Questions discussed in this category
Would you recommend left atrial appendage occlusion with or without continuing anticoagulation? In light of Maarse et al., JAMA Neurology 2024.
At what doses do you start? and how do you titrate therapy?
For additional context, work up with TTE and exercise stress testing have all been reassuring and normal.
Would a decrease in eGFR by more than 30% prompt you to consider decreasing or discontinuing these medications?
It seems clear that longer monitoring yields more AF detected. What is less clear to me is whether all ILR-detected AF is relevant and merits anticoag...
Are there specific scenarios in which you employ BPAP with a back up rate?
Kunadian, et al., PMID 39225274
Soloman, et al., PMID 39225278
Freixa, et al., PMID 39110427
Cholesterol Treatment Trialists' (CTT) Collaboration
How do you balance between having a higher long-term blood pressure to prevent flow failure and leading to worsening of stenosis or occlusion from the...
Hendriks, et al., PMID 38576380
Hermann, et al., SMART Trial, PMID 38587261
Such as breast plans with < 200 cGy mean heart dose
If PVC burden exceeded 10-15%, would you offer ablation in the absence of specific symptoms?
Is your pattern for drug monitoring different if digoxin is being given for afib vs HFrEF?
Would coronary disease anatomy influence your selection of which type of antiplatelet agent to continue?
Levi et al., PMID 38551563
Can sotalol initiation for atrial fibrillation be performed safely outpatient, and if so, what would be a reasonable approach to accomplishing this?&n...
How would you balance the stroke risk against the bleeding risk? And how would the AF burden play into your decision- would you treat 6 minutes of AF ...
PARAGON HF trial, PMID: 31475794
The REPRIEVE trial included participants who were between 40 and 75 years old.
Do you have a preference on type of adjunct AV nodal blocker to use, and do propafenone and flecainide have similar safety profiles?
Ferrell et al., PMID 38448791
Does your preferred dose change if this were in a non-ACS setting with elective outpatient PCI?
Would you then opt for double vector DCCV to deliver 2, 360J shocks simultaneously, and/or bolus with amiodarone?
Marcus et al., PMID 34775507
Is there a percent change in QTc in which you would consider stopping amiodarone, especially in patients who have baseline wide QRS complexes?
Butler et al., PMID 38587237
(Since there is some suggestion that stains convert vulnerable plaque to stable calcified plaque and increase calcium score)
For example, for younger patients on amiodarone or those who wish to come off antiarrhythmics because of medication side effects.
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?
And when would you consider referral for staged/complex PCI instead?
Individual times in the therapeutic range while on VKA treatment was not registered in FRAIL-AF.
Joglar et al., PMID 38033089
Besides HR variability how can we explain resolution of the intermittent LBBB with HF GDMT (especially with ARNI use)?
Marcus et al., PMID 34775507
Sabatine et al., PMID 28304224
Do you insist on ambulatory/home blood pressures to rule in/out white coat hypertension? Does your practice have a system to log patients' BPs to supp...
In the span between the HACA trial and the Targeted Temperature Management in Out-of-Hospital Cardiac Arrest study (Dankiewicz et al., PMID 34133859),...
Would the context of prior stroke/TIA impact the decision to hospitalize or pursue expedited outpatient evaluation?
Patient with negative blood cultures, completed 6 weeks of IV antibiotics and vegetation persists. CT imaging without evidence of malignancy. No evide...
Is there a specific tyrosine kinase inhibitor that you would prefer to use?
And who would you not recommend to undergo surgeries?
For radiation oncologists, how do you ameliorate the risk for radiation-related injury to epicardial coronaries during treatment sessions?
Had you seen the patient immediately after the coronary CTA results, would you have directly proceeded with cath or also ordered an noninvasive functi...
If these patients were already prescribed non-selective beta blockers outpatient, do you recommend withholding these medications in the acute phase?&n...
Is there a role in regional analyses with T1/T2 mapping, such as in the case of RV cardiomyopathies?
The patient is not pacemaker dependent.
Would you extend length of time for anticoagulation if the apex remained akinetic on surveillance TTEs?
Is the data compelling enough to merit intensifying or initiating primary prevention if the patient has CHIP?
If delayed complete revascularization is favored, would you consider staged PCI during that same admission or PCI outpatient?
Do you have a specific protocol you follow during the stress echo, and if so, what echo parameters are you using to evaluate for exercised-induced hea...
What are the real-life implications of the MONITOR-AF study to the routine management of AF?
Do you obtain serial cardiac PET scans?
In FRAIL-AF, switching VKA therapy to a NOAC was associated with higher risk of bleeding in elderly, frail patients.
Do you include the amount of IV amiodarone already administered as part of the loading dose?
How do you determine duration of therapy for Tafamidis, or is it continued indefinitely for the patient?
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...
Would you consider further imaging like coronary calcium scoring or coronary CTA to further risk stratify them?
The basis of the question is that HFrEF trials enroll patients who have Class II-IV symptoms. If their LV systolic function recovers and they become a...
Would you begin with DMARD therapy like MTX or would you consider starting with an IL-1 antagonist such as Acralyst?
In FRAIL-AF, participants were switched from VKA to dabigatran, rivaroxaban, apixaban, and edoxaban.
And how do patient characteristics affect your decisions?
Do you typically push for myocardial biopsy in this case?
In which clinical scenario(s) would you consider checking HVPG?
(ie., assessing gait speed, cognition, physical function, fall history, orthostatic vital signs, etc.)
Is there an approach to tapering the other two medications while uptitrating Droxidopa dosing to reduce the risk of supine hypertension?
Specifically, what is your approach to outpatient monitoring to assess atrial fibrillation burden for patients with CHADS2Vasc score>2?
Do you ever recommend "bridging" with low-dose aspirin?
If PPCM is suspected, what are your targeted hemodynamic goals during the delivery phase?
Recent AHA guidelines state that all women who have had a diagnosis of preeclampsia in a prior pregnancy should receive an evaluation of cardiac risk....
How would you assess response to bempedoic acid and its safety on outpatient labs, and how frequently would you have labs monitored?
How often should cardiac MRI be ordered in this context?
For the first time in my 27-year career, I was asked to consult on a patient in his early 40s with immersion pulmonary edema from scuba diving. &...
While the current guidelines favor early surgery (within 48 hrs of diagnosis) for this population based on the results of the EASE trial (link attache...
Do you favor awake intubation in these cases?
Is there literature to support superiority of levophed over dobutamine, or vice versa?
And if so, what is a reasonable length of time for outpatient cardiac monitoring?
Assuming the patient is symptomatic and/or has compression of ventricles, what field design and dose-fractionation would you use?
If so, how long are they on degarelix before the switch?
Are there any significant benefits to lowering moderately elevated lipoprotein A levels?
If so, would you prefer a P2Y12i over low-dose aspirin?
(i.e. frequency of serial BNP, troponin, cMRI)
Do you distinguish between primary and secondary prevention? Wilson et al., PMID 31130428 is helpful, but curious how people apply this data in practi...
If the pacemaker receives no dose, what dose are the leads allowed to receive and still function? Should interrogation(s) be done weekly?Does dose per...
The EVEREST Outcome trial (Konstam et al., PMID 17384437)
How do you use this information in clinical practice?
Would you bridge with enoxaparin 0.7 mg/kg/day in an ESKD patient, as described in a previous retrospective study (Pon et al., PMID: 24718051)?
If so, how frequently should we measure iron saturation/ferritin levels post-iron infusion?
E.g. in a patient with tenuous cardiac function, would starting treatment several weeks earlier potentially improve outcomes?
Would you continue ibrutinib even if they are placed on anti-platelet therapy such as clopidogrel or ticagrelor?
When do you switch to an altern...
(Assuming that the patient would require V-pacing almost all the time)
Please comment on temperature recommendations and role of exchange transfusion.
If a patient had prior breast conserving treatment and now has inflammatory breast disease, would you prophylactical send the patient to a cardiologis...
How do you approach secondary stroke prevention for patients with ischemic stroke, atrial fibrillation, and signs of cerebral amyloid angiopathy/micro...
Please comment on bridging.
How does presence of intraventricular hemorrhage change your recommendations?
Recent Japanese guidelines recommend <10MV beams, heart rhythm society and AAPM suggest up to 10MV beams are safe, recommending ≤10MV beams. Giv...
Dr. Charles-Schoeman presented data at ACR 21 showing that, paradoxically, there is a U-shaped relationship between inflammation and LDL levels in pat...
Do you feel comfortable with BTK inhibitors in these patients?
In ELEVATE-RR patients on a/c were excluded, and rate of atrial fibrillation in the ac...
For a relatively young, medically compliant patient with HFrEF (EF<35%) and h/o embolic stroke, what is the consensus of starting AC for secondary ...
For example, with a Watchman device? What is the evidence behind this?
If no anthracycline, what alternative regimen would you consider?
Is there any safety data to proceed with TKIs/TDM-1 or to proceed as standard with THP?
Does the type of cardiac involvement impact this choice?
Do you repeat the loading dose of trastuzumab?
Would you consider using radiotherapy for persistent malignant pericardial effusion? What dose-fractionation would you use, and what would your ...
Would you even consider trabectedin in this case given its cardiotoxicity?
Patient does not want chemo but is tolerating these well otherwise.
Is there an established benefit for this? For instance if your patient has cardiac calcifications on imaging but no history of cardiac disease are the...
When 5FU is a backbone to so many regimens, when (if ever) do you consider re-challenging so as not to abandon an entire line of therapy?
Can these patients be re-challenged with Herceptin?
How does it vary for patients with a history of hypertension, diabetes, CHF, and coronary artery disease?
Is there a dose constraint you are using for LV-V5?https://www.ncbi.nlm.nih.gov/pubmed/28095159?dopt=Abstract
Would you treat if the patient is asymptomatic? If you do treat with RT, what dose-fractionation would you use, and what volumes do you target?
How do you best counsel their radiation risks?
How might a recent (within 6 months) myocardial infarction affect your recommendations?
In a case-control study by Darby et al in the New England Journal of Medicine, patients treated for breast cancer with radiation were found to have an...
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