Cardiology

Preventive Cardiology

Questions discussed in this category

How would you counsel a patient on the risk/benefit profile of preventive management such as statin initiation if they have an elevated lipoprotein (a) level, markedly elevated LDL > 200 but a CAC score of 0 without other CV risk factors?

1 Answer available

Is moderate intensity statin plus ezetimibe just as effective as high intensity statin monotherapy in preventing major cardiovascular events?

2 Answers available

Would you recommend statin initiation in a young adult patient (age < 40) with type 1 diabetes mellitus and LDL cholesterol levels greater than 100 without any cardiovascular risk factors?

1 Answer available

What is a reasonable approach to coronary calcification that is incidentally found on CT in a patient who does not have symptoms suggestive of angina?

1 Answer available

How do you approach the management of aortic stenosis in an elderly, frail patient with multiple comorbidities who is symptomatic but considered high risk for surgical aortic valve replacement?

3 Answers available

Should we recommend SGLT2i initiation at discharge to all patients hospitalized with acute myocardial infarction?

Butler et al., PMID 38587237

1 Answer available

For isolated and very high lipoprotein (a) levels (LDL of > 140, has an Lp(a) > 100) in a patient with no cardiac symptoms or risk factors, would you start lipid lowering treatment, such as with a PCSK9i if they develop statin intolerance?

If their calcium score and stress tests are normal, would you still treat?

1 Answer available

How do you decide between ordering coronary calcium scoring versus coronary CTA in asymptomatic patients with low to moderate risk for CAD?

6 Answers available

What are your top takeaways from AHA 2024?

1 Answer available

How do you counsel patients on wearable heart monitor devices when they ask about specific products and diagnostic accuracy of these devices available on the market?

2 Answers available

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?

1 Answer available

Is there a specific INR cut-off value that would prompt you to consider administering vitamin K for patients with mechanical valves requiring urgent non-cardiac surgery and if so, what would be your starting dose?

1 Answer available

With the recent trials such as SELECT and STEP-HFpEF demonstrating benefits of GLP1-agonists in terms of CV risk reduction and improved exercise function, have you begun to incorporate this class of medications into routine CV health maintenance for patients with HFpEF and/or pre-existing CAD?

2 Answers available

When would you consider long-term cardiac monitoring to look for atrial fibrillation in patients with mitral stenosis given their baseline elevated risk for atrial fibrillation and thrombosis?

1 Answer available

What is your approach to evaluating a patient with a suspected myocardial contusion?

1 Answer available

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?

2 Answers available

What are some potential etiologies to consider for isolated, mildly elevated BNP levels with normal TTE findings in an asymptomatic, elderly patient?

3 Answers available

Should low-intensity statins be favored to minimize the risk of diabetes onset while still offering cardiovascular benefit for patients with prediabetes where a statin is indicated?

Cholesterol Treatment Trialists' (CTT) Collaboration

2 Answers available

What is your preferred, first-line class of anti-anginals for MINOCA with proven epicardial coronary vasospasm?

1 Answer available

Do you favor aspirin or P2Y12 inhibitor monotherapy following completion of 12 months of DAPT post-PCI in patients with elevated bleeding risk?

5 Answers available

Would you recommend starting a moderate-intensity statin in a patient under the age of 40 years old with HIV and a 10-year ASCVD risk estimate below 5%?

The REPRIEVE trial included participants who were between 40 and 75 years old.

1 Answer available

Would you consider opting for beta blocker withdrawal to improve exercise capacity in patients with heart failure with preserved ejection fraction and chronotropic incompetence?

1 Answer available

Should CT coronary calcium score be avoided in dialysis patients in light of presumed high prevalence of CAC in this population?

3 Answers available

What are your top takeaways from ACC 2024?

3 Answers available

Is it worth getting a calcium score on a patient who is already on statin therapy?

(Since there is some suggestion that stains convert vulnerable plaque to stable calcified plaque and increase calcium score)

1 Answer available

How frequently do you obtain lipoprotein (a) levels on asymptomatic patients without a prior history of CAD?

5 Answers available

What are alternate approaches to medical therapy and/or interventions to consider in patients with refractory, severe coronary vasospasm despite short-acting nitrates, calcium channel blockers, L-arginine, and clonidine?

5 Answers available

Is a daily prophylactic dose of aspirin appropriate for patients with coronary artery calcification by Chest CT or an elevated calcium score?

If so, is there a quantitative calcium score or a reported severity of CT coronary artery calcification that would lead you to start daily aspirin?

6 Answers available

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?

And when would you consider referral for staged/complex PCI instead?

1 Answer available

If prompted as an outpatient, how do you counsel patients on the rare cardiac complications of vaccinations including myocarditis?

1 Answer available

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?

1 Answer available

What is your target or goal lipoprotein (a) level for patients on PCSK9 inhibitors for either primary or secondary prevention?

2 Answers available

When would you consider initiating patients with CAD and aortic stenosis on PCSK9 inhibitors (as an adjunct to statin therapy), given favorable findings in the FOURIER trial?

Sabatine et al., PMID 28304224

3 Answers available

When would you consider initiating GDMT for new onset HF in the geriatric population?

1 Answer available

How do you counsel patients with non-statin associated inflammatory myopathies about statin use?

1 Answer available

Should colchicine be considered in patients with ischemic heart disease and persistently elevated hsCRP despite statin and aspirin therapy and appropriate physical activity?

0 Answers available

Given that there are a fair number of myocarditis cases without a troponin elevation, how do you clinically approach the diagnosis of myocarditis?

1 Answer available

What would be your threshold to offer coronary angiography for patients presenting with atypical chest pain features and Wellens syndrome on EKG without a troponin elevation or dynamic EKG changes?

1 Answer available

What is your typical approach to the use of beta blockers in the setting of recent cocaine use amongst patients presenting with cocaine-related MI, arrhythmias, or new-onset heart failure?

If these patients were already prescribed non-selective beta blockers outpatient, do you recommend withholding these medications in the acute phase?&n...

1 Answer available

What is your preferred choice of anticoagulant (VKA vs. DOAC) in patients with an LV thrombus and apical infarct?

Would you extend length of time for anticoagulation if the apex remained akinetic on surveillance TTEs?

2 Answers available

Which class(es) of antihypertensives do you recommend for first-line therapy for hypertension in severe aortic stenosis?

1 Answer available

What are your top takeaways from AHA 2023?

4 Answers available

When would you consider initiation of low-dose aspirin for primary prevention and/or statin therapy in patients with acceptable bleeding risk and evidence of coronary artery calcification on prior CT chest imaging?

1 Answer available

What is your approach to counseling an octogenarian on the risks and benefits of LHC in the context of NSTEMI complicated by new-onset heart failure and AKI on CKD?

If LHC is deferred, would you consider loading with plavix and treating for ACS for 48 hours (assuming acceptable bleeding risk) and optimizing GDMT p...

1 Answer available

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?

Would you consider further imaging like coronary calcium scoring or coronary CTA to further risk stratify them?

1 Answer available

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 compliant with medications)?

2 Answers available

What is a reasonable surveillance strategy and length of time to maintain patients with thrombosed bioprosthetic valves on systemic anticoagulation?

1 Answer available

Do you recommend noninvasive testing or coronary angiography as the initial test for pre-kidney transplant evaluation of an asymptomatic patient older than 50 years of age with ESKD secondary to diabetic nephropathy and no known history of CAD?

1 Answer available

When would you consider initiation of bempedoic acid for statin intolerant patients (i.e. LDL threshold, comorbidities)?

How would you assess response to bempedoic acid and its safety on outpatient labs, and how frequently would you have labs monitored?

1 Answer available

When should cardiac MRI be obtained alongside standard echocardiography for outpatient monitoring of the progression of chronic aortic regurgitation?

How often should cardiac MRI be ordered in this context?

1 Answer available

Can DOACs be a reasonable alternative (instead of VKA) for management of LV thrombus post-MI and what is a reasonable follow-up time for surveillance outpatient imaging and subsequent duration of therapy outpatient?

1 Answer available

What are your diagnostic and management approaches beyond statin therapy for hyperlipidemia in young adults with significantly elevated LDL levels in isolation (i.e. reasonable calcium score, normal lipoprotein A levels)?

1 Answer available

How frequently and when should lipoprotein A levels be monitored?

Are there any significant benefits to lowering moderately elevated lipoprotein A levels?

1 Answer available

Is it sufficient to maintain patients with atrial fibrillation and established PAD on a DOAC or VKA alone, or is there an additional benefit to adding an antiplatelet agent for CVD benefit?

If so, would you prefer a P2Y12i over low-dose aspirin?

1 Answer available

When would it be reasonable to consider enhanced external counter-pulsation therapy in patients with refractory angina despite maximally tolerated anti-anginal therapy?

4 Answers available

Should statin initiation be considered in young adult patients with autoimmune disease or chronic inflammatory conditions without an elevated ASCVD risk score given risk of underestimation of underlying CVD?

2 Answers available

For young adults (20-39 years of age) with moderate hypercholesterolemia, should we aim to reduce LDL-C levels by > or equal to 50% and maintain them on long-term statin therapy?

1 Answer available

What is your preferred rate control agent for atrial fibrillation with rapid ventricular rate, and why?

1 Answer available

Would you empirically elective to anticoagulate patients with a remote (i.e. >10 year) history of paroxysmal atrial fibrillation presenting with newly diagnosed CVA, presumed cardioembolic in etiology, without any documented recurrence of AF?

3 Answers available

Papers discussed in this category

J Am Coll Cardiol, 2019 Jan 28

2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society.

Stroke, 2019-06

Perioperative/Postoperative Atrial Fibrillation and Risk of Subsequent Stroke and/or Mortality.

Journal of cardiovascular imaging, 2018 Jun 22

Antihypertensive Treatment in Severe Aortic Stenosis.

J Am Coll Cardiol, 2020 Sep 29

Time Course of LDL Cholesterol Exposure and Cardiovascular Disease Event Risk.

Clinical medicine & research, 2013-12

The role of enhanced external counter pulsation therapy in clinical practice.

N Engl J Med, 2017 Mar 17

Evolocumab and Clinical Outcomes in Patients with Cardiovascular Disease.

Lancet (London, England), 2015 Jul 15

Small bites versus large bites for closure of abdominal midline incisions (STITCH): a double-blind, multicentre, randomised controlled trial.

The New England journal of medicine, 2020 Mar 30

Initial Invasive or Conservative Strategy for Stable Coronary Disease.

Circulation. Cardiovascular quality and outcomes, 2020 Mar 10

Suboptimal Management of Cardiovascular Risk Factors Among Non-US-Citizen Immigrants: Time to Build a Healthier Immigrant Workforce in the United States.

JAMA cardiology, 2021 Feb 01

Value of Coronary Artery Calcium Scanning in Association With the Net Benefit of Aspirin in Primary Prevention of Atherosclerotic Cardiovascular Disease.

The New England journal of medicine, 2001-08-16

Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation.

Lancet (London, England), 2023 Mar 06

Inflammation and cholesterol as predictors of cardiovascular events among patients receiving statin therapy: a collaborative analysis of three randomised trials.

Circulation, 2023 Nov 13

Sudden Cardiac Death in National Collegiate Athletic Association Athletes: A 20-Year Study.

Circulation, 2023 Nov 11

Arrhythmic Risk In Biventricular Pacing Compared with Left Bundle Branch Area Pacing: Results From The International LBBAP Collaborative Study (I-CLAS).

Circulation. Cardiovascular quality and outcomes, 2023 Nov 06

Off-Label Dosing of Direct Oral Anticoagulants Among Inpatients with Atrial Fibrillation in the United States.

American heart journal, 2017 Apr 24

Rationale and design of the Apixaban for the Reduction of Thrombo-Embolism in Patients With Device-Detected Sub-Clinical Atrial Fibrillation (ARTESiA) trial.

The New England journal of medicine, 2023 Nov 11

Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes.

American heart journal, 2023 Mar 25

Screening for peripartum cardiomyopathies using artificial intelligence in Nigeria (SPEC-AI Nigeria): Clinical trial rationale and design.

JAMA, 2023 Nov 11

Aspirin and Hemocompatibility Events With a Left Ventricular Assist Device in Advanced Heart Failure: The ARIES-HM3 Randomized Clinical Trial.

The British journal of cardiology, 2022 Jul 19

Age and the power of zero CAC in cardiac risk assessment: overview of the literature and a cautionary case.

Journal of clinical lipidology, 2020 Jan 02

Coronary artery disease with normal lipids and low coronary artery calcium in two women with high lipoprotein(a).

Clinical cardiology, 2020 Feb 19

Beta-blockers withdrawal in patients with heart failure with preserved ejection fraction and chronotropic incompetence: Effect on functional capacity rationale and study design of a prospective, randomized, controlled trial (The Preserve-HR trial).

PloS one, 2023 Nov 16

Effects of beta-blocker withdrawal in patients with heart failure with preserved ejection fraction: A protocol for systematic review and meta-analysis.

Curr Rheumatol Rep, 2020 Aug 26

Lipid-lowering Therapies in Myositis.

American heart journal, 2020 Oct 13

Rationale and design of ApoA-I Event Reducing in Ischemic Syndromes II (AEGIS-II): A phase 3, multicenter, double-blind, randomized, placebo-controlled, parallel-group study to investigate the efficacy and safety of CSL112 in subjects after acute myocardial infarction.

The New England journal of medicine, 2024 Apr 07

Microaxial Flow Pump or Standard Care in Infarct-Related Cardiogenic Shock.

Circulation, 2016-12-13

Safety and Tolerability of CSL112, a Reconstituted, Infusible, Plasma-Derived Apolipoprotein A-I, After Acute Myocardial Infarction: The AEGIS-I Trial (ApoA-I Event Reducing in Ischemic Syndromes I).

American heart journal, 2022 May 17

Empagliflozin in patients post myocardial infarction rationale and design of the EMPACT-MI trial.

The New England journal of medicine, 2024 Apr 06

Semaglutide in Patients with Obesity-Related Heart Failure and Type 2 Diabetes.

The New England journal of medicine, 2024 Apr 06

Empagliflozin after Acute Myocardial Infarction.

JACC. Cardiovascular interventions, 2014-07

Futility, benefit, and transcatheter aortic valve replacement.

The New England journal of medicine, 2010 Sep 22

Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery.

JACC. Cardiovascular interventions, 2020 Feb 12

Balloon Aortic Valvuloplasty as a Bridge to Aortic Valve Replacement: A Contemporary Nationwide Perspective.

Circulation research, 2020 Jun 18

Population-Based Screening for Atrial Fibrillation.

Journal of the American College of Cardiology, 2024 Aug 29

Effect of Screening for Undiagnosed Atrial Fibrillation on Stroke Prevention.

The New England journal of medicine, 2024 Nov 16

Tirzepatide for Heart Failure with Preserved Ejection Fraction and Obesity.

JAMA, 2024 Nov 18

Oral Muvalaplin for Lowering of Lipoprotein(a): A Randomized Clinical Trial.

International journal of cardiology. Cardiovascular risk and prevention, 2024 Oct 24

Treatment optimisation for blood pressure with single-pill combinations in India (TOPSPIN) - Protocol design and baseline characteristics.

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