Cardiology
Expert discussions on heart failure, arrhythmias, interventional procedures, and cardiovascular risk management.
Recent Discussions
What are your criteria for deciding if a patient who had VF arrest in the setting of subacute myocarditis requires ICD or long term WCD?
This is a complex question with multiple variables. In general, if the patient had a VF arrest, then we are no longer talking about primary prevention, this would be a secondary prevention indication. For me, I would want to identify a reversible cause with reasonable expectation that the VF episode...
How long would you treat a patient with recent history of TAVR presenting with E faecalis bacteremia with unclear source with TEE showing thickened valves but no obvious vegetation?
Treatment duration depends on other additional factors.TEE showed leaflet thickening- a non-specific finding, not a feature per Duke's major imaging criteria. Another feature to consider would be an associated new-onset valvular insufficiency that might increase the likelihood of IE. In such cases, ...
Is there enough evidence now to use injectable semaglutide as a foundational therapy for symptomatic heart failure with preserved ejection fraction in the setting of overweight or obesity?
While the evidence for using injectable semaglutide in the setting of heart failure with preserved ejection fraction (HFpEF) and overweight/obesity is promising, it's still considered emerging! STEP-HFpEF trial: This large, well-designed study showed that semaglutide significantly improved symptoms,...
Can bleeding risk when switching from VKA treatment to a NOAC in frail, elderly patients be accurately compared if individual times in therapeutic range while on VKA treatment are not captured?
It has been postulated that, among patients who do not have an INR within therapeutic range, about half have subtherapeutic values and half have supratherapeutic values. Therefore, the latter are at higher risk of bleeding complications. Time in therapeutic range (TTR) ranges around 60-70% in random...
In people who have had a single detected episode of atrial fibrillation, but none documented subsequently, is there any consideration for increased thrombolembolic risk just from altered atrial architecture, impaired contractility?
Clarification, impaired left atrial contractility
What are your top takeaways from ISHLT 2024?
I had the privilege of attending ISHLT 2024, and I am delighted to share insights from three standout presentations that I believe will significantly influence our field.1. Trifecta Heart Study by Dr. Philip HalloranImpact: This presentation explored innovative blood-based techniques such as cell-fr...
Do you recommend taking any unique approaches to managing patients with persistent hypertension following bilateral renal artery stenting?
Yes, I will be more aggressive with lipid management, sometimes using PCSK9-INH in addition to a statin, if the cause of the renal artery stenosis was atherosclerotic-related. Also, I typically get yearly ultrasounds to evaluate the patency of the renal artery stents. From a management perspective, ...
What is your approach to counseling a patient with stable but severe multivessel coronary disease if the patient does not wish to undergo bypass surgery?
The question assumes that a stable patient with multivessel disease would do better with bypass surgery. If the ejection fraction is less than 35% then the long-term outcome from the STITCH trial showed a reduction in mortality. There is no comparable data for angioplasty. If the patient refuses sur...
What is a reasonable way to treat statin-induced myalgia and what statin substitute would you consider using in the event the myalgia is not resolved?
Qunol co administration Vytorin - lower doses PCSK9
How do you advise patients with paroxysmal atrial fibrillation regarding their caffeine consumption, given that a randomized clinical trial found no association between caffeine intake and the triggering of AF episodes?
There is no data to support that limited caffeine consumption should not be forced upon patients for AF prevention because it does not cause AF. Then again, there are patients who are sensitive to it and they should avoid it. I think patients are told to stop it because we want to blame something fo...