Cardiology
Expert discussions on heart failure, arrhythmias, interventional procedures, and cardiovascular risk management.
Recent Discussions
What is your approach to considering geriatric patients for complex PCI given their overall frailty and increased risk of complications such as bleeding and stroke?
I would do everything I could with respect to medical and lifestyle therapy for such a patient. They are at very high risk for a bad outcome in the cath lab.
When would you consider initiating GDMT for new onset HF in the geriatric population?
I would always treat with GDMT but would start low and slowly advance watching for AE's.
What is a reasonable blood pressure goal for refractory HTN in the geriatric population?
Resistant hypertension is defined as a blood pressure that remains above goal despite concurrent use of three antihypertensive agents of different classes taken at maximally tolerated doses, one of which should be a diuretic. Refractory hypertension is defined as uncontrolled blood pressure despite ...
How do you decide on an outpatient maintenance diuretic regimen for patients approaching discharge for ADHF?
Good question. More from my personal observational experience. I reduce the dose to minimal once the patient is well compensated clinically and other pillars are tolerated well. If the SGLT2i, ARNI, and beta blockers are already on board and the patient coming off the IV lasix, I will add low-dose M...
Should we be more concerned about cardiac toxicity following breast radiotherapy?
The way I interpret the data with all caveats that threshold dose and time period for any cardiac morbidity is significantly lower than what was expected. For that reason, all efforts should be made to avoid any direct photon beam wherever possible to go through any portion of heart by using any one...
How do you counsel men with prostate cancer on the cardiovascular risks of androgen deprivation therapy?
This is a complex issue and depends on the specific setting (concurrent with XRT), the risk of the patient, and the specific CV risks of that patient. In the metastatic setting, there is almost never a contraindication to hormonal therapy given that prostate cancer is the likely cause of death in th...
What is your approach to left sided PMRT in patients with on-going cardiac issues (ie. cardiomyopathy, heart failure, coronary heart disease)?
In this circumstance, like for any medical intervention, we need to carefully weigh the risks and benefits of treatment. The likelihood of radiotherapy-induced cardiac injury appears to dependent on two variables: 1) Cardiac dose. This is variably defined - I think mean heart dose may be the best su...
For a young patient with stage 4 endometrial cancer with an excellent response to anthracyclines, would you continue to give anthracyclines beyond the standard dosage cap if cardiac function remains normal by echocardiogram?
A few things to consider in this case: What is the status of her stage IV disease/what response has she had to chemotherapy? How is she tolerating chemotherapy? If she has symptomatic disease and is contuning to respond to therapy, then it becomes a discussion of risk versus benefits (risk of cardio...
When would you consider using radiation for cardiac metastases?
I would consider it if it's likely to be effective based on histology. If it it a relatively radioresistant tumor, I would consider if there's no other viable option.
How are you using the data on cardiac morbidity in regards to the LV-V5 in breast cancer patients?
At present we use MHD as our hard constraints and limit to less than 2Gy for patients with breast only RT. Besides make sure that no part of beam passes through any portion of heart (thus limiting heart dose from scatter and transmission only) Darby data was also validated by similar study from UK w...