Cardiology
Expert discussions on heart failure, arrhythmias, interventional procedures, and cardiovascular risk management.
Recent Discussions
Would you recommend giving N-acetylcysteine in addition to holding diuretics in a patient with chronic kidney disease and mild hypervolemia who is planned to have a contrast study?
There are several meta-analyses showing conflicting evidence on the use of N-acetylcysteine to prevent contrast-associated AKI. However, the largest randomized trial (PRESERVE) did not show any benefit from using oral N-acetylcysteine in 4993 high-risk patients undergoing scheduled angiography (Weis...
In patients with Tetralogy of Fallot and an indication for primary prevention ICD (NSVT, induced VT during EPS, or Low LVEF), should pulmonary valve interventions be offered PRIOR to ICD to assess if improvement in VT burden/EF?
There is a lot to consider for this question.First, appropriate indications for primary prevention ICD in tetralogy of Fallot are not at all clear. While arrhythmias and left ventricular dysfunction are clearly risk factors for malignant arrhythmias, that is very different from saying that individua...
What other considerations for hyperlipidemia management would you have for a patient with multiple prior PCIs whose LDL remains above goal on high intensity statin, ezetimibe, and evolocumab, assuming the patient is compliant with medications?
There are a few options, most of which depend on insurance coverage and patient preferences. But first, would do a chart biopsy to assess the efficacy of each of the therapies to better understand the reason for persistent LDL elevation. Perhaps they have a dysfunctional LDL receptor, so upregulatio...
What are your typical recommendations for when a patient can return to work following a cardiac arrest, considering the variation in neurological recovery and the potential ramifications based on the type of job?
Impossible to answer categorically. As the question implies, there are so many variables, including the nature of the job, physical demands, patient age, co-morbidities, and extent of neurological and psychological recovery. The latter may be the most important since return to work may be helpful or...
How do you view the balance between opting for percutaneous coronary intervention and prioritizing optimal medical therapy as the initial treatment choice for patients with stable angina?
This is the holy grail of Cardiovascular practice on how to marry the prevalent scientific data to clinical practice. In my opinion, an astute history and in-depth analysis of patient symptoms (angina and ischemia with their varied clinical presentations) hold the key to individualized patient care....
How soon after initiating oral anticoagulation therapy for atrial fibrillation can it be interrupted for surgery or procedures?
As with most things medical, multiple answers. If a patient walks into my office for preOp "clearance" and behold, they are in atrial fib, but asymptomatic, then it would depend on the urgency of their surgery. If elective, then you have time to work up his atrial fib and look for a reversal cause (...
What is the optimal BP target for patients with diabetes and hypertension to reduce their risk of MI/stroke?
From the 2025 ADA Standards of Care, section 10 discusses Cardiovascular Disease and Risk Management. With proper blood pressure technique, the recommended blood pressure treatment goal is less than 130/80 mmHg if this can be achieved safely. Several randomized controlled trials are referenced with ...
For patients presenting with ACS and severe aortic stenosis with critical left main disease, would you consider BAV prior to PCI to the left main?
This sounds like a CABG AVR case on the surface; if inoperable or at prohibitive surgical risk, CHIP of the LNA lesion, followed by same setting or elective setting TAVR remains an option. CFA access with a large bore sheath (for CHIP/IABP or IMPELLA) will allow for an easy transition exchange for t...
What has been your approach to using contrast enhancement agent in the echo lab in pregnant patients if there is concern for LV thrombus or poor imaging windows for LVEF/valvular disease assessment?
This is a quote from a recent ACC article: "The use of agitated saline for evaluation of intracardiac shunting is not recommended in the setting of pregnancy. There are no empirical safety data on the use of ultrasound-enhancing agents (perflutren, sulfur hexafluoride) in pregnancy, although data fr...
Is there evidence to support the use of automated blood pressure checks during exercise stress testing, or does manual BP remain superior in terms of accuracy and consistency?
While there are certainly some advantages with automated blood pressure monitors, there are some limitations that require a manual backup or check. Exercise peak BPs should be verified with manual cuffs as well as measurements during arrhythmias, which can affect the accuracy of automated devices. A...