Cardiology
Expert discussions on heart failure, arrhythmias, interventional procedures, and cardiovascular risk management.
Recent Discussions
Is there any benefit in maintaining statin or aspirin therapy in patients >75 years old with stable, multivessel ischemic heart disease in light of challenges encountered with polypharmacy?
This is a great geriatric cardiology question because it acknowledges that guidelines may not apply in an older patient with multiple medical problems and a complex medication regimen. The question further implies that treatment should be individualized and patient-centered. I agree with the questio...
Would you recommend PFO closure in patients >60 years old with presumed paradoxical embolism as their mechanism of stroke?
Technically, based on the available clinical trial evidence, PFO closure is not indicated for patients over age 60 or for patients whose stroke was > 6 months ago. However, we frequently need to extrapolate from clinical trial populations to manage the patients we see in practice. Also, presumably, ...
How would you approach the timing of hemodialysis for an ESKD patient with no urgent indications who has NSTEMI with a troponin level of 10 ng/dl, has not had dialysis in 2 days, and is planned for left heart catheterization the next day?
If the patient is mildly hypovolemic without evidence of respiratory insufficiency, hyperkalemia, or significant acidosis, then proceeding to cath and following with dialysis is reasonable. The other question is to ask, is cardiac catheterization is necessary, and is this a type 1 MI versus chronic ...
How frequently do you obtain lipoprotein (a) levels on asymptomatic patients without a prior history of CAD?
Recent recommendations are considering that the entire population ought to be tested at least once in their lifetime given the estimated prevalence in the general population of some degree of elevation in as many as 20% of the population. That said I certainly check in most people with a family hist...
What is the best approach for single vessel mid-LAD CTO in patient with preserved EF and no anginal symptoms?
Unless there are symptoms or severe ischemia refractory to optimal medical therapy, a PCI is generally not considered indicated in this setting. The presence of collaterals, additional disease, regional viability and technical complexity would enter into the decision as well. Lloyd W Klein MDUCSF
For patients with hypertension who have normal filling pressures following right cardiac catheterization, can hypertension still be attributed to volume overload?
I do not think of chronic hypertension as a disease of volume overload. Loop diuretics are indeed very poor antihypertensive agents. I agree that cardiac loading conditions are dynamic, but in a patient with normal filling pressures and hypertension, I would think of inappropriately increased periph...
How frequently should outpatient mobile cardiac telemetry be ordered following resolution of post-CABG-related atrial fibrillation for patients off anticoagulation?
I am not a big user of MCOTs in general so I would say that I rarely use them in the postoperative setting. I very much like MCOT monitors but the struggle with reimbursement often makes it a challenge. we do routinely get atrial fibrillation burden with our standard event monitor which certainly im...
What is your approach to risk stratification of asymptomatic patients with pre-excitation syndrome?
When addressing pre-excitation on EKG, some good references include: ACC online expert analysis 2012 PACES/HRS expert consensus statement Editorial on the 2012 PACES guidelines about the challenges of being more aggressive In general, I agree with Dr. @Dr. First Last and the ACC expert analysis that...
Is there any difference in the cardiovascular risk reduction profile of brand name Vascepa versus generic icosapent ethyl for patients with hypertriglyceridemia?
The major clinical trial data (Bhatt et al., PMID 30415628) showing benefit for Icosapent Ethyl were with medication provided by the company that ultimately branded the medication. That is no different from the clinical trials showing the benefit of statins or anti-hyperglycemic medications. We do n...
How do you counsel patients with non-statin associated inflammatory myopathies about statin use?
Patients with non-HMGCR-associated myositis could try statins, keeping in mind that they could develop statin-associated muscle symptoms (SAMS). Therefore, would start with fluvastatin/pravastatin/pitavastatin (that are less likely to cause SAMS) at a low dose and slowly escalate if there are no sid...