Cognition in the era of technology: “Seeing the shades of gray”

Abstract

The enormous impact of the so-called technology explosion in cardiovascular medicine is well known. Figure 1 reminds us that the cognitive aspects of our specialty have expanded in concert with technology and that patients who we used to see only in terms of black or white are now routinely evaluated in terms of the broad spectrum between the extremes. Our task as cardiovascular specialists is to locate the appropriate diagnostic and therapeutic shade of gray for each patient. My theme today is that cognitive issues are more dominant in this process than we often realize. I hope to illustrate this point by discussing two of our most commonly used technologies. coronary arteriography and studies of myocardial perfusion. as they relate to coronary artery disease. Figure 2 reminds us that patient care decisions in coronary artery disease usually involve considerations of arteriographic status, left ventricular function and the individual clinical profile. The clinical profile, of course, includes a number of pertinent variables. and perfusion studies are only one of these. Let us begin. however. by considering coronary arteriography.