Cardiology
Expert discussions on heart failure, arrhythmias, interventional procedures, and cardiovascular risk management.
Recent Discussions
In patients with moderate calcific mitral stenosis, possible HFpEF and dyspnea on exertion, how would you differentiate the etiology of the symptoms?
I would consider a dobutamine stress echocardiogram to evaluate the flow across the valve as well as diastolic parameters. If this does not answer the question, an exercise right heart catheterization could be helpful and could also look into concomitant pulmonary hypertension as a cause of dyspnea....
How soon after an elective, uncomplicated coronary intervention would you feel comfortable having a patient travel by air?
Usually, 3-5 days after uncomplicated PCI. But in the era of transradial and 5-fr sheaths, and in the absence of Sx, with preserved LV EF, this may be truncated to 48 hours.
Would you make any dialysis prescription modifications for an ESKD patient who develops tachycardia during a hemodialysis session?
Arrhythmias that initiate during dialysis treatment are almost always due to hypokalemia. Unfortunately, changing the potassium bath after an arrhythmia has already started will likely not help. The answer to the question depends on the circumstances of the patient. If unstable, would stop dialysis....
Is azilsartan superior to other angiotension receptor blockers in regard to cardiorenal outcome data?
In short, there are no data. There are very few head-to-head comparisons of ARBs on hard outcomes. Azilsartan was used in SPRINT (alongside losartan and valsartan), though the secondary analyses focused on class effect as opposed to specific med-to-med comparisons within a class (DeCarolis et al., P...
What is your loading dose goal and typical loading regimen for PO amiodarone in patients with atrial fibrillation?
I generally aim for a loading dose of 10 grams. This is a combination of both IV and PO amiodarone administered. For an outpatient, I utilize one of the original dosing schedules consisting of 200 mg TID x 3 weeks, followed by 200 mg daily (although this is a little more than 10 grams). For an inpat...
What is your preferred, first-line class of anti-anginals for MINOCA with proven epicardial coronary vasospasm?
We typically start with long-acting nitrates such as isosorbide mono or dinitrate, but often patients will have adverse effects to nitrates that make long-term use challenging. We have had good results with non-dihydropyridine calcium channel blockers, particularly diltiazem, both as short and long-...
How do you approach revascularization in patients over 75 years with NSTEMI, given recent evidence from the SENIOR-RITA trial that an invasive strategy does not significantly reduce cardiovascular events compared to a conservative strategy?
The Senior-Rita trial was a randomized trial of nstemi patients over the age of 75 randomized to conservative therapy versus an invasive strategy plus optimal medical therapy. Non-fatal MI was more common in the conservative strategy group but overall a primary outcome event occurred in 25-26% in bo...
In patients with resolved LV thrombus post-MI after 3-6 months of anticoagulation, would you consider surveillance imaging for thrombus recurrence if there is persistent apical akinesis?
A common and sometimes challenging scenario. If there is persistent LV dysfunction (EF <40%) with apical akinesis /aneurysm, I maintain anticoagulation regardless of thrombus resolution. Recurrence of thrombus, even after echo imaging evidence of resolution in this state has been observed. There is ...
What are your top takeaways from AHA 2025?
The signal across fields: cardiology is moving toward biology + behavior to prevent and treat disease earlier/better. POLY-HF: A single once-daily polypill (β-blocker + MRA + SGLT2i) in HFrEF improved LVEF, QOL, and cut HF events by ~60% vs usual care → major signal that adherence-first strategies ...
Would you consider overdrive pacing for recurrent torsades des pointes in a patient without an obvious drug causing QTc prolongation or significant electrolyte abnormality?
Overdrive pacing is a guideline-recommended treatment for recurrent torsade de pointes in the setting of prolonged QT interval, particularly for patients with bradycardia exacerbating the QT prolongation. Isoproterenol infusion is another option to treat these patients. In these patients, the overdr...