Cardiology
Expert discussions on heart failure, arrhythmias, interventional procedures, and cardiovascular risk management.
Recent Discussions
What are your top takeaways for the 2026 ACC/AHA lipid guidelines?
Kudos to the writing committee for this long-awaited update! The 2026 ACC/AHA Dyslipidemia Guideline officially replaces the 2018 standards, reflecting nearly a decade of new clinical evidence.Here are the 10 biggest shifts every clinician should know: The PREVENT Era is Here: We are moving beyond t...
What are your top takeaways from ACC 2026?
From the arrhythmia perspective, and in my opinion, there were 3 studies of note at the ACC: Champion-AF that demonstrated non-inferiority for LAAO closure devices versus NOACs for stroke prevention and superiority in terms of bleeding (but not of major bleeding). Although the topline results were e...
What is the appropriate cardiac work-up and management for an otherwise healthy individual who has experienced immersion pulmonary edema while scuba diving?
Immersion pulmonary edema (IPE) is rare in the general population, but does occur in approximately 1% of triathletes and more frequently among military recruits (Kumar and Thompson, PMID 30403902). IPE is due to acute increases in pulmonary capillary wedge pressure (PCWP), which can flood the alveol...
Have you changed your approach to delaying hip surgery in the context of decompensated CHF given the findings of the HIP-ATTACK study?
That is an interesting question. Patients with a hip fracture have a high mortality, and delaying surgery could contribute to this mortality. On the other side of the pendulum is acute heart failure. Patients with acute heart failure have increased mortality in the perioperative period. Some of this...
When do you opt to administer IV iron for patients with heart failure who may also have anemia of chronic disease or at risk for iron deposition disease?
I do not hesitate to administer IV iron in a patient with heart failure (chronic inflammation) if serum ferritin levels are <30 ng/ml and TSAT is under 20%. This is the only way, besides blood transfusions, to improve Hgb levels in this patient population.
How would you manage MRSA and Enterococcus faecalis bacteriuria in a patient presenting in severe heart failure without urinary symptoms, fever, or chills, two negative blood cultures, and whose transthoracic echocardiogram shows no new valvular abnormalities?
The core question here is: are you dealing with asymptomatic bacteriuria or a true infection? In the absence of urinary symptoms and in following the IDSA UTI guidelines, asymptomatic bacteria should not be treated except in specific clinical scenarios - pregnancy, urologic instrumentation, renal tr...
How long do you recommend waiting before competitive sports athletes resume sports activities following inpatient management for an NSTEMI?
Dear Dr. @Dr. First Last - thank you for your question. We address this issue in the new ACC/AHA Scientific Statement by Kim et al., PMID 39976316.Clinical Considerations for Competitive Sports Participation for Athletes With Cardiovascular Abnormalities: A Scientific Statement From the American Hea...
Do you generally recommend device exchange/removal in patients with gram positive bacteremia in the setting of intra-aortic balloon bump or other mechanical circulatory devices?
I am assuming in this case that the patient has a mechanical circulatory support device such as an LVAD, IABP, or another implantable device, and has developed gram-positive bacteremia. No further details about the device type or clinical scenario are provided. In such cases, device removal is recom...
Is it a good practice to prescribe clonidine to take as needed for occasional severe blood pressure elevations?
Prescribing as needed clonidine is not part of my routine BP management. If the BP is uncontrolled consistently then long-acting medications can be uptitrated or dose adjusted. As needed clonidine may be helpful in the initial evaluation period or when making medications changes. It is important for...
What are your preferred femoral vascular closure devices for severely calcified femoral artery vessels following PCI, especially with higher sticks, and why?
One should not have high sticks. The femoral access should be methodical. One should make sure to mark the inferior border of the inguinal ligament and stay below the ligament. I always use a micropuncture needle and obtain fluoroscopy to assess the position of the needle in relation to the femoral ...