Cardiology
Expert discussions on heart failure, arrhythmias, interventional procedures, and cardiovascular risk management.
Recent Discussions
How do you approach caring for patients admitted with decompensated CHF, but who also exhibit hypotension and do not have overt signs of hypervolemia on exam?
This is a case where you might be concerned about the patient sliding into cardiogenic shock. Remember that in the context of chronic heart failure, cardiogenic shock tends to present more insidiously because these patients are typically compensated at low or borderline low cardiac output (Abraham e...
What parameters would you use to decide whether to stop hydroxychloroquine in a patient whose lupus is well controlled but is found to have a prolonged QT interval on routine EKG?
This is an excellent question for which there is no one-size-fits-all answer. The first question is how prolonged the QT is, and if there is another drug they are on that is contributing to the prolonged QT. Obviously, it is important to avoid prescribing other medications that prolong the QT. It is...
How often do you recommend performing an advanced lipid panel for monitoring of lipid lowering therapy?
I am late to the responses, but I do not ever order an advanced lipid panel. Our institution does not have it on the lab menu either (one has to go to an outside lab to get it done). Anything needed for CV risk assessment can be gleaned from the history, including family history and a standard lipid...
Is there a role for aspirin 81 mg daily in patients with nonischemic dilated cardiomyopathy with reduced EF?
When there are other indications for antiplatelet therapy such as history of stroke, PVD, etc., Aspirin has a role in pharmacological therapy of patients with non-ischemic dilated cardiomyopathy and a reduced left ventricular ejection fraction. However, in the absence of coexisting indications, ther...
What is the frequency in which patients should be taking pill in the pocket medication for paroxysmal atrial fibrillation before you begin to consider maintenance dosing medications instead?
This is very patient-specific; they need to have a good understanding of the process and good access to an EKG (even if it is a consumer device like Kardia). I find many patients either do not understand fully or respect the potential dangers of these medications. For example, they will take multipl...
How do you think about using contraction alkalosis as a mark of achieving goal diuresis?
Thank you for your insightful question. Residual congestion at discharge for patients treated for decompensated heart failure is associated with increased rates of readmission and mortality. While I do occasionally use the development of metabolic alkalosis as a marker of decongestion, a review of t...
Do you recommend checking urine sodium 2 hours after loop diuretic administration to determine the need for dose adjustment in a patient with acute decompensated heart failure?
I know that is maybe a more physiologic way, but I can tell if it is working just by the urine output. The urine output is not going to increase following a loop diuretic without a natriuresis. And what good id an increased urine Na if the volume of urine is insufficient? If I am diuresing in decom...
Would you consider a secondary prevention ICD in a patient who had a cardiac arrest deemed attributable to a spontaneous coronary artery dissection (SCAD), with no intervention performed?
In patients who experience a cardiac arrest attributed to spontaneous coronary artery dissection (SCAD), the decision to pursue secondary prevention ICD implantation requires careful consideration of the reversibility of the underlying cause and the presence of any residual arrhythmogenic substrate....
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?
In an older patient with severe aortic stenosis (AS) who is not a candidate for surgery, there are 3 treatment options – TAVR, balloon aortic valvuloplasty (BAV), and medical management.In the original PARTNER trial, 358 patients with severe AS who, in the judgement of at least 2 cardiac surgeons, w...
What is a reasonable protocol for how long to hold warfarin and/or DOACs before cardiac catheterization?
Thanks for bringing up this question Dr. @Dr. First Last. This is one of the most common questions my nurses ask me when scheduling cardiac catheterizations and other procedures. Here is my answer based on experience and literature. As such, there is no formal study, but the risk of thromboembolism ...