Cardiology
Expert discussions on heart failure, arrhythmias, interventional procedures, and cardiovascular risk management.
Recent Discussions
Would you consider amiodarone for the treatment of atrial fibrillation with RVR in patients who cannot tolerate beta blockers but have a high CHA2DS2-VASc score and are not on anticoagulation?
We typically do not due to risk of chemical cardioversion and precipitating an embolism.
In post-AFib ablation patients with a retroperitoneal bleed requiring transfusion, when should oral anticoagulation be restarted?
There is no easy answer. Much of the decision will depend on the cause of the bleed (e.g., spontaneous versus iatrogenic), the patient's comorbidities and bleeding risk scores, the indication for oral anticoagulation (OAC), and the availability of alternatives such as left atrial appendage occlusion...
How do you explain the use of an AI scribe to patients the first time it is used in their care?
I use an AI scribe in my outpatient clinic, and around 90–95% of my patients agree to it. I obtain consent at the start of each visit and make it clear that it's completely optional—that they can say no at the start or change their mind at any point in the visit, with no impact on their care. I also...
What would be your advice to providers who are wary of QTc prolongation after starting an amiodarone load and wish to discontinue it?
Amiodarone has been studied in patients with prior TDP patients and found to be safe (small paper from Mattioni et al., PMID 2774388 at Northwestern at the time of my EP fellowship). Amiodarone has been found to be more effective when it prolongs the QT, and the 500 mS limit does not apply to it as ...
What is a reasonable minimal duration of DAPT following drug coated balloon angioplasty for ISR lesions?
A reasonable duration of dual antiplatelet therapy (DAPT) following drug-coated balloon (DCB) angioplasty for in-stent restenosis (ISR) is at least one month. A JAMA Cardiology review (2025) suggests a minimum of 30 days of DAPT. A JACC review (2022) recommends the following durations: stable corona...
Do you routinely condition the implantation of a microaxial flow pump upon echocardiographic exclusion of left ventricular thrombus?
This question highlights a disconnect in current evidence-based guidelines. There is broad consensus across multisociety guidelines and statements (Bernhardt et al., PMID 36805198; Rihal et al., PMID 25861963) that left ventricular thrombus constitutes a contraindication to implantation of a microax...
How do you approach the management of older adult patients with coronary artery disease on aspirin who have developed intermittent diverticular bleeds?
This is a tough clinical scenario that comes up often in older adults. You will often have subspecialists involved and will need to adapt your approach to their management and communication styles. Generalists can add value here by looking at the whole picture and figuring out what matters most to t...
Is there any utility in starting quinidine for non-ischemic VT storm refractory to amiodarone, lidocaine?
Unfortunately, there are no data regarding this strategy. In addition, IV quinidine is generally not available in the US. In this clinical scenario, in addition to beta-blockade, my choice might be to try mexiletine, although again, it is only available orally and there are scant data in this regard...
Is there a role for routine stress testing in intermediate-high risk CAD patients with a significantly elevated coronary calcium score who are otherwise asymptomatic?
Current data does not support stress testing in asymptomatic intermediate risk individuals in general and those with incidental CAC also do not have an indication for the test. ASCVD risk factor modification suffices.
How do you manage patients with atrial fibrillation having a thromboembolic infarct despite being on adequate anticoagulation?
This scenario is always challenging. In terms of anticoagulation, the efficacy of DOACs in preventing embolic events in AF patients is around 70%, which is impressive compared to warfarin but not foolproof. In cases of a second embolic event while on anticoagulation, two reasonable approaches are of...