Cardiology
Expert discussions on heart failure, arrhythmias, interventional procedures, and cardiovascular risk management.
Recent Discussions
Is there any benefit to supervised PAD exercise programs in the presence of collaterals seen on angiography for patients with severe claudication and significant lesions?
Yes, exercise benefits for claudication are more about muscle training and metabolism and general physical conditioning than building of collateral circulation.
Would you favor stopping low-dose aspirin and continuing OAC alone in a patient with atrial fibrillation and mild coronary artery calcification seen on routine chest imaging?
Absolutely, most of the patients that I would treat with dual-antithrombotics (as opposed to dual antiplatelet plus/minus anticoagulant), have had clinical events. Most commonly MI and/ or stent plus atrial fibrillation. Your patient has one clinical event (AF) and another "subclinical" condition.
What are your management strategies for malignant pericardial effusion with a high risk of spontaneous hemorrhage, particularly in patients requiring anticoagulation for chronic atrial fibrillation?
We have many patients with malignant pericardial effusion who tolerate anticoagulation for DVT/PE/afib. In those patients, when AC is restarted (for example after pericardiocentesis), close monitoring with serial echo in a few days would be performed to see if effusion reaccumulates faster. Also, th...
What is your target or goal lipoprotein (a) level for patients on PCSK9 inhibitors for either primary or secondary prevention?
Let me compliment the clinician who submitted the question because he/she measured lipoprotein (a) [Lp(a)] in the first place. Lp(a) was first described in 1964, but its contribution to atherosclerotic vascular disease risk has only recently attracted widespread attention. Part of that attention is ...
Would you recommend hospitalization for surgery for a large papillary fibroelastoma or atrial myxoma discovered on an outpatient echocardiogram?
NOT necessarily to hospitalize if incidental finding given that both of these lesions are typically present for years prior to diagnosis (unless of course you are concerned about getting sued if a bad outcome occurs). If these lesions are found in the context of a recent neurological syndrome then c...
What is the best approach in management of device related thrombus seen immediately after watchman deployment?
Continue ASA and Eliquis for several weeks and then recheck.
Should we recommend SGLT2i initiation at discharge to all patients hospitalized with acute myocardial infarction?
The strict answer to this question, including "all patients hospitalized with acute MI" is no based on the results of the recently reported EMPACT-MI trial. In this study of more than 6000 patients empagliflozin did not significantly improve a composite endpoint of hospitalization for heart failure ...
For patients who have undergone ablation for atrial fibrillation with elevated bleeding risk, what is your risk/benefit approach when deciding to continue oral anticoagulation long-term?
I would generally determine the continuation of anticoagulation based on the patient's ChADSVASC score rather than the perceived success of ablation as many will have a burden of subclinical PAF despite ablation. So, if they are at high risk for stroke/systemic embolism, based on ChADSVASC, I would ...
What percentage of patients with non-sustained focal atrial tachycardia detected on an outpatient Holter develop paroxysmal atrial fibrillation, and how should we identify and treat patients at the highest risk of progressing to PAF?
I agree with most of the points by Dr. @Dr. First Last. I'll go through my train of thought from monitoring to what the %age is (PAT progressing to PAF) to afib management/reasons we care. Apologies for the length of response:1) The right monitoring technology should balance what you are looking for...
For patients with high-risk stress test features with ischemic EKG changes and mild to no symptoms, what would be your threshold to directly admit them for coronary angiography, or pursue outpatient elective coronary angiogram?
The key is whether there is a stable clinical history. In the absence of any symptoms suggesting a change in clinical trajectory, the evaluation should be done without a direct admission particularly in order to allow patients to plan rather than create a sense of emergency. Unprovoked symptoms that...