Cardiology
Expert discussions on heart failure, arrhythmias, interventional procedures, and cardiovascular risk management.
Recent Discussions
Which type of patients with asymptomatic peripheral arterial disease with an ABI score of less than 0.9, is it reasonable to offer antiplatelet and statin therapy to?
This is an important question. Unfortunately, there is no good evidence to help answer it. So what I am about to say is not evidence-based, but it is common sense. Since patients with PAD have an increased rate of MI, Stroke, and CV death, they should all receive maximum medical therapy. I believe t...
In patients who are on 3 of the 4 pillars of HF therapy for HFrEF, would you add the 4th pillar if they are no longer in symptomatic HF and LVEF normalizes?
This is a great question, and a data-free zone. The way I see it, the LV recovered with 3 pillars, and assuming the EF is normal and patient asymptomatic, I'm not sure what benefit is derived from the fourth pillar. I would not add it as there is no data that in patients with HFimpEF already on 3 pi...
Is there a role of maximizing GDMT medications for patients with durable VADs?
Yes. There is a role both to (1) reduce morbidity and mortality in patients with heart failure supported with durable LVADs and (2) the potential to promote myocardial recovery concomitantly with mechanical unloading provided by the LVAD. There is no published, prospective, RCT outcomes data yet to ...
Are there any circumstances in which you would consider PCI for CAV, especially for focal/tubular lesions, if the patient is a candidate for re-transplantation?
Most consider PCI for CAV a palliative intervention. If a patient is a re-do transplant candidate and have other high-risk features related to CAV (e.g. restrictive physiology, arrhythmias, etc), then an evaluation for re-transplant should be pursued. If they are not a candidate, then PCI is certain...
Would you favor PCI or CABG for younger patients with radiation-associated cardiac disease in the absence of any significant valvular abnormalities?
Despite the fact that the common and most serious radiation-induced coronary stenosis (RICS) are ostial lesions of the left main and ostial RCA, we heavily favor PCI when feasible due to fibrotic mediastinal changes causing significant technical challenges during CABG. Restenosis is another challeng...
What is the role of mechanical circulatory support in mixed cardiogenic vasodilatory shock?
To structure management for any individual patient with "mixed" shock, it is prerequisite to define the nature, sequence and contributors to the admixture of circulatory derangements. Temporary mechanical circulatory support (tMCS) provides hemodynamic value for patients with a critical insufficienc...
In light of recent trials evaluating NPO before cath (CHOW NOW, SCOFF, etc.) are centers still restricting oral intake pre-procedure?
Despite compelling growing evidence supporting that NPO is safe for diagnostic procedures (coronary angiogram, RHC), most institutions are still reluctant to change, likely related to: Medical inertia Nursing staff hesitation Upper management Medical liability M&M related concerns Lack of guideline...
What patient population is most likely to benefit from pill in pocket strategy for management of paroxysmal atrial fibrillation in an unmonitored setting?
Ideal patients are those with structurally normal hearts, no ischemia, and no renal impairment. For pill-in-the-pocket anti-arrhythmic therapy, I don't think an adjunctive AV node blocker is required for single-dose administration. Most patients who use pill-in-the-pocket antiarrhythmic therapy are ...
Would you start ASA and/or statin therapy on an asymptomatic patient noted to have incidental pathologic Q waves on EKG, assuming no prior history of ischemic heart disease?
I would start with a thorough H and P and comprehensive risk evaluation with necessary screening including blood work, at least a stress echocardiogram if not a full echocardiogram in addition, and also offer Calcium scoring. Given more details are not given regarding the patient's age and functiona...
Should we begin using bromocriptine for CVD management during pregnancy per ESC guidelines in patients with peripartum cardiomyopathy?
The use of bromocriptine for managing cardiovascular disease during pregnancy, particularly in the context of peripartum cardiomyopathy (PPCM), is a topic of growing interest and debate.Before answering this question, I want to make a few points: PPCM is thought to involve a combination of factors i...