprotein Subfractions in Type 2 Diabetes. Heart, lung & circulation, 26(3), 209-210.
• Alexander, K. P., Rich, M. W., Forman, D. E., Wenger, N. K., Dodson, J. A., Alpert, J. S., Kirkpatrick, J. N., & Maurer, M. S. (2016). Top 10 List for the Cardiovascular Care of Older Adults. The American journal of medicine. doi:10.1016/j.amjmed.2016.04.031
• Alpert, J. S. (2016). "If you are not a liberal when you are young, you have no heart and if you are not a conservative when old, you have no brain.". The American journal of medicine. doi:10.1016/j.amjmed.2016.01.054
• Alpert, J. S. (2016). 'Thank You, Doctor' Says It All. The American journal of medicine, 129(1), 1-2. doi:10.1016/j.amjmed.2015.07.002
• Alpert, J. S. (2016). A Home Diagnosis. The American journal of medicine, 129(2), 129-30. doi:10.1016/j.amjmed.2015.10.017
• Alpert, J. S. (2016). An Amazing Story: The Discovery of Insulin. The American journal of medicine. doi:10.1016/j.amjmed.2016.01.001
• Alpert, J. S. (2016). Can toothpaste make a difference in your life?. The American journal of medicine. doi:10.1016/j.amjmed.2016.09.002
• Alpert, J. S. (2016). Digital Medicine: "O brave new world". The American journal of medicine. doi:10.1016/j.amjmed.2016.06.056
• Alpert, J. S. (2016). Endocarditis Is Alive and Well, Unfortunately. The American journal of medicine.
• Alpert, J. S. (2016). Genetically Informed Medicine. The American journal of medicine. doi:10.1016/j.amjmed.2016.04.037
• Alpert, J. S. (2016). How Can We Improve the Management of Patients with Hypertension?. The American journal of medicine. doi:10.1016/j.amjmed.2016.08.016
• Alpert, J. S. (2016). On Immigration: Welcome to America!. The American journal of medicine.
• Alpert, J. S. (2016). Reflections on a recent trip to Lithuania and the global family of physicians. The American journal of medicine. doi:10.1016/j.amjmed.2016.05.024
• Alpert, J. S. (2016). TEMPORARY REMOVAL: The American Journal of Medicine: Excellence in Publishing 2015. The American journal of medicine.
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  The publisher regrets that this article has been temporarily removed. A replacement will appear as soon as possible in which the reason for the removal of the article will be specified, or the article will be reinstated. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
• Alpert, J. S. (2016). The Readmission Problem: A Modest Proposal Seeking a Solution. The American journal of medicine. doi:10.1016/j.amjmed.2016.10.014
• Alpert, J. S. (2016). The electronic medical record in 2016. Digital Medicine, 2(2), 48-51. doi:10.4103/2226-8561.189504
• Alpert, J. S. (2016). The medical application of digital medicine. Digital Med, 2(1), 40-41. doi:DOI:10.4103/2226-8561.182300
• Alpert, J. S. (2016). We Have Come a Long Way. The American journal of medicine. doi:10.1016/j.amjmed.2016.01.002
• Alpert, J. S., & Thygesen, K. A. (2016). The Case for a Revised Definition of Myocardial Infarction-The Ongoing Conundrum of Type 2 Myocardial Infarction vs Myocardial Injury. JAMA cardiology, 1(3), 249-50. doi:10.1001/jamacardio.2016.0543
• Alpert, J. S., Singh, B., Menoyo, J., Kosiborod, M., & Rasmussen, H. S. (2016). RAPID ONSET OF POTASSIUM:LOWERING WITH SODIUM ZIRCONIUM CYCLOSILICATE (ZS-9) ACROSS PATIENTS STRATIFIED BY RACE, AGE, AND COMORBIDITIES IN THE RANDOMIZED, DOUBLE:BLIND, PLACEBO:CONTROLLED PHASE 3 HARMONIZE STUDY. Journal of the American College of Cardiology, 67(13), 1345. doi:10.1016/s0735-1097(16)31346-8
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  Hyperkalemia (HK) (serum potassium [K+] ≥5.1 mEq/L) is a common electrolyte disorder associated with potentially fatal arrhythmias. Patients with heart failure (HF), chronic kidney disease (CKD), diabetes mellitus (DM), and those receiving renin-antiotensin-aldosterone system inhibitors (RAASi)
• Chen, Q. M., & Alpert, J. S. (2016). Nutraceuticals: Evidence of Benefit in Clinical Practice?. The American journal of medicine. doi:10.1016/j.amjmed.2016.03.036
• Chen, Q. M., & Alpert, J. S. (2016). To Supplement or Not, a Role for Antioxidant Vitamins in the Management of Heart Failure?. The American journal of medicine.
• Dalen, J. E., & Alpert, J. S. (2016). Cryptogenic Strokes and Patent Foramen Ovales: What's The Right Treatment?. Am J Med. doi:10.1016/j.amjmed.2016.08.006
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  More than 25% of all ischemic strokes per year are cryptogenic; that is their cause is not determined after an appropriate evaluation. In 1988 it was reported that the incidence of a patent foramen ovale (PFO) was 30 to 40% in young patients with a cryptogenic stroke compared to 25% in the general population. This led to the suspicion that cryptogenic strokes were due to paradoxical embolism; that is a venous thrombus crossing a patent foramen ovale to enter the left atrium and then the arterial circulation. Very few of the patients considered to have paradoxical embolism were shown to have co-existent venous thromboembolism. This suspicion of paradoxical embolism led to thousands of patients undergoing surgical closure of their patent foramen ovale. Surgical closure was replaced by closure of the patent foramen ovale by a variety of transvenous devices. Others recommended anticoagulant or anti-platelet therapy to prevent recurrent ischemic strokes. Three randomized clinical trials totaling more than 2,000 patients compared closure of the patent foramen ovale to medical therapy. All three trials reported that closure of the patent foramen ovale provided no benefit compared to medical therapy. Subsequent trials have demonstrated no benefit of anticoagulation compared to anti platelet therapy in patients with cryptogenic strokes with or without a patent foramen ovale. Patients with cryptogenic strokes should be evaluated for the presence of venous thromboembolism. If venous thromboembolism is present, treatment should be the same as for pulmonary embolism: anticoagulation. If venous thromboembolism is not present antiplatelet therapy is indicated.
• Desai, H., Natt, B., Bime, C., Dill, J., Dalen, J. E., & Alpert, J. S. (2016). Pulmonary Embolism with Right Ventricular Dysfunction: Who Should Receive Thrombolytic Agents?. The American journal of medicine.
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  Appropriate management of pulmonary embolism patients with right ventricular dysfunction is uncertain. Recent guidelines have stressed the need for more data on the use of thrombolytic agents in the stable pulmonary embolism patient with right ventricular dysfunction. The objective of this study is to investigate the hypothesis that thrombolytic therapy in hemodynamically stable pulmonary embolism patients with right ventricular dysfunction is not associated with improved mortality.
• Desai, H., Ta, T. C., & Alpert, J. S. (2016). The Pretender: Pulmonary Embolism. The American journal of medicine. doi:10.1016/j.amjmed.2016.06.012
• Gibson, C. M., Pinto, D. S., Chi, G., Arbetter, D., Yee, M., Mehran, R., Bode, C., Halperin, J., Verheugt, F. W., Wildgoose, P., Burton, P., van Eickels, M., Korjian, S., Daaboul, Y., Jain, P., Lip, G. Y., Cohen, M., Peterson, E. D., & Fox, K. A. (2016). Recurrent Hospitalization Among Patients With Atrial Fibrillation Undergoing Intracoronary Stenting Treated With 2 Treatment Strategies of Rivaroxaban or a Dose-Adjusted Oral Vitamin K Antagonist Treatment Strategy. Circulation. doi:10.1161/CIRCULATIONAHA.116.025783.
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  -Patients with atrial fibrillation who undergo intracoronary stenting traditionally are treated with a vitamin K antagonist (VKA) plus dual antiplatelet therapy (DAPT), yet this treatment leads to high risks of bleeding. We hypothesized that a regimen of rivaroxaban plus a P2Y12 inhibitor monotherapy or rivaroxaban plus DAPT could reduce bleeding and thereby have a favorable impact on all-cause mortality and the need for rehospitalization.
• Hasin, Y., Hasin, T., Mossinson, D., Abend, Y., Caspi, A., & Alpert, J. (2016). CardioPulse: Reducing the number of inappropriate invasive procedures in cardiology utilizing an online regulatory system. European heart journal, 37(9), 732-3.
• Yucel, E. K., Woodard, P. K., White, R. D., White, C. S., Ward, R. P., Udelson, J. E., Rybicki, F. J., Rubin, G. D., Rosenberg, C., Peacock, W. F., Patel, M. R., Mahmarian, J. J., Litt, H., Levy, P. D., Leipsic, J., Kramer, C. M., Kontos, M. C., Klein, L. W., Kazerooni, E. A., , Isselbacher, E. M., et al. (2016). 2015 ACR/ACC/AHA/AATS/ACEP/ASNC/NASCI/SAEM/SCCT/SCMR/SCPC/SNMMI/STR/STS Appropriate Utilization of Cardiovascular Imaging in Emergency Department Patients With Chest Pain: A Joint Document of the American College of Radiology Appropriateness Criteria Committee and the American College of Cardiology Appropriate Use Criteria Task Force.. Journal of the American College of Radiology : JACR, 13(2), e1-e29. doi:10.1016/j.jacr.2015.07.007
• Alpert, J. S. (2015). 'Doctor, I think that I might be having a heart attack'. The American journal of medicine, 128(2), 103-4.
• Alpert, J. S. (2015). 'The only thing we have to fear is fear itself'. The American journal of medicine, 128(4), 327-8.
• Alpert, J. S. (2015). Airline hygiene. The American journal of medicine, 128(8), 799.
• Alpert, J. S. (2015). Best of 2014. The American journal of medicine, 128(7), 667.
• Alpert, J. S. (2015). Good Advice from Anthony Bourdain. The American journal of medicine, 128(11), 1159.
• Alpert, J. S. (2015). Medicine, yes; politics, no!. The American journal of medicine, 128(3), 211-2.
• Alpert, J. S. (2015). Palm Reading, Observation, and Intuition. The American journal of medicine, 128(12), 1263-4.
• Alpert, J. S. (2015). Required Reading for Anyone Involved in Postgraduate Medical Education (Part 2). The American journal of medicine, 128(9), 929-30.
• Alpert, J. S. (2015). Required reading for anyone involved in graduate medical education. The American journal of medicine, 128(5), 441-2.
• Alpert, J. S. (2015). The Jeremiah Metzger Lecture: Jeremiah Metzger and the Era of Heliotherapy. Transactions of the American Clinical and Climatological Association, 126, 219-26.
• Alpert, J. S. (2015). The fastest way to make an enemy. The American journal of medicine, 128(6), 551-2.
• Alpert, J. S. (2015). What's in a word? Using words carefully. The American journal of medicine, 128(10), 1045-6.
• Alpert, J. S., Hannley, P. P., & Baird, I. (2015). A Decade of Work and Progress. The American Journal of Medicine, 128(1), 1-2. doi:10.1016/j.amjmed.2014.10.001
• Bhatt, A. B., Foster, E., Kuehl, K., Alpert, J. S., Brabeck, S., Crumb, S., Davidson JR, W. R., Earing, M. G., Ghoshhajra, B. B., Karamlou, T., Mital, S., & Tseng, Z. H. (2015). Congenital Heart Disease in the older adult. American Heart Association, 131(10.116/CIR.0000000000000204), 1884-1931.
• Bhatt, A. B., Foster, E., Kuehl, K., Alpert, J., Brabeck, S., Crumb, S., Davidson, W. R., Earing, M. G., Ghoshhajra, B. B., Karamlou, T., Mital, S., Ting, J., Tseng, Z. H., & , A. H. (2015). Congenital heart disease in the older adult: a scientific statement from the American Heart Association. Circulation, 131(21), 1884-931.
• Dalen, J. E., Devries, S., Alpert, J. S., & Willett, W. (2015). It's time to replace organic chemistry with nutrition as a pre-med requirement. The American journal of medicine, 128(10), 1048-9.
• Dalen, J. E., Waterbrook, K., & Alpert, J. S. (2015). Why Do So Many Americans Oppose the Affordable Care Act?. Am J Med. pii: S0002-9343(15)00164-3. doi: 10.1016/j.amjmed.2015.01.032 [Epub ahead of print].
• Dalen, J. E., Waterbrook, K., & Alpert, J. S. (2015). Why do so many Americans oppose the Affordable Care Act?. The American journal of medicine, 128(8), 807-10.
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  The Patient Protection and Affordable Care Act (ACA) was passed by a Democratic Congress and signed into law by a Democratic president in 2010. Republican congressmen, governors, and Republican candidates have consistently opposed the ACA and have vowed to repeal it. Polls have consistently shown that it is supported by
• Huang, J. J., Desai, C., Singh, N., Sharda, N., Fernandes, A., Riaz, I. B., & Alpert, J. S. (2015). Summer syncope syndrome redux. The American journal of medicine.
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  While antihypertensive therapy is known to reduce the risk for heart failure, myocardial infarction, and stroke, it can often cause orthostatic hypotension and syncope, especially in the setting of polypharmacy and possibly, a hot and dry climate. The objective of the present study was to investigate whether the results of our prior study involving continued use of antihypertensive drugs at the same dosage in the summer as in the winter months for patients living in the Sonoran desert resulted in an increase in syncopal episodes during the hot summer months.
• Serpytis, P., Karvelyte, N., Serpytis, R., Kalinauskas, G., Rucinskas, K., Samalavicius, R., Ivaska, J., Glaveckaite, S., Berukstis, E., Tubaro, M., Alpert, J. S., & Laucevičius, A. (2015). Post-infarction ventricular septal defect: risk factors and early outcomes. Hellenic journal of cardiology : HJC = Hellēnikē kardiologikē epitheōrēsē, 56(1), 66-71.
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  Rupture of the ventricular septum complicates acute myocardial infarction in 0.2% of cases in the thrombolytic era. Ventricular septal defect (VSD) has a mortality of 90-95% in medically managed and 19-60% in surgically treated patients.
• Serpytis, p., Karvelyte, N., Serpytis, R., Kalinauskas, G., Rucinskas, K., Samalavicius, R., Ivaska, J., Glaveckaite, S., Berukstis, E., Tubaro, M., Alpert, J. S., & Laucevicius, A. (2015). Post- infarction ventricular septal defect: Risk Factors and early outcomes. Hellenic J Cardiol 2015;56:66-71.
• Abidov, A., & Alpert, J. S. (2014). Importance of echocardiographic findings in the acute presentation of Behçet's disease--diagnostic and prognostic considerations. Echocardiography (Mount Kisco, N.Y.), 31(8), 913-5.
• Alpert, J. S. (2014). Are there circumstances where I would refuse to participate in caring for a patient?. The American journal of medicine, 127(4), 251-2.
• Alpert, J. S. (2014). Baseball lingo in the medical world. The American journal of medicine, 127(9), 801.
• Alpert, J. S. (2014). Compliance/adherence to physician-advised diagnostic and therapeutic strategies. The American journal of medicine, 127(8), 685-6.
• Alpert, J. S. (2014). Dolce far niente - it is sweet doing nothing. The American journal of medicine, 127(7), 569.
• Alpert, J. S. (2014). Exercise is just as important as your medication. The American journal of medicine, 127(10), 897-8.
• Alpert, J. S. (2014). Hey, doc, how much longer am I going to live?. The American journal of medicine, 127(1), 5.
• Alpert, J. S. (2014). My recent reading list of nonmedical books. The American journal of medicine, 127(2), 101-2.
• Alpert, J. S. (2014). Standing on the shoulders of giants. The American journal of medicine, 127(5), 359-60.
• Alpert, J. S. (2014). The NOACs (novel oral anticoagulants) have landed!. The American journal of medicine, 127(11), 1027-8.
• Alpert, J. S. (2014). To dig or not to dig. The American journal of medicine, 127(6), 461-2.
• Alpert, J. S., & Tagler, J. (2014). The publisher and the editor: friend or foe. The American journal of medicine, 127(12), 1137-8.
• Alpert, J. S., Thygesen, K. A., White, H. D., & Jaffe, A. S. (2014). Diagnostic and therapeutic implications of type 2 myocardial infarction: review and commentary. The American journal of medicine, 127(2), 105-8.
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  The Task Force for the Universal Definition of Myocardial Infarction recently published updated guidelines for the clinical and research diagnosis of myocardial infarction under a variety of circumstances and in a variety of categories. A type 1 myocardial infarction (MI) is usually the result of atherosclerotic coronary artery disease with thrombotic coronary arterial obstruction secondary to atherosclerotic plaque rupture, ulceration, fissuring, or dissection, causing coronary arterial obstruction with resultant myocardial ischemia and necrosis. Patients with a type 2 MI do not have atherosclerotic plaque rupture. In this latter group of patients, myocardial necrosis occurs because of an increase in myocardial oxygen demand or a decrease in myocardial blood flow. Type 2 MI has been the subject of considerable clinical discussion and confusion. This review by knowledgeable members of the Task Force seeks to help clinicians resolve the confusion surrounding type 2 MI.
• Asencio, L. A., Huang, J. J., & Alpert, J. S. (2014). Combining antiplatelet and antithrombotic therapy (triple therapy): what are the risks and benefits?. The American journal of medicine, 127(7), 579-85.
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  Most patients with mechanical heart valves and many patients with atrial fibrillation will require long-term anticoagulation therapy. For patients with mechanical prosthetic valves, only warfarin is indicated. However, for patients with nonvalvular atrial fibrillation who are at increased risk for embolic stroke, one of the newer antithrombotic medications, such as rivaroxaban, dabigatran, and apixaban, also can be used. Patients with indications for antithrombotic therapy often will have coexisting vascular disease, such as coronary artery disease, requiring concomitant antiplatelet therapy with aspirin alone or more commonly with a dual antiplatelet regimen, aspirin and clopidogrel, or prasugrel or ticagrelor. The risks and benefits of this approach are still not well defined, and current guidelines have included recommendations based primarily on expert opinion.
• Dalen, J. E., Alpert, J. S., Goldberg, R. J., & Weinstein, R. S. (2014). The epidemic of the 20(th) century: coronary heart disease. The American journal of medicine, 127(9), 807-12.
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  Heart disease was an uncommon cause of death in the US at the beginning of the 20th century. By mid-century it had become the commonest cause. After peaking in the mid-1960s, the number of heart disease deaths began a marked decline that has persisted to the present. The increase in heart disease deaths from the early 20th century until the 1960s was due to an increase in the prevalence of coronary atherosclerosis with resultant coronary heart disease, as documented by autopsy studies. This increase was associated with an increase in smoking and dietary changes leading to an increase in serum cholesterol levels. In addition, the ability to diagnose acute myocardial infarction with the aid of the electrocardiogram increased the recognition of coronary heart disease before death. The substantial decrease in coronary heart disease deaths after the mid-1960s is best explained by the decreased incidence, and case fatality rate, of acute myocardial infarction and a decrease in out-of-hospital sudden coronary heart disease deaths. These decreases are very likely explained by a decrease in coronary atherosclerosis due to primary prevention, and a decrease in the progression of nonobstructive coronary atherosclerosis to obstructive coronary heart disease due to efforts of primary and secondary prevention. In addition, more effective treatment of patients hospitalized with acute myocardial infarction has led to a substantial decrease in deaths due to acute myocardial infarction. It is very likely that the 20th century was the only century in which heart disease was the most common cause of death in America.
• Desai, C. K., Huang, J., Lokhandwala, A., Fernandez, A., Riaz, I. B., & Alpert, J. S. (2014). The role of vitamin supplementation in the prevention of cardiovascular disease events. Clinical cardiology, 37(9), 576-81.
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  The production, sale, and consumption of multiple vitamins is a multibillion-dollar industry. Most Americans take some form of supplement ostensibly for prevention of cardiovascular disease. It has been claimed that vitamin A retards atherogenesis. Vitamin C is an antioxidant and is thought to possibly decrease free radical-induced endothelial injury, which can lead to atherosclerotic plaque formation. Vitamin E has been extensively studied for its possible effects on platelet function as well as inhibition of foam-cell formation. Low levels of vitamin D have been thought to negatively impact myocardial structure and increase the risk for cardiovascular events. Increased intake of vitamin B6, B12, and folate has been associated with reduction of homocysteine levels; elevated homocysteine blood levels have been associated with the occurrence of stroke, heart attack, and cardiovascular death. The purpose of this study was to review the currently available literature for vitamin supplementation with respect to prevention of cardiovascular disease. Unfortunately, the current evidence suggests no benefit exists with vitamin supplementation in the general US population. Further research is needed to evaluate whether there are specific populations that might benefit from vitamin supplementation.
• Doroghazi, R. M., & Alpert, J. S. (2014). A medical education as an investment: financial food for thought. The American journal of medicine, 127(1), 7-11.
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  Every year that the training period can be shortened increases the value of a medical education. Tuition covers only a fraction of the cost of medical education, making the societal investment in older students less financially robust. Shortening training periods would immediately solve the shortage of residency training positions. With a few exceptions, a medical education is a good investment for women. We are skeptical of the proposals to address the skyrocketing student debt because they do not confront the primary problem. The best way to minimize debt is thrift, and the best way to make a career in medicine more desirable is to shorten the training time.
• Doroghazi, R. M., & Alpert, J. S. (2014). The reply. The American journal of medicine, 127(8), e23.
• Huang, J. J., Sharda, N., Riaz, I. B., & Alpert, J. S. (2014). Summer syncope syndrome. The American journal of medicine, 127(8), 787-90.
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  Antihypertensive therapy is associated with significant relative risk reductions in the incidence of heart failure, myocardial infarction, and stroke. However, a common adverse reaction to antihypertensive therapy is orthostatic hypotension, dehydration, and syncope. We propose that continued use of antihypertensive medications at the same dosage during the dry summer months in patients living in the Sonoran desert leads to an increase in syncopal episodes.
• January, C. T., Wann, L. S., Alpert, J. S., Calkins, H., Cigarroa, J. E., Cleveland, J. C., Conti, J. B., Ellinor, P. T., Ezekowitz, M. D., Field, M. E., Murray, K. T., Sacco, R. L., Stevenson, W. G., Tchou, P. J., Tracy, C. M., Yancy, C. W., & , A. C. (2014). 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Journal of the American College of Cardiology, 64(21), e1-76.
• January, C. T., Wann, L. S., Alpert, J. S., Calkins, H., Cigarroa, J. E., Cleveland, J. C., Conti, J. B., Ellinor, P. T., Ezekowitz, M. D., Field, M. E., Murray, K. T., Sacco, R. L., Stevenson, W. G., Tchou, P. J., Tracy, C. M., Yancy, C. W., & , A. T. (2014). 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation, 130(23), e199-267.
• January, C. T., Wann, L. S., Alpert, J. S., Calkins, H., Cigarroa, J. E., Cleveland, J. C., Conti, J. B., Ellinor, P. T., Ezekowitz, M. D., Field, M. E., Murray, K. T., Sacco, R. L., Stevenson, W. G., Tchou, P. J., Tracy, C. M., Yancy, C. W., & , A. T. (2014). 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation, 130(23), 2071-104.
• Riaz, I. B., Asawaeer, M., Riaz, H., Gabriel, W. M., Tabash, I. K., Bilal, J., & Alpert, J. S. (2014). Optimal anticoagulation duration of unfractionated and low molecular weight heparin in non-ST elevation acute coronary syndrome: a systematic review of the literature. International journal of cardiology, 177(2), 461-6.
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  In this PCI era, non-invasive management for patients presenting with non-ST elevation acute coronary syndrome continues to be relevant in several clinical circumstances. The duration of anticoagulation in non-invasively treated group is not clear. The use of heparin can be associated with fatal side effects. Thus, defining the optimal duration of therapy has significant implications for patient safety and cost.
• White, H. D., Thygesen, K., Alpert, J. S., & Jaffe, A. S. (2014). Clinical implications of the Third Universal Definition of Myocardial Infarction. Heart (British Cardiac Society), 100(5), 424-32.
• White, H. D., Thygesen, K., Alpert, J. S., & Jaffe, A. S. (2014). Republished: clinical implications of the third universal definition of myocardial infarction. Postgraduate medical journal, 90(1067), 502-10.
• White, H., Thygesen, K., Alpert, J. S., & Jaffe, A. (2014). Universal MI definition update for cardiovascular disease. Current cardiology reports, 16(6), 492.
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  The new third universal definition of myocardial infarction (MI) is based on troponin elevation together with ischemic symptoms, ischemic ECG changes, and imaging evidence. MIs are classified into five types as to whether they are spontaneous, secondary to imbalance between coronary artery blood supply and demand, related to sudden death, or related to revascularization procedures. The definition is based on a rise and/or fall in troponin levels occurring in a clinical setting. There have been modifications over previous definitions with adding intracoronary thrombus as a criterion, adding a new type of MI type 4c, and raising the cutpoint for the diagnosis of MI related to percutaneous coronary intervention to five times the 99(th) percentile upper reference limit and requiring evidence of ischemia or angiographic complications. In clinical practice, trials, and registries, different definitions are used. There is a need for consistency with regard to the definition of MI and the universal definition should be implemented.
• Alpert, J. S. (2013). 'Doctor, my heart keeps skipping a beat'. The American journal of medicine, 126(5), 367.
• Alpert, J. S. (2013). Atrial fibrillation: food for thought in 2013. The American journal of medicine, 126(11), 937-8.
• Alpert, J. S. (2013). Marijuana for diabetic control. The American journal of medicine, 126(7), 557-8.
• Alpert, J. S. (2013). Osler's nodes and Janeway lesions are not the result of small-vessel vasculitis. The American journal of medicine, 126(10), 843-4.
• Alpert, J. S. (2013). Philematology: the science of kissing. A message for the marital month of june. The American journal of medicine, 126(6), 466.
• Alpert, J. S. (2013). Skepticism or 'things I was taught that weren't true'. The American journal of medicine, 126(2), 91-2.
• Alpert, J. S. (2013). Some reflections on China, US-Chinese relations, and healthcare in China. The American journal of medicine, 126(3), 187-8.
• Alpert, J. S. (2013). Tempus fugit--time flies, use it wisely. The American journal of medicine, 126(8), 659-60.
• Alpert, J. S. (2013). The team approach--go team!!. The American journal of medicine, 126(4), 275.
• Alpert, J. S., & Francis, G. S. (2013). Practicing 'check the box' medicine. The American journal of medicine, 126(12), 1027-8.
• Alpert, J. S., & Hannley, P. P. (2013). Moving countries toward healthier lifestyles. The American journal of medicine, 126(1), 1-2.
• Alpert, J. S., Jaffe, A. S., Chaitman, B. R., White, H. D., Thygesen, K., Katus, H. A., Apple, F. S., Lindahl, B., Morrow, D. A., Clemmensen, P. M., Johanson, P., Hod, H., Underwood, R., Bonow, R. O., Pinto, F., Gibbons, R. J., Fox, K. A., Atar, D., Newby, L. K., , Galvani, M., et al. (2013). Documento de consenso de expertos. Tercera definición universal del infarto de miocardio. Revista Espanola De Cardiologia, 66(2), 132-132. doi:10.1016/j.recesp.2012.11.005
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  Autores/Miembros del Grupo de Trabajo Presidentes: Kristian Thygesen (Dinamarca), Joseph S. Alpert (Estados Unidos), Harvey D. White (Nueva Zelanda); Subcomite sobre Biomarcadores: Allan S. Jaffe (Estados Unidos), Hugo A. Katus (Alemania), Fred S. Apple (Estados Unidos), Bertil Lindahl (Suecia) y David A. Morrow (Estados Unidos); Subcomite del ECG: Bernard R. Chaitman (Estados Unidos), Peter M. Clemmensen (Dinamarca), Per Johanson (Suecia) y Hanoch Hod (Israel); Subcomite de Imagen: Richard Underwood (Reino Unido), Jeroen J. Bax (Paises Bajos), Robert O. Bonow (Estados Unidos), Fausto Pinto (Portugal) y Raymond J. Gibbons (Estados Unidos); Subcomite de Clasificacion: Keith A. Fox (Reino Unido), Dan Atar (Noruega), L. Kristin Newby (Estados Unidos), Marcello Galvani (Italia) y Christian W. Hamm (Alemania); Subcomite de Intervencion: Barry F. Uretsky (Estados Unidos), P. Gabriel Steg (Francia), William Wijns (Belgica), Jean-Pierre Bassand (Francia), Phillippe Menasche (Francia) y Jan Ravkilde (Dinamarca); Subcomite de Ensayos y Registros: E. Magnus Ohman (Estados Unidos), Elliott M. Antman (Estados Unidos), Lars C. Wallentin (Suecia), Paul W. Armstrong (Canada) y Maarten L. Simoons (Paises Bajos); Subcomite de Insuficiencia Cardiaca: James L. Januzzi (Estados Unidos), Markku S. Nieminen (Finlandia), Mihai Gheorghiade (Estados Unidos) y Gerasimos Filippatos (Grecia); Subcomite de Epidemiologia: Russell V. Luepker (Estados Unidos), Stephen P. Fortmann (Estados Unidos), Wayne D. Rosamond (Estados Unidos), Dan Levy (Estados Unidos) y David Wood (Reino Unido); Subcomite de Perspectivas Globales: Sidney C. Smith (Estados Unidos), Dayi Hu (China), Jose Luis Lopez-Sendon (Espana), Rose Marie Robertson (Estados Unidos), Douglas Weaver (Estados Unidos), Michal Tendera (Polonia), Alfred A. Bove (Estados Unidos), Alexander N. Parkhomenko (Ucrania), Elena J. Vasilieva (Rusia) y Shanti Mendis (Suiza)
• Biasucci, L. M., Koenig, W., Mair, J., Mueller, C., Plebani, M., Lindahl, B., Rifai, N., Venge, P., Hamm, C., Giannitsis, E., Huber, K., Galvani, M., Tubaro, M., Collinson, P., Alpert, J. S., Hasin, Y., Katus, H., Jaffe, A. S., Thygesen, K., & , S. G. (2013). How to use C-reactive protein in acute coronary care. European heart journal, 34(48), 3687-90.
• Frishman, W. H., & Alpert, J. S. (2013). Reducing hospital readmissions for cardiovascular disease: is it feasible?. The American journal of medicine, 126(9), 753-4.
• Guérin, A., Lin, J., Jhaveri, M., Wu, E. Q., Yu, A. P., Cloutier, M., Gauthier, G., & Alpert, J. S. (2013). Outcomes in atrial fibrillation patients on combined warfarin & antiarrhythmic therapy. International journal of cardiology, 167(2), 564-9.
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  This retrospective cohort study compared rates of treatment persistence, incidences of de novo stroke, arterial embolism, and hemorrhage/bleeding, and healthcare resource use and costs between atrial fibrillation/flutter (AF/AFL) patients receiving concomitant warfarin (W)+amiodarone (A) or warfarin+other antiarrhythmic drug (OAAD) therapy in real-world practice.
• Thygesen, K., Alpert, J. S., & Jaffe, A. S. (2013). Erratum: Third universal definition of myocardial infarction (Journal of the American College of Cardiology (2012) 60 (158-98) DOI: 10.1016/j.jacc.2012. 08.001). Journal of the American College of Cardiology, 61(5). doi:10.1016/j.jacc.2012.12.006
• Thygesen, K., Alpert, J. S., Jaffe, A. S., Simoons, M. L., Chaitman, B. R., & White, H. D. (2013). Expert Consensus Document. Third Universal Definition of Myocardial Infarction. Revista Espanola De Cardiologia, 66(02), 132-132. doi:10.1016/j.rec.2012.11.006
• Alpert, J. S. (2012). A few unpleasant facts about atherosclerotic arterial disease in the United States and the world. The American journal of medicine, 125(9), 839-40.
• Alpert, J. S. (2012). Can you trust a computer to read your electrocardiogram?. The American journal of medicine, 125(6), 525-6.
• Alpert, J. S. (2012). Changing US and world demographics: consequences for the practice of medicine. The American journal of medicine, 125(5), 427-8.
• Alpert, J. S. (2012). New directions in anticoagulation. The American journal of medicine, 125(3), 217-8.
• Alpert, J. S. (2012). The times they are a-changin': Bob Dylan, 1964. The American journal of medicine, 125(8), 729.
• Alpert, J. S. (2012). What is true today is often not true tomorrow. The American journal of medicine, 125(10), 945-6.
• Alpert, J. S., & Chen, Q. M. (2012). Has the genomic revolution failed?. Clinical cardiology, 35(3), 178-9.
• Alpert, J. S., & Chen, Q. M. (2012). Modern medicine and the Garden of Eden. The American journal of medicine, 125(11), 1043-4.
• Alpert, J. S., & Chen, Q. M. (2012). So, you want to live to 120? The genie in the bottle. The American journal of medicine, 125(7), 621-2.
• Alpert, J. S., & Frishman, W. H. (2012). A bridge too far: a critique of the new ACGME duty hour requirements. The American journal of medicine, 125(1), 1-2.
• Alpert, J. S., & Jaffe, A. S. (2012). Interpreting biomarkers during percutaneous coronary intervention: the need to reevaluate our approach. Archives of internal medicine, 172(6), 508-9.
• Alpert, J. S., & Shapiro, E. (2012). The anatomy and physiology of the US health care system in 2050? An exercise in prognostication, fantasy, and hope. The American journal of medicine, 125(12), 1151-2.
• Jaffe, A. S., & Alpert, J. S. (2012). Misconstrued intentions: setting the record straight-reply.. Archives of internal medicine, 172(18), 1425-7. doi:10.1001/archinternmed.2012.4125
• Sorrell, V. L., Pancyzk, E., & Alpert, J. S. (2012). A new disease: bicuspid aortic valve aortopathy syndrome. The American journal of medicine, 125(4), 322-3.
• Stowell, S. A., Gardner, A. J., Alpert, J. S., Naccarelli, G. V., Harkins, T. P., Louder, A. M., & Tamariz, L. (2012). Impact of certified CME in atrial fibrillation on administrative claims. The American journal of managed care, 18(5), 253-60.
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  To determine whether changes in physician behavior associated with a continuing medical education (CME) activity on atrial fibrillation (AF) can be measured using an administrative claims database.
• Thygesen, K., Alpert, J. S., Jaffe, A. S., Simoons, M. L., Chaitman, B. R., White, H. D., & , T. F. (2012). Third universal definition of myocardial infarction. Nature reviews. Cardiology, 9(11), 620-33.
• Thygesen, K., Alpert, J. S., Jaffe, A. S., Simoons, M. L., Chaitman, B. R., White, H. D., & , W. G. (2012). Third universal definition of myocardial infarction. Global heart, 7(4), 275-95.
• Thygesen, K., Alpert, J. S., Jaffe, A. S., Simoons, M. L., Chaitman, B. R., White, H. D., , J. E., , A. F., Thygesen, K., Alpert, J. S., White, H. D., , B. S., Jaffe, A. S., Katus, H. A., Apple, F. S., Lindahl, B., Morrow, D. A., , E. S., Chaitman, B. R., , Clemmensen, P. M., et al. (2012). Third universal definition of myocardial infarction. Journal of the American College of Cardiology, 60(16), 1581-98.
• Thygesen, K., Alpert, J. S., Jaffe, A. S., Simoons, M. L., Chaitman, B. R., White, H. D., , J. E., Katus, H. A., Lindahl, B., Morrow, D. A., Clemmensen, P. M., Johanson, P., Hod, H., Underwood, R., Bax, J. J., Bonow, R. O., Pinto, F., Gibbons, R. J., Fox, K. A., , Atar, D., et al. (2012). Third universal definition of myocardial infarction. Circulation, 126(16), 2020-35.
• Thygesen, K., Alpert, J. S., Jaffe, A. S., Simoons, M. L., Chaitman, B. R., White, H. D., , W. G., Thygesen, K., Alpert, J. S., White, H. D., Jaffe, A. S., Katus, H. A., Apple, F. S., Lindahl, B., Morrow, D. A., Chaitman, B. A., Clemmensen, P. M., Johanson, P., Hod, H., , Underwood, R., et al. (2012). Third universal definition of myocardial infarction. European heart journal, 33(20), 2551-67.
• Thygesen, K., Mair, J., Giannitsis, E., Mueller, C., Lindahl, B., Blankenberg, S., Huber, K., Plebani, M., Biasucci, L. M., Tubaro, M., Collinson, P., Venge, P., Hasin, Y., Galvani, M., Koenig, W., Hamm, C., Alpert, J. S., Katus, H., Jaffe, A. S., & , S. G. (2012). How to use high-sensitivity cardiac troponins in acute cardiac care. European heart journal, 33(18), 2252-7.
• Thygesen, K., Mair, J., Mueller, C., Huber, K., Weber, M., Plebani, M., Hasin, Y., Biasucci, L. M., Giannitsis, E., Lindahl, B., Koenig, W., Tubaro, M., Collinson, P., Katus, H., Galvani, M., Venge, P., Alpert, J. S., Hamm, C., Jaffe, A. S., & , S. G. (2012). Recommendations for the use of natriuretic peptides in acute cardiac care: a position statement from the Study Group on Biomarkers in Cardiology of the ESC Working Group on Acute Cardiac Care. European heart journal, 33(16), 2001-6.
• Alpert, J. S. (2011). Biomarkers in clinical practice. The American journal of medicine, 124(8), 677-8.
• Alpert, J. S. (2011). Can primary care medicine be saved?. The American journal of medicine, 124(12), 1093-4.
• Alpert, J. S. (2011). Cardiology patient page. Nutritional advice for the patient with heart disease: what diet should we recommend for our patients?. Circulation, 124(10), e258-60.
• Alpert, J. S. (2011). Cardiology patient page. What you need to know if you have coronary artery disease. Circulation, 124(6), e176-8.
• Alpert, J. S. (2011). It is only the ignorant who despise education. The American journal of medicine, 124(2), 91-2.
• Alpert, J. S. (2011). Role modeling: a personal anecdote. The American journal of medicine, 124(4), 281-2.
• Alpert, J. S. (2011). Some simple rules for effective communication in clinical teaching and practice environments. The American journal of medicine, 124(5), 381-2.
• Alpert, J. S. (2011). The 10 things I like best about my job. The American journal of medicine, 124(8), 679-80.
• Alpert, J. S. (2011). The 800-pound gorilla in the healthcare living room. The American journal of medicine, 124(3), 187-8.
• Alpert, J. S. (2011). The importance of being elderly-some thoughts on the care of geriatric patients. The American journal of medicine, 124(10), 889-90.
• Alpert, J. S. (2011). The ten most annoying things that happen during my work day--and perhaps in yours as well. The American journal of medicine, 124(9), 789-90.
• Alpert, J. S. (2011). There is nothing prosaic about the PROSE competition. The American journal of medicine, 124(7), 573-4.
• Alpert, J. S. (2011). What Exactly Does an Editor Do. The American Journal of Medicine, 124(6), 475-476. doi:10.1016/j.amjmed.2011.02.013
• Alpert, J. S. (2011). You only have to exercise on the days that you eat. The American journal of medicine, 124(1), 1.
• Alpert, J. S., Guerin, A., Lin, J., Jhaveri, M., & Wu, E. Q. (2011). EVALUATION OF INTERNATIONAL NORMALIZED RATIO MONITORING AND ANTICOAGULATION CONTROL IN ATRIAL FIBRILLATION/FLUTTER PATIENTS USING WARFARIN AND ANTIARRHYTHMIC DRUG THERAPY. Journal of the American College of Cardiology, 57(14), E1246. doi:10.1016/s0735-1097(11)61246-1
• Shanmugasundaram, M., Ram, V. K., Luft, U. C., Szerlip, M., & Alpert, J. S. (2011). Peripheral arterial disease--what do we need to know?. Clinical cardiology, 34(8), 478-82.
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  Peripheral artery disease (PAD) results from progressive narrowing of arteries secondary to atherosclerosis and is defined as an Ankle Brachial Index of
• Alpert, J. S. (2010). "So, doctor, what's so bad about being fat?" Combating the obesity epidemic in the United States. The American journal of medicine, 123(1), 1-2.
• Alpert, J. S. (2010). A review of clinical guidelines with some thoughts about their utility and appropriate use. The American journal of medicine, 123(7), 573-6.
• Alpert, J. S. (2010). Aortic stenosis in the 21st century. The American journal of medicine, 123(10), 875-6.
• Alpert, J. S. (2010). Balancing work, family and friends, and lifestyle. The American journal of medicine, 123(9), 775-6.
• Alpert, J. S. (2010). Finding the right job in clinical practice or academia: advice for young clinicians and investigators. Circulation, 121(16), 1862-5.
• Alpert, J. S. (2010). Leadership in academic medicine. The American journal of medicine, 123(12), 1071-2.
• Alpert, J. S. (2010). Learning to write: a personal reflection. The American journal of medicine, 123(8), 671-2.
• Alpert, J. S. (2010). Managing myocardial infarction in the elderly: what should the clinician do?. The American journal of medicine, 123(11), 969-70.
• Alpert, J. S. (2010). Sunshine: clinical friend or foe?. The American journal of medicine, 123(4), 291-2.
• Alpert, J. S. (2010). Thank You, Thank You, Thank You. The American Journal of Medicine, 123(3), 197. doi:10.1016/j.amjmed.2009.12.001
• Alpert, J. S. (2010). Why are we ignoring guideline recommendations?. The American journal of medicine, 123(2), 97-8.
• Alpert, J. S. (2010). “Dear Editor: Can You Please Expedite My Manuscript's Publication in the AJM?”. The American Journal of Medicine, 123(5), 383. doi:10.1016/j.amjmed.2010.01.005
• Alpert, J. S., Kern, K. B., & Ewy, G. A. (2010). The risk of stent thrombosis after coronary arterial stent implantation. The American journal of medicine, 123(6), 479-80.
• Gillum, R. F., Albertorio-Díaz, J. R., & Alpert, J. S. (2010). Disparities in rates of acute MI hospitalization and coronary procedures on the US-Mexico border. The American journal of medicine, 123(7), 625-30.
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  Hospitalization rates for acute myocardial infarction can provide insight into the utilization of care by disadvantaged populations. However, these data have not been reported for the US-Mexico border region.
• Greenland, P., Alpert, J. S., Beller, G. A., Benjamin, E. J., Budoff, M. J., Fayad, Z. A., Foster, E., Hlatky, M. A., Hodgson, J. M., Kushner, F. G., Lauer, M. S., Shaw, L. J., Smith, S. C., Taylor, A. J., Weintraub, W. S., Wenger, N. K., Jacobs, A. K., & , A. C. (2010). 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 122(25), e584-636.
• Greenland, P., Alpert, J. S., Beller, G. A., Benjamin, E. J., Budoff, M. J., Fayad, Z. A., Foster, E., Hlatky, M. A., Hodgson, J. M., Kushner, F. G., Lauer, M. S., Shaw, L. J., Smith, S. C., Taylor, A. J., Weintraub, W. S., Wenger, N. K., Jacobs, A. K., & , A. C. (2010). 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 122(25), 2748-64.
• Greenland, P., Alpert, J. S., Beller, G. A., Benjamin, E. J., Budoff, M. J., Fayad, Z. A., Foster, E., Hlatky, M. A., Hodgson, J. M., Kushner, F. G., Lauer, M. S., Shaw, L. J., Smith, S. C., Taylor, A. J., Weintraub, W. S., Wenger, N. K., Jacobs, A. K., Smith, S. C., Anderson, J. L., , Albert, N., et al. (2010). 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology, 56(25), e50-103.
• Shanmugasundaram, M., Rough, S. J., & Alpert, J. S. (2010). Dyslipidemia in the elderly: should it be treated?. Clinical cardiology, 33(1), 4-9.
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  Elderly or older adults constitute a rapidly growing segment of the United States population, thus resulting in an increase in morbidity and mortality related to cardiovascular disease-an increase that is reaching epidemic proportions. Dyslipidemia is a well established risk factor for cardiovascular disease and is estimated to account for more than half of the global cases of coronary artery disease. Despite the increased prevalence of dyslipidemia in the older adult population, controversy persists regarding the benefits of treatment in this group. Epidemiologic studies have shown that dyslipidemia is often underdiagnosed and under treated in this population probably as a result of a paucity of evidence regarding the impact of treatment in delaying the progression of atherosclerotic disease, concerns involving increased likelihood of adverse events or drug interactions, or doubts regarding the cost effectiveness of lipid-lowering therapy in older adults. In conclusion, despite the proven efficacy of lipid-lowering therapy in decreasing cardiovascular morbidity and mortality, these therapies have been underutilized in older patients.
• Thygesen, K., Mair, J., Plebani, M., Venge, P., Collinson, P., Lindahl, B., Giannitsis, E., Hasin, Y., Galvani, M., Tubaro, M., Alpert, J. S., Biasucci, L. M., Koenig, W., Mueller, C., Huber, K., Hamm, C., Jaffe, A. S., & Katus, H. A. (2010). Recommendations for the use of cardiac troponin measurement in acute cardiac care.. European heart journal, 31(18), 2197-204. doi:10.1093/eurheartj/ehq251
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  The release of cardiomyocyte components, i.e. biomarkers, into the bloodstream in higher than usual quantities indicates an ongoing pathological process. Thus, detection of elevated concentrations of cardiac biomarkers in blood is a sign of cardiac injury which could be due to supply-demand imbalance, toxic effects, or haemodynamic stress. It is up to the clinician to determine the most probable aetiology, the proper therapeutic measures, and the subsequent risk implied by the process. For this reason, the measurement of biomarkers always must be applied in relation to the clinical context and never in isolation. There are a large number of cardiac biomarkers, but they can be subdivided into four broad categories, those related to necrosis, inflammation, haemodynamic stress, and/or thrombosis. Their usefulness is dependent on the accuracy and reproducibility of the measurements, the discriminatory limits separating pathology from physiology, and their sensitivity and specificity for specific organ damage and/or disease processes. In recent years, cardiac biomarkers have become important adjuncts to the delivery of acute cardiac care. Therefore, the Working Group on Acute Cardiac Care of the European Society of Cardiology established a committee to deal with ongoing and newly developing issues related to cardiac biomarkers. The intention of the group is to outline the principles for the application of various biomarkers by clinicians in the setting of acute cardiac care in a series of expert consensus documents. The first of these will focus on cardiac troponin, a pivotal marker of cardiac injury/necrosis.
• Alpert, J. S. (2009). "Common sense is not so common" (what we all need to remember)--part one. The American journal of medicine, 122(8), 700-1.
• Alpert, J. S. (2009). "Don't look back; something might be gaining on you". The American journal of medicine, 122(10), 885.
• Alpert, J. S. (2009). "Hey, doc, is it OK for me to drink coffee?". The American journal of medicine, 122(7), 597-8.
• Alpert, J. S. (2009). Failing grades in the adoption of healthy lifestyle choices. The American journal of medicine, 122(6), 493-4.
• Alpert, J. S. (2009). Reflections on the changing aspects of aortic stenosis in the 21st century. The American journal of medicine, 122(4), 313-4.
• Alpert, J. S. (2009). Some thoughts on bedside teaching. The American journal of medicine, 122(3), 203-4.
• Alpert, J. S. (2009). The American Journal of Medicine blog: an invitation to participate. The American journal of medicine, 122(2), 103.
• Alpert, J. S. (2009). The importance of mentoring and of being mentored. The American journal of medicine, 122(12), 1070.
• Alpert, J. S., & Mandell, B. F. (2009). Back to the future: medical students can matter again. The American journal of medicine, 122(11), 971-2.
• Alpert, J. S., Mladenovic, J., & Hellmann, D. B. (2009). Should a hand-carried ultrasound machine become standard equipment for every internist?. The American journal of medicine, 122(1), 1-3.
• Dalen, J. E., & Alpert, J. S. (2009). Premed requirements: the time for change is long overdue!. The American journal of medicine, 122(2), 104-6.
• Floyd, K. C., Yarzebski, J., Spencer, F. A., Lessard, D., Dalen, J. E., Alpert, J. S., Gore, J. M., & Goldberg, R. J. (2009). A 30-year perspective (1975-2005) into the changing landscape of patients hospitalized with initial acute myocardial infarction: Worcester Heart Attack Study. Circulation. Cardiovascular quality and outcomes, 2(2), 88-95.
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  The effects of lifestyle changes and evolving treatment practices on coronary disease incidence rates, demographic and clinical profile, and the short-term outcomes of patients hospitalized with acute myocardial infarction have not been well characterized. The purpose of this study was to examine multidecade-long trends (1975-2005) in the incidence rates, demographic and clinical characteristics, treatment practices, and hospital outcomes of patients hospitalized with an initial acute myocardial infarction from a population-based perspective.
• Indik, J. H., & Alpert, J. S. (2009). The patient with atrial fibrillation. The American journal of medicine, 122(5), 415-8.
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  Atrial fibrillation is a frequently encountered arrhythmia, particularly affecting the elderly. Patients at significant risk for stroke should be considered for anticoagulation with warfarin. Management of atrial fibrillation revolves around either controlling the ventricular rate response or trying to maintain sinus rhythm with either pharmacologic or nonpharmacologic therapies. There are many treatment options to consider, based upon the patient's expectations, symptoms, and comorbid conditions. Therefore, the treatment of atrial fibrillation must be individualized.
• Landesberg, G., Beattie, S. W., & Alpert, J. S. (2009). Fluvastatin in patients undergoing vascular surgery. The New England journal of medicine, 361(22), 2186-7; author reply 2187-8.
• Landesberg, G., Beattie, W. S., Mosseri, M., Jaffe, A. S., & Alpert, J. S. (2009). Perioperative myocardial infarction. Circulation, 119(22), 2936-44.
• Maisel, W. H., Hauser, R. G., Hammill, S. C., Hauser, R. G., Ellenbogen, K. A., Epstein, A. E., Hayes, D. L., Alpert, J. S., Berger, R. D., Curtis, A. B., Dubin, A. M., Estes, N. A., Gura, M. T., Krahn, A. D., Lampert, R., Lindsay, B. D., Wilkoff, B. L., , H. R., , A. C., & , A. H. (2009). Recommendations from the Heart Rhythm Society Task Force on Lead Performance Policies and Guidelines: developed in collaboration with the American College of Cardiology (ACC) and the American Heart Association (AHA). Heart rhythm : the official journal of the Heart Rhythm Society, 6(6), 869-85.
• Shanmugasundaram, M., & Alpert, J. S. (2009). Acute coronary syndrome in the elderly. Clinical cardiology, 32(11), 608-13.
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  The spectrum of acute coronary syndrome (ACS) including unstable angina, non-ST-elevation myocardial infarction and ST-elevation myocardial infarction accounts for increasing numbers of deaths among persons age > or = 65 years in the US. This is important given demographic changes involving falling birth rates and increasing life expectancy. Elderly patients are likely to benefit the most from treatment of ACS, even though community practice still demonstrates less use of cardiac medications as an early-invasive approach among this population.
• Shanmugasundaram, M., Fain, M. J., Mohler, J., Wendel, C. S., & Alpert, J. S. (2009). Predictors of Recurrent Cardiovascular hospitalizations in Patients with Diastolic Heart Failure. Journal of Cardiac Failure, 15(6), S 121.
• Alpert, J. S. (2008). 12 Guides to Health, Happiness, and Longevity (with Apologies to P.J. O'Rourke). The American journal of medicine, 121(7), 551-2.
• Alpert, J. S. (2008). A plethora of prognostic pearls. Circulation, 118(13), 1312-3.
• Alpert, J. S. (2008). A water-based exercise program for patients with coronary artery disease. Cardiology, 111(4), 254-6.
• Alpert, J. S. (2008). Dealing with ethical conflicts in clinical research. The American journal of medicine, 121(6), 457.
• Alpert, J. S. (2008). Doctors and the drug industry: further thoughts for dealing with potential conflicts of interest?. The American journal of medicine, 121(4), 253-5.
• Alpert, J. S. (2008). How green is the green journal?. The American journal of medicine, 121(9), 741.
• Alpert, J. S. (2008). Lab tests don't make diagnoses, doctors do. The American journal of medicine, 121(2), 87-8.
• Alpert, J. S. (2008). Physician depression. The American journal of medicine, 121(8), 643.
• Alpert, J. S. (2008). There is no substitute for brilliance except for experience. The American journal of medicine, 121(10), 833.
• Alpert, J. S. (2008). Why internists need to be able to manage patients with myocardial infarction. The American journal of medicine, 121(5), 357.
• Alpert, J. S., Thygesen, K., Jaffe, A., & White, H. D. (2008). The universal definition of myocardial infarction: a consensus document: ischaemic heart disease. Heart (British Cardiac Society), 94(10), 1335-41.
• Alpert, J. S., Thygesen, K., White, H. D., & Jaffe, A. S. (2008). Implications of the universal definition of myocardial infarction. Nature clinical practice. Cardiovascular medicine, 5(11), 678-9.
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  The original WHO definition of myocardial infarction (MI) was revised in 2000 and further refined in 2007. Central to the new universal definition of MI was the use of the highly sensitive and specific biomarker troponin. In the investigation reviewed in this commentary, Hochholzer et al. showed that acute and long-term postinfarction prognosis and mortality were adversely affected when patients met the newly revised criteria for acute MI.
• Dalen, J. E., & Alpert, J. S. (2008). National Health Insurance: could it work in the US?. The American journal of medicine, 121(7), 553-4.
• Phan, H. M., Alpert, J. S., & Fain, M. (2008). Frailty, inflammation, and cardiovascular disease: evidence of a connection. The American journal of geriatric cardiology, 17(2), 101-7.
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  Frailty is a progressive physiologic decline in multiple body systems marked by loss of function, loss of physiologic reserve, and increased vulnerability to disease and death. Until recently, frailty has been poorly defined in the medical literature. One currently accepted definition of frailty is having 3 of the following 5 attributes: unintentional weight loss, muscle weakness, slow walking speed, easy exhaustion, and low physical activity. The mechanisms that underline frailty remain unclear. Significantly higher levels of markers of inflammation and the clotting cascade have been found in frail persons compared with nonfrail persons. These markers are also risk factors for the development of coronary heart disease. Recent research has indicated that frailty is a clinical manifestation of cardiovascular disease, especially of heart failure. Thus, understanding the connection between frailty and cardiovascular disease may lead to development of new interventions that will prevent and reverse the associated morbidity and mortality.
• Ramaraj, R., & Alpert, J. S. (2008). Indian poverty and cardiovascular disease. The American journal of cardiology, 102(1), 102-6.
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  Cardiovascular disease is among the world's leading causes of death, and nearly 80% of deaths occur in developing countries. Cardiovascular disease is becoming a major health problem in India, where life expectancy has increased with decreases in infectious disease and childhood mortality. It is well established that this population experiences coronary artery disease at a younger age than other populations. With infectious diseases still endemic, noncommunicable diseases are a lower priority for the governments of developing countries. There is a clear progression to degenerative and lifestyle-related diseases such as cardiovascular disease as a result of current social and economic change. The lack of a public response to the increasing risk for cardiovascular disease thus far is due mostly to a perception among policy makers and the public that cardiovascular disease is largely a problem of the urban rich. In conclusion, this review addresses the imminent threats and ways to tackle the epidemic in India.
• Ramaraj, R., Sorrell, V. L., Marcus, F., & Alpert, J. S. (2008). Recently defined cardiomyopathies: a clinician's update. The American journal of medicine, 121(8), 674-81.
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  Cardiomyopathy is a generic term for any heart disease in which the heart muscle is involved and functions abnormally. Recent developments and ongoing research in cardiology have led to descriptions of 3 previously less recognized or incompletely characterized cardiomyopathies. These entities are being increasingly noticed in adult patient populations. Primary care providers and cardiovascular specialists need to be aware of the clinical features of these illnesses and the best strategies for diagnosis and management. We have discussed the causes and diagnostic methods for these newly described cardiomyopathies and ways to manage them.
• Shanmugasundaram, M., & Alpert, J. S. (2008). Diastolic Heart Failure: How should it be managed?. Arizona Geriatric Society Journal, 13(2), 7 - 10.
• Thygesen, K., Alpert, J. S., Jaffe, A. S., & White, H. D. (2008). Diagnostic application of the universal definition of myocardial infarction in the intensive care unit. Current opinion in critical care, 14(5), 543-8.
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  Myocardial infarction is a clinical diagnosis based on clinical presentation and laboratory tests. Clinicians have often defined myocardial infarction in different ways. In order to have a consistent universal definition, the four major international cardiac societies recently completed a consensus to define myocardial infarction in a universally acceptable manner.
• Thygesen, K., Alpert, J. S., White, H. D., & , J. E. (2008). [Universal definition of the myocardial infarction]. Kardiologia polska, 66(1), 47-62.
• , T. A., Douglas, P. S., Khandheria, B., Stainback, R. F., Weissman, N. J., , T. A., Brindis, R. G., Patel, M. R., Alpert, J. S., Fitzgerald, D., Heidenreich, P., Martin, E. T., Messer, J. V., Miller, A. B., Picard, M. H., Raggi, P., Reed, K. D., Rumsfeld, J. S., Steimle, A. E., , Tonkovic, R., et al. (2007). ACCF/ASE/ACEP/ASNC/SCAI/SCCT/SCMR 2007 appropriateness criteria for transthoracic and transesophageal echocardiography: a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group, American Society of Echocardiography, American College of Emergency Physicians, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and the Society for Cardiovascular Magnetic Resonance. Endorsed by the American College of Chest Physicians and the Society of Critical Care Medicine. Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography, 20(7), 787-805.
• Alpert, J. S. (2007). Are stem cells and genetic therapies ready for "prime time"?. The American journal of medicine, 120(2), 103-4.
• Alpert, J. S. (2007). Peer review: the best of the blemished?. The American journal of medicine, 120(4), 287-8.
• Alpert, J. S., & Goldberg, R. J. (2007). Dear patient: association is not synonymous with causality. The American journal of medicine, 120(8), 649-50.
• Alpert, J. S., & Powers, P. J. (2007). Who will care for the frail elderly?. The American journal of medicine, 120(6), 469-71.
• Alpert, J. S., & Thygesen, K. (2007). A new global definition of myocardial infarction for the 21st century. Polskie Archiwum Medycyny Wewnętrznej, 117(11-12), 485-6.
• Alpert, J. S. (2006). A near-failing grade: federal planning for US healthcare. The American journal of medicine, 119(5), 371-2.
• Alpert, J. S. (2006). A universal language of the heart. The American journal of medicine, 119(7), 539-40.
• Alpert, J. S. (2006). In medicine, signs of evolution are ever-present. The American journal of medicine, 119(4), 291.
• Alpert, J. S. (2006). My personal philosophy for academic medicine. The American journal of medicine, 119(10), 811.
• Alpert, J. S. (2006). Online buyers beware: a warning for physicians and patients. The American journal of medicine, 119(8), 623.
• Alpert, J. S. (2006). Practicing medicine in Plato's Cave. The American journal of medicine, 119(6), 455-6.
• Alpert, J. S. (2006). The triumph of hope over experience. The American journal of medicine, 119(12), 1003-4.
• Alpert, J. S. (2006). What diet should we recommend to patients?. The American journal of medicine, 119(9), 715-6.
• Alpert, J. S. (2006). Will the real myocardial infarction please stand up?. Clinical chemistry, 52(5), 795-6.
• Alpert, J. S., & Thygesen, K. (2006). A call for universal definitions in cardiovascular disease. Circulation, 114(8), 757-8.
• Carlson, M. D., Wilkoff, B. L., Maisel, W. H., Carlson, M. D., Ellenbogen, K. A., Saxon, L. A., Prystowsky, E. N., Alpert, J. S., Cain, M. E., Ching, E. A., Curtis, A. B., Davies, D. W., Hammill, S. C., Hauser, R. G., Lampert, R., Zipes, D. P., , A. C., , A. H., & , I. C. (2006). Recommendations from the Heart Rhythm Society Task Force on Device Performance Policies and Guidelines Endorsed by the American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA) and the International Coalition of Pacing and Electrophysiology Organizations (COPE). Heart rhythm : the official journal of the Heart Rhythm Society, 3(10), 1250-73.
• Alpert, J. S. (2005). An in-flight reflection on safety and quality. The American journal of medicine, 118(12), 1311.
• Alpert, J. S. (2005). Atrial fibrillation: now one of the most common causes for hospitalization. Current cardiology reports, 7(3), 149-50.
• Alpert, J. S. (2005). Current realities and potential new pathways for cardiology training. Current cardiology reports, 7(2), 77-8.
• Alpert, J. S. (2005). Doctor, can I eat salmon?. Current cardiology reports, 7(2), 79-80.
• Alpert, J. S. (2005). Doctors and the drug industry: how can we handle potential conflicts of interest?. The American journal of medicine, 118(2), 99-100.
• Alpert, J. S. (2005). Ethical precepts for cardiologists. Current cardiology reports, 7(1), 1-2.
• Alpert, J. S. (2005). Science, skepticism, and global warming. The American journal of medicine, 118(8), 807.
• Alpert, J. S. (2005). Sunset and sunrise. The American journal of medicine, 118(1), 1.
• Alpert, J. S. (2005). The Vioxx debacle. The American journal of medicine, 118(3), 203-4.
• Alpert, J. S. (2005). The answer you get depends on the question you ask. The American journal of medicine, 118(7), 693.
• Alpert, J. S. (2005). Viagra: the risks of recreational use. The American journal of medicine, 118(6), 569-70.
• Alpert, J. S., & Powers, P. J. (2005). Obesity: a complex public health challenge. The American journal of medicine, 118(9), 935.
• Alpert, J. S. (2004). Angioplasty or pharmacologic thrombolysis or both for ST-elevation myocardial infarction: the current debate. Current cardiology reports, 6(1), 1-2.
• Alpert, J. S. (2004). My cardiovascular wish list for 2004. Current cardiology reports, 6(2), 77-8.
• Alpert, J. S. (2004). Nanette K. Wenger: a woman's life in cardiology. Clinical cardiology, 27(2), 114-5.
• Alpert, J. S. (2004). Restenosis following percutaneous coronary arterial intervention: what should the clinician do in order to identify and treat this complication?. Current cardiology reports, 6(6), 391-2.
• Alpert, J. S. (2004). Spontaneous coronary artery dissection: an uncommon but dangerous condition. Current cardiology reports, 6(4), 233-4.
• Alpert, J. S. (2004). Sudden death and acute myocardial infarction following major psychologic trauma. Current cardiology reports, 6(3), 147-8.
• Alpert, J. S., Malasky, B. R., & Thygesen, K. (2004). Redefining myocardial infarction for the 21st century. Transactions of the American Clinical and Climatological Association, 115, 79-94; discussion 94-6.
• Alpert, J. S., Shine, K. I., Adams, R. J., Antman, E. M., Kavey, R. E., Friedman, L., Frye, R. L., Harrington, R. A., Korn, D., Merz, J. F., & Ofili, E. (2004). Task force 1: The ACCF and AHA codes of conduct in human subjects research. Journal of the American College of Cardiology, 44(8), 1724-8.
• Antman, E. M., Anbe, D. T., Armstrong, P. W., Bates, E. R., Green, L. A., Hand, M., Hochman, J. S., Krumholz, H. M., Kushner, F. G., Lamas, G. A., Mullany, C. J., Ornato, J. P., Pearle, D. L., Sloan, M. A., Smith, S. C., Alpert, J. S., Anderson, J. L., Faxon, D. P., Fuster, V., , Gibbons, R. J., et al. (2004). ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction--executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction). Circulation, 110(5), 588-636.
• Antman, E. M., Anbe, D. T., Armstrong, P. W., Bates, E. R., Green, L. A., Hand, M., Hochman, J. S., Krumholz, H. M., Kushner, F. G., Lamas, G. A., Mullany, C. J., Ornato, J. P., Pearle, D. L., Sloan, M. A., Smith, S. C., Alpert, J. S., Anderson, J. L., Faxon, D. P., Fuster, V., , Gibbons, R. J., et al. (2004). ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction; A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of patients with acute myocardial infarction). Journal of the American College of Cardiology, 44(3), E1-E211.
• Eagle, K. A., Guyton, R. A., Davidoff, R., Edwards, F. H., Ewy, G. A., Gardner, T. J., Hart, J. C., Herrmann, H. C., Hillis, L. D., Hutter, A. M., Lytle, B. W., Marlow, R. A., Nugent, W. C., Orszulak, T. A., Antman, E. M., Smith, S. C., Alpert, J. S., Anderson, J. L., Faxon, D. P., , Fuster, V., et al. (2004). ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery). Journal of the American College of Cardiology, 44(5), e213-310.
• Eagle, K. A., Guyton, R. A., Davidoff, R., Edwards, F. H., Ewy, G. A., Gardner, T. J., Hart, J. C., Herrmann, H. C., Hillis, L. D., Hutter, A. M., Lytle, B. W., Marlow, R. A., Nugent, W. C., Orszulak, T. A., Antman, E. M., Smith, S. C., Alpert, J. S., Anderson, J. L., Faxon, D. P., , Fuster, V., et al. (2004). ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery). Circulation, 110(9), 1168-76.
• Francis, C. K., Alpert, J. S., Clark, L. T., Ofili, E. O., & Wong, R. C. (2004). Working group 3: How to encourage more minorities to choose a career in cardiology. Journal of the American College of Cardiology, 44(2), 241-5.
• Goldberg, R. J., Spencer, F. A., Yarzebski, J., Lessard, D., Gore, J. M., Alpert, J. S., & Dalen, J. E. (2004). A 25-year perspective into the changing landscape of patients hospitalized with acute myocardial infarction (the Worcester Heart Attack Study). The American journal of cardiology, 94(11), 1373-8.
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  Over the past several decades, significant advances have been made in the primary and secondary prevention of coronary artery disease. However, effects of changing lifestyle and treatment practices on demographic and clinical profiles and on hospital outcomes of patients who present with acute myocardial infarction (AMI) have not been well characterized. We carried out a prospective population-based investigation of >25-year trends (1975 to 2001) in demographic and clinical characteristics, treatment practices, and hospital outcomes of patients who had been hospitalized with AMI. Residents of a metropolitan area (Worcester, Massachusetts) who had been hospitalized with validated AMI (n = 10,440) in all greater Worcester hospitals during thirteen 1-year periods between 1975 and 2001 comprised the sample of interest. Patients who had been hospitalized during the most recent study years were significantly older, were more likely to be women, and had a greater prevalence of co-morbidities. Hospitalized patients were increasingly more likely to receive effective cardiac medications and coronary interventions over the period under investigation. Multivariable-adjusted hospital survival rates improved considerably over time, whereas different trends were observed in the occurrence of several important clinical complications. The present results provide insights into the changing characteristics of patients who are hospitalized with AMI, treatment practices, and their short-term outcomes. Given the magnitude of AMI and evolving approaches to manage it, continued monitoring of these trends remains of considerable clinical and public health importance.
• Kamineni, R., & Alpert, J. S. (2004). Acute coronary syndromes: initial evaluation and risk stratification. Progress in cardiovascular diseases, 46(5), 379-92.
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  Chest pain, the second most frequent presenting complaint in the emergency department (ED), often poses a challenge to the physicians dealing with these patients owing to the wide spectrum of presentation of acute coronary syndromes (ACS). A majority of the patients presenting with chest pain are usually admitted to the hospital for further evaluation and management. Despite the availability of modern-day tools for diagnosis of acute myocardial infarction (AMI), about 5% of patients with AMI are missed in the ED with subsequent associated morbidity and mortality and legal consequences. Several centers have adapted critical pathways derived from American College of Cardiology/American Heart Association (ACC/AHA) guidelines for the management of patients presenting with ACS. We now have some evidence suggesting adherence to the critical pathways derived from ACC/AHA guidelines will optimize the quality of patient care and probably result in better patient outcomes. This article reviews initial evaluation and the importance of risk stratification of the patients presenting with chest pain using the currently available clinical and diagnostic tools. Critical pathways derived from the ACC/AHA guidelines for various presentations of ACS are also reviewed.
• Wenger, N. K., Gregoratos, G., Kitzman, D. W., Scheidt, S., Weber, M. A., & Alpert, J. S. (2004). Guidelines of the Cardiogeriatrics Department of the Brazilian Cardiology Society: commentary by Editorial Board Members of The American Journal of Geriatric Cardiology. The American journal of geriatric cardiology, 13(4), 209-16.
• Adams, R. J., Chimowitz, M. I., Alpert, J. S., Awad, I. A., Cerqueria, M. D., Fayad, P., Taubert, K. A., & , A. H. (2003). Coronary risk evaluation in patients with transient ischemic attack and ischemic stroke: a scientific statement for healthcare professionals from the Stroke Council and the Council on Clinical Cardiology of the American Heart Association/American Stroke Association. Stroke; a journal of cerebral circulation, 34(9), 2310-22.
• Adams, R. J., Chimowitz, M. I., Alpert, J. S., Awad, I. A., Cerqueria, M. D., Fayad, P., Taubert, K. A., , S. C., & , A. S. (2003). Coronary risk evaluation in patients with transient ischemic attack and ischemic stroke: a scientific statement for healthcare professionals from the Stroke Council and the Council on Clinical Cardiology of the American Heart Association/American Stroke Association. Circulation, 108(10), 1278-90.
• Alpert, J. S. (2003). Advice for young physicians. Archives of internal medicine, 163(1), 12-4.
• Alpert, J. S. (2003). Aortic stenosis: a new face for an old disease. Archives of internal medicine, 163(15), 1769-70.
• Alpert, J. S. (2003). Back to the future: what kind of doctor is best for patients with heart disease?. Cardiology in review, 11(3), 109-10. doi:DOI: 10.1097/01.CRD.0000052634.90968.F8
• Alpert, J. S. (2003). Defining myocardial infarction: "will the real myocardial infarction please stand up?". American heart journal, 146(3), 377-9.
• Alpert, J. S. (2003). Diabetes mellitus and the risk for cardiovascular disease. Current cardiology reports, 5(5), 337.
• Alpert, J. S. (2003). Do selective cyclo-oxygenase-2 nonsteroidal anti-inflammatory agents increase the risk for acute myocardial infarction?. Current cardiology reports, 5(6), 415-6.
• Alpert, J. S. (2003). Reflections on the evolution of cardiology and cardiac surgery over the past 50 years. Current cardiology reports, 5(2), 91.
• Alpert, J. S. (2003). The importance of being a platelet. Current cardiology reports, 5(1), 1-2.
• Alpert, J. S. (2003). The thrombosed prosthetic valve: current recommendations based on evidence from the literature. Journal of the American College of Cardiology, 41(4), 659-60.
• Alpert, J. S. (2003). Where do we go from here? Relations between the medical profession and the pharmaceutical industry. Current cardiology reports, 5(3), 169-70.
• Blomström-Lundqvist, C., Scheinman, M. M., Aliot, E. M., Alpert, J. S., Calkins, H., Camm, A. J., Campbell, W. B., Haines, D. E., Kuck, K. H., Lerman, B. B., Miller, D. D., Shaeffer, C. W., Stevenson, W. G., Tomaselli, G. F., Antman, E. M., Smith, S. C., Alpert, J. S., Faxon, D. P., Fuster, V., , Gibbons, R. J., et al. (2003). ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias--executive summary. a report of the American college of cardiology/American heart association task force on practice guidelines and the European society of cardiology committee for practice guidelines (writing committee to develop guidelines for the management of patients with supraventricular arrhythmias) developed in collaboration with NASPE-Heart Rhythm Society. Journal of the American College of Cardiology, 42(8), 1493-531.
• Blomström-Lundqvist, C., Scheinman, M. M., Aliot, E. M., Alpert, J. S., Calkins, H., Camm, A. J., Campbell, W. B., Haines, D. E., Kuck, K. H., Lerman, B. B., Miller, D. D., Shaeffer, C. W., Stevenson, W. G., Tomaselli, G. F., Antman, E. M., Smith, S. C., Alpert, J. S., Faxon, D. P., Fuster, V., , Gibbons, R. J., et al. (2003). ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias--executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Supraventricular Arrhythmias). Circulation, 108(15), 1871-909.
• Bokhari, S. I., & Alpert, J. S. (2003). Probable acute coronary syndrome secondary to fat embolism. Cardiology in review, 11(3), 156-9.
• Cheitlin, M. D., Armstrong, W. F., Aurigemma, G. P., Beller, G. A., Bierman, F. Z., Davis, J. L., Douglas, P. S., Faxon, D. P., Gillam, L. D., Kimball, T. R., Kussmaul, W. G., Pearlman, A. S., Philbrick, J. T., Rakowski, H., Thys, D. M., Antman, E. M., Smith, S. C., Alpert, J. S., Gregoratos, G., , Anderson, J. L., et al. (2003). ACC/AHA/ASE 2003 Guideline Update for the Clinical Application of Echocardiography: summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to Update the 1997 Guidelines for the Clinical Application of Echocardiography). Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography, 16(10), 1091-110.
• Cheitlin, M. D., Armstrong, W. F., Aurigemma, G. P., Beller, G. A., Bierman, F. Z., Davis, J. L., Douglas, P. S., Faxon, D. P., Gillam, L. D., Kimball, T. R., Kussmaul, W. G., Pearlman, A. S., Philbrick, J. T., Rakowski, H., Thys, D. M., Antman, E. M., Smith, S. C., Alpert, J. S., Gregoratos, G., , Anderson, J. L., et al. (2003). ACC/AHA/ASE 2003 guideline update for the clinical application of echocardiography: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to Update the 1997 Guidelines for the Clinical Application of Echocardiography). Circulation, 108(9), 1146-62.
• Gibbons, R. J., Abrams, J., Chatterjee, K., Daley, J., Deedwania, P. C., Douglas, J. S., Ferguson, T. B., Fihn, S. D., Fraker, T. D., Gardin, J. M., O'Rourke, R. A., Pasternak, R. C., Williams, S. V., Gibbons, R. J., Alpert, J. S., Antman, E. M., Hiratzka, L. F., Fuster, V., Faxon, D. P., , Gregoratos, G., et al. (2003). ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina). Circulation, 107(1), 149-58.
• Klocke, F. J., Baird, M. G., Lorell, B. H., Bateman, T. M., Messer, J. V., Berman, D. S., O'Gara, P. T., Carabello, B. A., Russell, R. O., Cerqueira, M. D., St John Sutton, M. G., DeMaria, A. N., Udelson, J. E., Kennedy, J. W., Verani, M. S., Williams, K. A., Antman, E. M., Smith, S. C., Alpert, J. S., , Gregoratos, G., et al. (2003). ACC/AHA/ASNC guidelines for the clinical use of cardiac radionuclide imaging--executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASNC Committee to Revise the 1995 Guidelines for the Clinical Use of Cardiac Radionuclide Imaging). Circulation, 108(11), 1404-18.
• Klocke, F. J., Baird, M. G., Lorell, B. H., Bateman, T. M., Messer, J. V., Berman, D. S., O'Gara, P. T., Carabello, B. A., Russell, R. O., Cerqueira, M. D., St John Sutton, M. G., DeMaria, A. N., Udelson, J. E., Kennedy, J. W., Verani, M. S., Williams, K. A., Antman, E. M., Smith, S. C., Alpert, J. S., , Gregoratos, G., et al. (2003). ACC/AHA/ASNC guidelines for the clinical use of cardiac radionuclide imaging--executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASNC Committee to Revise the 1995 Guidelines for the Clinical Use of Cardiac Radionuclide Imaging). Journal of the American College of Cardiology, 42(7), 1318-33.
• Alpert, J. S. (2002). Should we put angiotensin-converting enzyme inhibitors in the water supply?. Current cardiology reports, 4(4), 249-50.
• Alpert, J. S. (2002). The debate concerning detection of coronary calcification: who needs an electron beam computed tomography scan?. Current cardiology reports, 4(5), 349-50.
• Alpert, J. S. (2002). The lesson of Darwin for today's science. Current cardiology reports, 4(6), 441.
• Alpert, J. S. (2002). The scarred heart: mortality rates for myocardial infarction in the absence of modern therapy. Archives of internal medicine, 162(21), 2411-2.
• Alpert, J. S., Flanagan, D. M., & Botsford, N. A. (2002). The valley of the shadow of death revisited: case studies in academic health center strategies--what works and what fails. Cardiology in review, 10(4), 193-5. doi:DOI: 10.1097/01.CRD.0000024988.83780.75
• Braunwald, E., Antman, E. M., Beasley, J. W., Califf, R. M., Cheitlin, M. D., Hochman, J. S., Jones, R. H., Kereiakes, D., Kupersmith, J., Levin, T. N., Pepine, C. J., Schaeffer, J. W., Smith, E. E., Steward, D. E., Theroux, P., Gibbons, R. J., Alpert, J. S., Faxon, D. P., Fuster, V., , Gregoratos, G., et al. (2002). ACC/AHA 2002 guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction--summary article: a report of the American College of Cardiology/American Heart Association task force on practice guidelines (Committee on the Management of Patients With Unstable Angina). Journal of the American College of Cardiology, 40(7), 1366-74.
• Braunwald, E., Antman, E. M., Beasley, J. W., Califf, R. M., Cheitlin, M. D., Hochman, J. S., Jones, R. H., Kereiakes, D., Kupersmith, J., Levin, T. N., Pepine, C. J., Schaeffer, J. W., Smith, E. E., Steward, D. E., Theroux, P., Gibbons, R. J., Alpert, J. S., Faxon, D. P., Fuster, V., , Gregoratos, G., et al. (2002). ACC/AHA guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction--2002: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Unstable Angina). Circulation, 106(14), 1893-900.
• Chatterjee, K., De Marco, T., & Alpert, J. S. (2002). Pulmonary hypertension: hemodynamic diagnosis and management. Archives of internal medicine, 162(17), 1925-33.
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  Hemodynamic classification of pulmonary hypertension relates to the hemodynamic mechanisms of pulmonary arterial hypertension, such as abnormalities of pulmonary blood flow, pulmonary vascular resistance, and pulmonary venous pressures. The therapeutic approaches can be directed to the hemodynamic mechanisms of pulmonary hypertension.
• Eagle, K. A., Berger, P. B., Calkins, H., Chaitman, B. R., Ewy, G. A., Fleischmann, K. E., Fleisher, L. A., Froehlich, J. B., Gusberg, R. J., Leppo, J. A., Ryan, T., Schlant, R. C., Winters, W. L., Gibbons, R. J., Antman, E. M., Alpert, J. S., Faxon, D. P., Fuster, V., Gregoratos, G., , Jacobs, A. K., et al. (2002). ACC/AHA Guideline Update for Perioperative Cardiovascular Evaluation for Noncardiac Surgery--Executive Summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). Anesthesia and analgesia, 94(5), 1052-64.
• Gibbons, R. J., Balady, G. J., Bricker, J. T., Chaitman, B. R., Fletcher, G. F., Froelicher, V. F., Mark, D. B., McCallister, B. D., Mooss, A. N., O'Reilly, M. G., Winters, W. L., Gibbons, R. J., Antman, E. M., Alpert, J. S., Faxon, D. P., Fuster, V., Gregoratos, G., Hiratzka, L. F., Jacobs, A. K., , Russell, R. O., et al. (2002). ACC/AHA 2002 guideline update for exercise testing: summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines). Journal of the American College of Cardiology, 40(8), 1531-40.
• Gibbons, R. J., Balady, G. J., Bricker, J. T., Chaitman, B. R., Fletcher, G. F., Froelicher, V. F., Mark, D. B., McCallister, B. D., Mooss, A. N., O'Reilly, M. G., Winters, W. L., Gibbons, R. J., Antman, E. M., Alpert, J. S., Faxon, D. P., Fuster, V., Gregoratos, G., Hiratzka, L. F., Jacobs, A. K., , Russell, R. O., et al. (2002). ACC/AHA 2002 guideline update for exercise testing: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines). Circulation, 106(14), 1883-92.
• Gregoratos, G., Abrams, J., Epstein, A. E., Freedman, R. A., Hayes, D. L., Hlatky, M. A., Kerber, R. E., Naccarelli, G. V., Schoenfeld, M. H., Silka, M. J., Winters, S. L., Gibbons, R. I., Antman, E. M., Alpert, J. S., Hiratzka, L. F., Faxon, D. P., Jacobs, A. K., Fuster, V., Smith, S. C., & , A. C. (2002). ACC/AHA/NASPE 2002 guideline update for implantation of cardiac pacemakers and antiarrhythmia devices: summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/NASPE Committee to Update the 1998 Pacemaker Guidelines). Journal of cardiovascular electrophysiology, 13(11), 1183-99.
• Gregoratos, G., Abrams, J., Epstein, A. E., Freedman, R. A., Hayes, D. L., Hlatky, M. A., Kerber, R. E., Naccarelli, G. V., Schoenfeld, M. H., Silka, M. J., Winters, S. L., Gibbons, R. J., Antman, E. M., Alpert, J. S., Gregoratos, G., Hiratzka, L. F., Faxon, D. P., Jacobs, A. K., Fuster, V., , Smith, S. C., et al. (2002). ACC/AHA/NASPE 2002 guideline update for implantation of cardiac pacemakers and antiarrhythmia devices: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/NASPE Committee to Update the 1998 Pacemaker Guidelines). Circulation, 106(16), 2145-61.
• Malasky, B. R., & Alpert, J. S. (2002). Diagnosis of myocardial injury by biochemical markers: problems and promises. Cardiology in review, 10(5), 306-17. doi:DOI: 10.1097/01.CRD.0000027247.58164.6A
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  The role of biochemical markers in the diagnosis of acute coronary syndromes has increased considerably in the past decade. The World Health Organization previously defined acute myocardial infarction as a combination of at least 2 of 3 components: symptoms consistent with acute myocardial infarction, electrocardiogram changes diagnostic of acute myocardial infarction, and an enzyme pattern with classic rise and fall. Measurement of creatine kinase and its MB fraction by various assays was the gold standard for the diagnosis. Troponins are more specific and sensitive markers for myocardial injury, and their increasing utilization has resulted in a broadening of the definition of acute myocardial infarction to incorporate high-risk acute coronary syndromes. Previously, traditional enzyme evaluation left patients with small amounts of cellular death undiagnosed; these patients were categorized as having unstable angina or, worse, noncardiac chest pain. Newer markers now identify these patients as a subgroup at high risk for cardiac death or cardiac events. Newer therapeutic interventions and a more invasive strategy have been shown to improve outcomes in this high-risk subgroup. Increased specificity has also reduced the number of patients who undergo extensive, expensive, and invasive evaluations for noncardiac syndromes due to false elevations of traditional markers. This article comprehensively reviews the evolution of biochemical markers for the diagnosis of acute myocardial infarction, addressing their promise for improving delivery of care and outcomes and their technical and diagnostic pitfalls.
• Newby, L. K., Alpert, J. S., Ohman, E. M., Thygesen, K., & Califf, R. M. (2002). Changing the diagnosis of acute myocardial infarction: implications for practice and clinical investigations. American heart journal, 144(6), 957-80.
• Alpert, J. S. (2001). Conflict of interest in cardiovascular publications. Cardiology, 95(2), 53-4.
• Alpert, J. S. (2001). Differences in outcome between percutaneous coronary intervention and coronary bypass grafting. Current cardiology reports, 3(3), 173-4.
• Alpert, J. S. (2001). Fascination with myocardial infarction and normal coronary arteries. European heart journal, 22(16), 1364-6.
• Alpert, J. S. (2001). Leadership in academic medicine: a personal perspective. Current cardiology reports, 3(4), 255-7.
• Alpert, J. S. (2001). The 10 most important advances in cardiovascular medicine during the past 50 years, with apologies to David Letterman. Current cardiology reports, 3(6), 433-5.
• Alpert, J. S. (2001). The effect of right ventricular dysfunction on left ventricular form and function. Chest, 119(6), 1632-3.
• Alpert, J. S. (2001). To define is divine. Current cardiology reports, 3(2), 97-9.
• Alpert, J. S. (2001). Will the real heart-healthy diet please stand up!. Current cardiology reports, 3(5), 335-6.
• Alpert, J. S., Flanagan, D. M., & Botsford, N. A. (2001). The future of academic medical centers in the United States: passing through the valley of the shadow of death. Archives of internal medicine, 161(8), 1047-9.
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  The last 2 decades witnessed remarkable events in the life of academic medical centers (AMCs) in the United States. Twenty years ago, AMCs were thriving as the era of fee-for-service medicine came to a close: clinical departments were expanding, hiring new faculty members, purchasing new equipment as necessary, and funding research projects and protected research time with the abundant clinical revenues. The subsequent 20 years since that golden era came to a close witnessed teh disappearance of these expansionary trends. Departments have contracted, protected research time and start-up funds have declined precipitously, and many faculty members are infected with a sense of malaise and fear for the future.
• Alpert, J. S., Flinn, R. S., & Flinn, I. P. (2001). So what's wrong with being fat?. European heart journal, 22(1), 10-1.
• Child, J. S., Collins-Nakai, R. L., Alpert, J. S., Deanfield, J. E., Harris, L., McLaughlin, P., Miner, P. D., Webb, G. D., & Williams, R. G. (2001). Task force 3: workforce description and educational requirements for the care of adults with congenital heart disease. Journal of the American College of Cardiology, 37(5), 1183-7.
• Furman, S., Alpert, J. S., Cohn, J. N., Timmis, G. C., & , H. G. (2001). Management of potential conflict of interest during publication and presentation. Journal of cardiac failure, 7(4), 367-8.
• Fuster, V., Rydén, L. E., Asinger, R. W., Cannom, D. S., Crijns, H. J., Frye, R. L., Halperin, J. L., Kay, G. N., Klein, W. W., Lévy, S., McNamara, R. L., Prystowsky, E. N., Wann, L. S., Wyse, D. G., Gibbons, R. J., Antman, E. M., Alpert, J. S., Faxon, D. P., Fuster, V., , Gregoratos, G., et al. (2001). ACC/AHA/ESC Guidelines for the Management of Patients With Atrial Fibrillation: Executive Summary A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to Develop Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the North American Society of Pacing and Electrophysiology. Circulation, 104(17), 2118-50.
• Fuster, V., Rydén, L. E., Asinger, R. W., Cannom, D. S., Crijns, H. J., Frye, R. L., Halperin, J. L., Kay, G. N., Klein, W. W., Lévy, S., McNamara, R. L., Prystowsky, E. N., Wann, L. S., Wyse, D. G., Gibbons, R. J., Antman, E. M., Alpert, J. S., Faxon, D. P., Fuster, V., , Gregoratos, G., et al. (2001). ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation: executive summary. A Report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to Develop Guidelines for the Management of Patients With Atrial Fibrillation): developed in Collaboration With the North American Society of Pacing and Electrophysiology. Journal of the American College of Cardiology, 38(4), 1231-66.
• Hunt, S. A., Baker, D. W., Chin, M. H., Cinquegrani, M. P., Feldman, A. M., Francis, G. S., Ganiats, T. G., Goldstein, S., Gregoratos, G., Jessup, M. L., Noble, R. J., Packer, M., Silver, M. A., Stevenson, L. W., Gibbons, R. J., Antman, E. M., Alpert, J. S., Faxon, D. P., Fuster, V., , Gregoratos, G., et al. (2001). ACC/AHA Guidelines for the Evaluation and Management of Chronic Heart Failure in the Adult: Executive Summary A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1995 Guidelines for the Evaluation and Management of Heart Failure): Developed in Collaboration With the International Society for Heart and Lung Transplantation; Endorsed by the Heart Failure Society of America. Circulation, 104(24), 2996-3007.
• Hunt, S. A., Baker, D. W., Chin, M. H., Cinquegrani, M. P., Feldman, A. M., Francis, G. S., Ganiats, T. G., Goldstein, S., Gregoratos, G., Jessup, M. L., Noble, R. J., Packer, M., Silver, M. A., Stevenson, L. W., Gibbons, R. J., Antman, E. M., Alpert, J. S., Faxon, D. P., Fuster, V., , Jacobs, A. K., et al. (2001). ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adult: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to revise the 1995 Guidelines for the Evaluation and Management of Heart Failure). Journal of the American College of Cardiology, 38(7), 2101-13.
• Huse, D. M., Roht, L. H., Alpert, J. S., & Hartz, S. C. (2001). Physicians' knowledge, attitudes, and practice of pharmacologic treatment of hypertension. The Annals of pharmacotherapy, 35(10), 1173-9.
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  To explore how well physicians who treat hypertension know the indications and contraindications for particular antihypertensive therapies, and how closely their opinions and practice of hypertension treatment agree with national guidelines.
• Mahaffey, K. W., & Alpert, J. S. (2001). Cardiac enzyme elevations after cardiac surgery: the cardiologist's perspective. American heart journal, 141(3), 321-4.
• Mathiasen, H., & Alpert, J. S. (2001). Only connect: musings on the relationship between literature and medicine. Family medicine, 33(5), 349-51.
• Stein, P. D., Alpert, J. S., Bussey, H. I., Dalen, J. E., & Turpie, A. G. (2001). Antithrombotic therapy in patients with mechanical and biological prosthetic heart valves. Chest, 119(1 Suppl), 220S-227S.
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  1. Permanent therapy with oral anticoagulants offers the most consistent protection in patients with mechanical heart valves. 2. Antiplatelet agents alone do not consistently protect patients with mechanical prosthetic heart valves, including patients in sinus rhythm with St. Jude Medical valves in the aortic position. 3. Levels of oral anticoagulants that prolong the INR to 2.0 to 3.0 appear satisfactory for patients with St. Jude Medical bileaflet and Medtronic-Hall tilting disk mechanical valves in the aortic position, provided they are in sinus rhythm and the left atrium is not enlarged. Presumably, this is also true for the CarboMedics bileaflet valve, based on the observation of no clinically important difference in the rate of systemic embolism with this valve and the St. Jude Medical bileaflet valve. 4. Levels of oral anticoagulants that prolong the INR to 2.5 to 3.5 are satisfactory for tilting disk valves and bileaflet prosthetic valves in the mitral position. 5. Experience in patients with caged ball valves who had prothrombin time ratios reported in terms of the INR is sparse, because few such valves have been inserted in recent years. The number of surviving patients with caged ball valves continues to decrease. It has been suggested that the most advantageous level of the INR in patients with caged ball or caged disk valves should be as high as 4.0 to 4.9. However, others have shown a high rate of major hemorrhage with an INR that is even somewhat lower, 3.0-4.5. The problem is self-limited, however, because few such valves are being inserted. 6. In patients with mechanical heart valves, aspirin, in addition to oral anticoagulants, has been shown to diminish the frequency of thromboemboli. The risk of bleeding is somewhat increased if the INR is 2.0 to 3.0 or 2.5 to 3.5. However, if the INR is 3.0 to 4.5, the risk of bleeding becomes excessive with aspirin. There are no investigations in which aspirin 80 mg/d in combination with oral anticoagulants was evaluated. 7. Data are insufficient to recommend dipyridamole over low doses of aspirin in combination with warfarin. Whether dipyridamole plus aspirin is more effective than aspirin alone when used with warfarin is undetermined. 8. Patients with bioprosthetic valves in the mitral position as well as patients with bioprosthetic valves in the aortic position may be at risk for thromboemboli during the first 3 months after operation. 9. Among patients with bioprosthetic valves in the mitral position, oral anticoagulants at an INR of 2.0 to 2.3 were as effective as an INR of 2.5 to 4.0 and were associated with fewer bleeding complications during the first 3 months after operation.10. Aspirin may reduce the long-term frequency of thromboembolism in patients with bioprosthetic valves.
• Thygesen, K. A., & Alpert, J. S. (2001). The definitions of acute coronary syndrome, myocardial infarction, and unstable angina. Current cardiology reports, 3(4), 268-72.
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  The acute coronary syndrome encompasses a spectrum of conditions that include acute myocardial infarction, unstable angina pectoris, and, to some extent, sudden cardiac death. Recently, the diagnosis of myocardial infarction has been redefined by The Joint European Society of Cardiology/American College of Cardiology Committee. However, the conceptual meaning of the term myocardial infarction has not been changed. Thus, the current diagnoses of myocardial infarction as well as of unstable angina are clinical syndromes based on symptoms, electrocardiogram, and sensitive biochemical markers.
• Alpert, J. S. (2000). Are data from clinical registries of any value?. European heart journal, 21(17), 1399-401.
• Alpert, J. S. (2000). Atrial fibrillation: a growth industry in the 21st century. European heart journal, 21(15), 1207-8.
• Alpert, J. S. (2000). Concerning gender and therapy after acute myocardial infarction: are there differences between men and women?. European heart journal, 21(4), 261-2.
• Alpert, J. S. (2000). Is there a difference between a chief of cardiology and a chief of medicine?. The American journal of cardiology, 86(6), 675-6.
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  The job of Chief of Medicine demands considerably more administrative effort than the Chief of Cardiology. However, one can still maintain a significant presence in cardiology as a Chief of Medicine. Each job has its own merits, joys, and irritations.
• Alpert, J. S. (2000). Medical refugees in America. Archives of internal medicine, 160(4), 417-8.
• Alpert, J. S. (2000). The not so obvious truth. European heart journal, 21(3), 180-1.
• Alpert, J. S., Thygesen, K., Antman, E., & Bassand, J. P. (2000). Myocardial infarction redefined--a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction. Journal of the American College of Cardiology, 36(3), 959-69.
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  Definition of MI. Criteria for acute, evolving or recent MI. Either one of the following criteria satisfies the diagnosis for an acute, evolving or recent MI: 1) Typical rise and gradual fall (troponin) or more rapid rise and fall (CK-MB) of biochemical markers of myocardial necrosis with at least one of the following: a) ischemic symptoms; b) development of pathologic Qwaves on the ECG; c) ECG changes indicative of ischemia (ST segment elevation or depression); or d) coronary artery intervention (e.g., coronary angioplasty). 2) Pathologic findings of an acute MI. Criteria for established MI. Any one of the following criteria satisfies the diagnosis for established MI: 1) Development of new pathologic Q waves on serial ECGs. The patient may or may not remember previous symptoms. Biochemical markers of myocardial necrosis may have normalized, depending on the length of time that has passed since the infarct developed. 2) Pathologic findings of a healed or healing MI.
• Bavry, A. A., Knoper, S., & Alpert, J. S. (2000). Segmental wall motion abnormalities in an individual with idiopathic pulmonary hemosiderosis. Cardiology, 93(3), 201-4.
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  Idiopathic pulmonary hemosiderosis (IPH) is a rare condition characterized by diffuse pulmonary hemorrhage of unknown etiology. Cardiac involvement in the form of myocarditis and right ventricular hypertrophy have been reported to occur in association with IPH, although findings on echocardiography have not been described. Herein is presented a case of an adult with IPH and echocardiographic abnormalities.
• Braunwald, E., Antman, E. M., Beasley, J. W., Califf, R. M., Cheitlin, M. D., Hochman, J. S., Jones, R. H., Kereiakes, D., Kupersmith, J., Levin, T. N., Pepine, C. J., Schaeffer, J. W., Smith, E. E., Steward, D. E., Theroux, P., Alpert, J. S., Eagle, K. A., Faxon, D. P., Fuster, V., , Gardner, T. J., et al. (2000). ACC/AHA guidelines for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Unstable Angina). Journal of the American College of Cardiology, 36(3), 970-1062.
• Braunwald, E., Antman, E. M., Beasley, J. W., Califf, R. M., Cheitlin, M. D., Hochman, J. S., Jones, R. H., Kereiakes, D., Kupersmith, J., Levin, T. N., Pepine, C. J., Schaeffer, J. W., Smith, E. E., Steward, D. E., Theroux, P., Gibbons, R. J., Alpert, J. S., Eagle, K. A., Faxon, D. P., , Fuster, V., et al. (2000). ACC/AHA guidelines for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction: executive summary and recommendations. A report of the American College of Cardiology/American Heart Association task force on practice guidelines (committee on the management of patients with unstable angina). Circulation, 102(10), 1193-209.
• Indik, ., & Alpert, . (2000). Post-Myocardial Infarction Pericarditis. Current treatment options in cardiovascular medicine, 2(4), 351-356.
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  Post-myocardial infarction pericarditis occurs in approximately 5% to 6% of patients who receive thrombolytic agents. It should be suspected in any patient with pleuropericardial pain. A pericardial friction rub may or may not be present. Differentiation of pericarditis from recurrent angina may be difficult, but a careful history and evaluation of serial electrocardiograms can help distinguish the two entities. Dressler's syndrome, pericarditis that occurs at least 1 week following myocardial infarction, is now exceedingly rare. Most cases of pericarditis have a benign course; however, because pericarditis is associated with larger infarcts, overall long-term mortality rate is increased. Rare complications include hemopericardium, cardiac tamponade, and constrictive pericarditis. Therapy is directed toward relief of pain, which usually responds well to nonsteroidal anti- inflammatory agents (eg, aspirin or ibuprofen).
• Indik, J. H., & Alpert, J. S. (2000). Detection of pulmonary embolism by D-dimer assay, spiral computed tomography, and magnetic resonance imaging. Progress in cardiovascular diseases, 42(4), 261-72.
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  Pulmonary embolism (PE) remains difficult to diagnose. Ventilation perfusion lung scan, the standard diagnostic test for PE, has poor overall sensitivity. The gold standard examination, pulmonary angiography, is invasive and has some risk, making clinicians reluctant to refer patients. In recent years, new diagnostic modalities have been investigated, including D-Dimer assays, spiral computed tomography (CT), and magnetic resonance imaging (MRI). The authors reviewed the literature and noted that the D-Dimer assays by ELISA or rapid ELISA design are approximately 90% to 95% sensitive, but are not specific for the diagnosis of pulmonary embolism. Spiral CT has been studied with conflicting results; however, in the largest studies the reported sensitivities are greater than approximately 85%. Electron beam CT is an alternative technique, which has not been as extensively studied. MRI is also useful for imaging the pulmonary arterial vasculature, but remains experimental. Although a more accurate assessment of the sensitivity of these new modalities will need to wait until a large angiographically controlled study, such as the planned PIOPED II, can be done, D-Dimer assay and spiral CT are often useful in the detection of pulmonary embolism. The authors make recommendations for their use in a diagnostic algorithm, as alternatives to the standard ventilation perfusion lung scan.
• Alpert, J. S. (1999). Coronary heart disease: where have we been and where are we going?. Lancet (London, England), 353(9164), 1540-1.
• Alpert, J. S. (1999). HDL on the rise. Health news (Waltham, Mass.), 5(11), 4.
• Alpert, J. S. (1999). The coronary care unit: a 35-year perspective. European heart journal, 20(11), 784-5.
• Alpert, J. S., & Leier, C. V. (1999). 30th Bethesda Conference: The Future of Academic Cardiology. Task force 4: faculty. Journal of the American College of Cardiology, 33(5), 1127-35.
• Crawford, M. H., Bernstein, S. J., Deedwania, P. C., DiMarco, J. P., Ferrick, K. J., Garson, A., Green, L. A., Greene, H. L., Silka, M. J., Stone, P. H., Tracy, C. M., Gibbons, R. J., Alpert, J. S., Eagle, K. A., Gardner, T. J., Gregoratos, G., Russell, R. O., Ryan, T. H., & Smith, S. C. (1999). ACC/AHA Guidelines for Ambulatory Electrocardiography. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the Guidelines for Ambulatory Electrocardiography). Developed in collaboration with the North American Society for Pacing and Electrophysiology. Journal of the American College of Cardiology, 34(3), 912-48.
• Crawford, M. H., Bernstein, S. J., Deedwania, P. C., DiMarco, J. P., Ferrick, K. J., Garson, A., Green, L. A., Greene, H. L., Silka, M. J., Stone, P. H., Tracy, C. M., Gibbons, R. J., Alpert, J. S., Eagle, K. A., Gardner, T. J., Gregoratos, G., Russell, R. O., Ryan, T. J., & Smith, S. C. (1999). ACC/AHA guidelines for ambulatory electrocardiography: executive summary and recommendations. A report of the American College of Cardiology/American Heart Association task force on practice guidelines (committee to revise the guidelines for ambulatory electrocardiography). Circulation, 100(8), 886-93.
• Eagle, K. A., Guyton, R. A., Davidoff, R., Ewy, G. A., Fonger, J., Gardner, T. J., Gott, J. P., Herrmann, H. C., Marlow, R. A., Nugent, W. C., O'Connor, G. T., Orszulak, T. A., Rieselbach, R. E., Winters, W. L., Yusuf, S., Gibbons, R. J., Alpert, J. S., Eagle, K. A., Garson, A., , Gregoratos, G., et al. (1999). ACC/AHA Guidelines for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1991 Guidelines for Coronary Artery Bypass Graft Surgery). American College of Cardiology/American Heart Association. Journal of the American College of Cardiology, 34(4), 1262-347.
• Eagle, K. A., Guyton, R. A., Davidoff, R., Ewy, G. A., Fonger, J., Gardner, T. J., Gott, J. P., Herrmann, H. C., Marlow, R. A., Nugent, W., O'Connor, G. T., Orszulak, T. A., Rieselbach, R. E., Winters, W. L., Yusuf, S., Gibbons, R. J., Alpert, J. S., Garson, A., Gregoratos, G., , Russell, R. O., et al. (1999). ACC/AHA guidelines for coronary artery bypass graft surgery: executive summary and recommendations : A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to revise the 1991 guidelines for coronary artery bypass graft surgery). Circulation, 100(13), 1464-80.
• Ryan, T. J., Antman, E. M., Brooks, N. H., Califf, R. M., Hillis, L. D., Hiratzka, L. F., Rapaport, E., Riegel, B., Russell, R. O., Smith, E. E., Weaver, W. D., Gibbons, R. J., Alpert, J. S., Eagle, K. A., Gardner, T. J., Garson, A., Gregoratos, G., & Smith, S. C. (1999). 1999 update: ACC/AHA Guidelines for the Management of Patients With Acute Myocardial Infarction: Executive Summary and Recommendations: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction). Circulation, 100(9), 1016-30.
• Ryan, T. J., Antman, E. M., Brooks, N. H., Califf, R. M., Hillis, L. D., Hiratzka, L. F., Rapaport, E., Riegel, B., Russell, R. O., Smith, E. E., Weaver, W. D., Gibbons, R. J., Alpert, J. S., Eagle, K. A., Gardner, T. J., Garson, A., Gregoratos, G., Ryan, T. J., & Smith, S. C. (1999). 1999 update: ACC/AHA guidelines for the management of patients with acute myocardial infarction. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction). Journal of the American College of Cardiology, 34(3), 890-911.
• Alpert, J. S. (1998). Factors leading to progression of atherosclerotic coronary artery disease in young males following a first myocardial infarction. European heart journal, 19(3), 364-5.
• Alpert, J. S. (1998). Prognosis in acute myocardial infarction. European heart journal, 19(7), 979-80.
• Alpert, J. S. (1998). Ten year risk of subsequent infarction and death following admission to a coronary care unit. European heart journal, 19(4), 534-5.
• Alpert, J. S. (1998). Treatment of chronic angina pectoris with combination mibefradil and beta-blocker therapy. Clinical cardiology, 21(2), 129.
• Alpert, J. S. (1998). Where have all the flowers gone: where is the joy in medicine?. Archives of internal medicine, 158(7), 693.
• Hutter, A. M., Alpert, J. S., Cheitlin, M. D., Crawford, M. H., Fye, W. B., Garson, A., & Ullyot, D. J. (1998). Access to cardiovascular care and related issues: Ad Hoc Task Force on access to cardiovascular care. American College of Cardiology. Journal of the American College of Cardiology, 31(2), 485-6.
• Rich, M. W., Cheitlin, M. D., Hazzard, W. R., & Alpert, J. S. (1998). Integration of Geriatrics into Cardiology Fellowship Training Programs: A Joint Position Paper from the American Geriatrics Society and the Society of Geriatric Cardiology. The American journal of geriatric cardiology, 7(4), 52-53.
• Stein, P. D., Alpert, J. S., Dalen, J. E., Horstkotte, D., & Turpie, A. G. (1998). Antithrombotic therapy in patients with mechanical and biological prosthetic heart valves. Chest, 114(5 Suppl), 602S-610S.
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  Permanent therapy with oral anticoagulants offers the most consistent protection in patients with mechanical heart valves. Antiplatelet agents alone do not consistently protect patients with mechanical prosthetic heart valves, including patients in sinus rhythm with St. Jude valves in the aortic position. Levels of oral anticoagulants that prolong the INR to 2.0 to 3.0 appear satisfactory for patients with bileaflet mechanical valves in the aortic position, provided they are in sinus rhythm and the left atrium is not enlarged. Oral anticoagulant levels that prolong the INR to 2.5 to 3.2 are satisfactory for patients with bileaflet mechanical aortic valves and atrial fibrillation. Oral anticoagulant levels that prolong the INR to 2.5 to 3.5 are satisfactory for tilting disk valves and bileaflet prosthetic valves in the mitral position. Experience is sparse in patients with caged ball valves who had prothrombin time ratios reported in terms of INR. It has been suggested that the most advantageous INR level in patients with caged ball or caged disk valves should be as high as 4.0 to 4.9. However, others have shown a high rate of major hemorrhage with an INR that is even somewhat lower (3.0 to 4.5). The problem is self-limited, however, because few such valves are being inserted. Aspirin, in addition to oral anticoagulants, in patients with mechanical heart valves has been shown to diminish the frequency of thromboemboli. The risk of bleeding may not be increased if the INR is low. A low rate of both thromboemboli and bleeding has been shown with an INR of 2.5 to 3.5 in combination with aspirin at a dose of 100 mg/d. There are no investigations in which an aspirin dose of 81 mg/d in combination with oral anticoagulants was evaluated. Dipyripdamole may be effective in reducing the rate of thromboemboli without increasing the rate of bleeding, but data are insufficient to recommend dipyridamole over low doses of aspirin. Patients with bioprosthetic valves in the mitral position, as well as patients with bioprosthetic valves in the aortic position, may be at risk for thromboemboli during the first 3 months after surgery. Among patients during the first 3 months after surgery with bioprosthetic valves in the mitral position, oral anticoagulants administered at an INR of 2.0 to 2.3 were as effective as at an INR of 2.5 to 4.5: additionally, fewer bleeding complications were seen.
• Alpert, J. S. (1997). Joseph Stephen Alpert, MD: a conversation with the editor. Interview by William Clifford Roberts. The American journal of cardiology, 79(9), 1208-21.
• Alpert, J. S. (1997). No change in post-myocardial infarction prognostic factors. European heart journal, 18(1), 11-2.
• Alpert, J. S., Bakx, A. L., Braun, S., Frishman, W. H., Schneeweiss, A., Tzivoni, D., & Kobrin, I. (1997). Antianginal and anti-ischemic effects of mibefradil in the treatment of patients with chronic stable angina pectoris. The American journal of cardiology, 80(4B), 20C-26C.
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  Five placebo-controlled, double-blind, multicenter, parallel-design studies were performed to evaluate the antianginal and anti-ischemic characteristics of the novel T-channel-selective calcium antagonist, mibefradil, in the treatment of patients with chronic stable angina pectoris. Of the 5 studies, 2 were monotherapy dose-finding trials and 3 were conducted in patients receiving background antianginal therapy: either beta blockers (2 studies) or long-acting nitrates (1 study). A total of 865 patients were randomized to 1 of 4 mibefradil dose groups (25, 50, 100, and 150 mg; n = 565) and placebo (n = 300). The antianginal and anti-ischemic effects of mibefradil were assessed across all 5 studies by evaluating exercise tolerance test variables, weekly number of anginal attacks and short-acting nitroglycerin consumption, and in both dose-finding studies, the number and total duration of silent ischemic episodes (48-hour Holter monitoring). A statistically significant increase in exercise duration was achieved in 3 of 5 studies with the 50-mg dose of mibefradil and in 3 of 3 studies with the 100-mg dose of the compound over the effects observed in the placebo groups. A significant delay in time to onset of ischemia during exercise was induced in all studies with the 50- and 100-mg doses of mibefradil. The 25-mg dose of mibefradil was not significantly better than placebo, and the effects of the 150-mg dose of the compound were similar to those observed with the 100-mg dose. Across all studies, a dose-related decrease was observed in the number of weekly anginal attacks and in weekly nitroglycerin consumption. Similarly, a significant dose-related decrease in the number and duration of silent ischemic episodes was observed during Holter monitoring for 48 hours in the 2 dose-finding studies. The antianginal and anti-ischemic effects were associated with a dose-related decrease in heart rate and double product both at rest and at exercise termination. Treatment with the 50- and 100-mg doses of mibefradil was found to be well tolerated and safe compared with placebo, a finding that held true for patients on chronic beta-blocker or long-acting nitrate therapy. Taken together, these studies indicate that mibefradil is an effective and well-tolerated once-daily treatment for chronic stable angina pectoris at doses of 50 and 100 mg, which are the lowest and highest effective doses of the compound, respectively.
• Alpert, J. S., Kobrin, I., DeQuattro, V., Friedman, R., Shepherd, A., Fenster, P. E., & Thadani, U. (1997). Additional antianginal and anti-ischemic efficacy of mibefradil in patients pretreated with a beta blocker for chronic stable angina pectoris. The American journal of cardiology, 79(8), 1025-30.
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  This study assessed the safety, tolerability, and efficacy of mibefradil when added to beta-blocker monotherapy in patients with chronic stable angina pectoris. Two hundred five patients were randomized to receive double-blind treatment with either placebo (n = 70), mibefradil 25 mg (n = 67), or mibefradil 50 mg (n = 68) for 2 weeks. Exercise tolerance tests (ETTs) were performed at the end of the run-in (baseline) and double-blind treatment periods, and patients maintained an anginal diary. Compared with placebo, treatment with mibefradil 50 mg resulted in significant increases in exercise duration (36 +/- 51 seconds; p = 0.036), time to onset of angina (48 +/- 65 seconds; p = 0.002), and time to persistent 1-mm ST-segment depression (47 +/- 77 seconds; p = 0.004). Greater reductions in heart rate, blood pressure, and the rate-pressure product were more apparent at each stage of the ETT in the 50-mg mibefradil group than in the placebo group. Daily treatment with mibefradil 50 mg was associated with a significant decrease in the number of weekly anginal attacks (-2.1 +/- 4.0, p = 0.020) compared with placebo. The addition of mibefradil to existing beta-blocker therapy was well tolerated. Dizziness was the most frequently reported adverse event in the mibefradil 50-mg dose, and occurred with an incidence of 4.4%. The addition of mibefradil 50 mg, administered once daily, to patients on stable beta-blocker therapy produced additive antianginal and anti-ischemic effects and was well tolerated.
• Bianco, J. A., & Alpert, J. S. (1997). Physiologic and clinical significance of myocardial blood flow quantitation: what is expected from these measurements in the clinical ward and in the physiology laboratory?. Cardiology, 88(1), 116-26.
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  In this essay we review data on absolute quantitation of myocardial blood flow (MBF) in humans. Earlier work established that coronary heart disease (CAD) can be detected by coronary angiography and that this disease has characteristic features at rest and during stress, which indicate the linkage between regional metabolic needs and myocardial perfusion. In the 1970s myocardial perfusion was mapped in patients with radioxenon, but this method had significant technical limitations. About the same time, radioactive microspheres were introduced for cardiovascular research and investigations; these particles provided insights on MBF in acute infarction and ischemia, myocardial reperfusion, collateral circulation, myocardial blood flow during exercise, coronary flow reserve (CFR), and layer-to-layer distribution of MBF. Studies with microspheres also permitted investigators to establish the presence in the heart of MBF heterogeneity. Currently, there are several techniques that aim at extending these concepts into clinical investigation. Two of these techniques, i.e. Doppler coronary flow velocity and fast magnetic resonance imaging assess epicardial flow dynamics and CFR. Contrast myocardial echocardiography is another novel technique which has been useful in mapping the area at risk, reperfusion, myocardial viability and collateral circulation. This essay also considers the emerging technique of intracoronary ultrasound which has shown evidence of disease underestimation by conventional contrast angiography. Positron emission tomography (PET) is a noninvasive technique that uniquely and quantitatively maps myocardial perfusion and CFR. The latter can be computed before and after angioplasty. PET studies have further demonstrated that chronic myocardial ischemia does not exist as a distinct state in patients with CAD. From the above investigations the concept has arisen that not only is CAD an entity involving epicardial vessels but also, in a significant portion of patients, an abnormal microcirculation plays an important role in the pathogenesis of ischemic syndromes. PET studies have relatively low spatial resolution since they cannot resolve layer-to-layer absolute MBF.
• Bianco, J. A., & Alpert, J. S. (1997). Towards absolute quantitation of myocardial blood flow in patients. Cardiology, 88(1), 52-3.
• Cheitlin, M. D., Alpert, J. S., Armstrong, W. F., Aurigemma, G. P., Beller, G. A., Bierman, F. Z., Davidson, T. W., Davis, J. L., Douglas, P. S., & Gillam, L. D. (1997). ACC/AHA Guidelines for the Clinical Application of Echocardiography. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Clinical Application of Echocardiography). Developed in collaboration with the American Society of Echocardiography. Circulation, 95(6), 1686-744.
• Cheitlin, M. D., Alpert, J. S., Armstrong, W. F., Aurigemma, G. P., Beller, G. A., Bierman, F. Z., Davidson, T. W., Davis, J. L., Douglas, P. S., Gillam, L. D., Lewis, R. P., Pearlman, A. S., Philbrick, J. T., Shah, P. M., Williams, R. G., Ritchie, J. L., Eagle, K. A., Gardner, T. J., Garson, A., , Gibbons, R. J., et al. (1997). ACC/AHA guidelines for the clinical application of echocardiography: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee on Clinical Application of Echocardiography). Developed in collaboration with the American Society of Echocardiography. Journal of the American College of Cardiology, 29(4), 862-79.
• Dalen, J. E., Alpert, J. S., & Hirsh, J. (1997). Thrombolytic therapy for pulmonary embolism: is it effective? Is it safe? When is it indicated?. Archives of internal medicine, 157(22), 2550-6.
• Mackstaller, L. L., & Alpert, J. S. (1997). Atrial fibrillation: a review of mechanism, etiology, and therapy. Clinical cardiology, 20(7), 640-50.
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  The prevalence of elderly individuals in the populations of developed countries is increasing rapidly, and atrial fibrillation (AF) is quite common in these elderly patients: currently, 11% of the U.S. population is between the ages of 65 and 85 years; 70% of people with AF are between the ages of 65 and 85 years. AF causes symptoms secondary to hemodynamic derangements that are the result of increased ventricular response and loss of atrial booster function. AF can lead to reversible impairment of left ventricular function, cardiac chamber dilatation, clinical heart failure, and thromboembolic events. AF requires treatment in order to prevent these potential complications. Type Ia, Ic, and III antiarrhythmics are capable of converting AF to normal sinus rhythm (NSR). Amiodarone has the greatest efficacy and safety for converting AF and maintaining NSR while digoxin and verapamil are ineffective in restoring NSR. Quinidine, flecainide, disopyramide, and sotalol have also been shown to maintain NSR after conversion of AF. Proarrhythmia is a definite concern with the latter four agents. Alternative therapy for AF includes anticoagulation with warfarin or aspirin for the prevention of thromboembolic events, and a variety of agents to control the ventricular response. All medications used to treat AF carry significant risks in the elderly, whether from proarrhythmia, overdosing because of compliance errors, or hemorrhage secondary to anticoagulation. Treatment of AF must be based on a careful risk-benefit evaluation. The physician must know the capability of the particular patient as well as drug mechanisms and effects in the elderly. The decision to convert patients from AF to NSR or to leave the patient in AF and control the ventricular response represents a complex intellectual challenge. Factors favoring one or the other of these two clinical strategies are discussed. Multicenter clinical trials, for example, the Atrial Fibrillation Follow-up Investigation Rhythm Management (AFFIRM) trial, are currently underway to assess various clinical strategies for maintenance of NSR following conversion from AF. Amiodarone is one of the drugs under investigation.
• Yun, D. D., & Alpert, J. S. (1997). Acute coronary syndromes. Cardiology, 88(3), 223-37.
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  Acute coronary syndromes are defined as unstable angina, non-Q-wave myocardial infarction, and Q-wave myocardial infarction. These entities remain among the commonest life-threatening illnesses in industrialized nations. Prompt recognition of a patient with an acute coronary syndrome is important since appropriate therapy can markedly improve the patient's prognosis. Reperfusion strategies for patients with Q-wave myocardial infarction, and anticoagulation and antiplatelet therapy for patients with unstable angina or non-Q-wave myocardial infarction are examples of such potentially life-saving interventions. A number of adjunctive pharmacological interventions are also beneficial following reperfusion therapy in patients with Q-wave myocardial infarction. Management of Complications following Q-wave myocardial infarction has improved markedly in recent years. This is particularly the case with postinfarction ischemia or heart failure. Persistent arrhythmias, and in particular ventricular arrhythmias, remain a troubling challenge for the clinician. Reperfusion therapy markedly reduces the incidence of complications following Q-wave myocardial infarction.
• Alpert, J. S. (1996). The Intersecting Paths of Geriatrics and Cardiology. The American journal of geriatric cardiology, 5(6), 9-10.
• Alpert, J. S., & Cheitlin, M. D. (1996). Update in cardiology. Annals of internal medicine, 125(1), 40-6.

Reviews

• Dalen, J. E., & Alpert, J. S. (2016. Silent Atrial Fibrillation and Cryptogenic Strokes.
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  A new suspected cause of cryptic strokes is "silent atrial fibrillation." Pacemakers and other implanted devices allow continuous recording of cardiac rhythm for months or years. They have discovered that short periods of atrial fibrillation lasting minutes or hours are frequent and usually are asymptomatic. A meta-analysis of 50 studies involving more than 10,000 patients with a recent stroke found that 7.7% had new atrial fibrillation on their admitting electrocardiogram. In 3 weeks during and after hospitalization, another 16.9% were diagnosed. A total of 23.7% of these stroke patients had silent atrial fibrillation; that is, atrial fibrillation diagnosed after hospital admission. Silent atrial fibrillation is also frequent in patients with pacemakers who do not have a recent stroke. In a pooled analysis of 3 studies involving more than 10,000 patients monitored for 24 months, 43% had at least 1 day with atrial fibrillation lasting more than 5 minutes. Ten percent had atrial fibrillation lasting at least 12 hours. Despite the frequency of silent atrial fibrillation in these patients with multiple risk factors for stroke, the annual incidence of stroke was only 0.23%. When silent atrial fibrillation is detected in patients with recent cryptogenic stroke, anticoagulation is indicated. In patients without stroke, silent atrial fibrillation should lead to further monitoring for clinical atrial fibrillation rather than immediate anticoagulation, as some have advocated.

Others

• Huang, J. J., Sharda, N., Riaz, I. B., & Alpert, J. S. (2014, Fall). The reply. The American journal of medicine.