Cardiology
Expert discussions on heart failure, arrhythmias, interventional procedures, and cardiovascular risk management.
Recent Discussions
How do you decide between manual pressure versus opting for a specific vascular closure device at the conclusion of a femoral access case?
Manual vs closure devices depend on the following: cathlab turnover- if fast turnover needed, manual pressure with sheath pull in PACU speeds up stuff, as long as the “puller” is not the provider cath’ing evidence for closure device vs manual pressure is only good for hospital LOS and early deambul...
What are your preferred methods for QTc calculation for normal, tachycardic and bradycardic heart rates?
This depends on the need for precision. If for clinical purposes, the Fredericia correction formula will suffice and is less sensitive to heart rate distortion than Bazett's. If the goal is to precisely define the QT interval in a clinical trial, such as a thorough QT study of a new chemical entity,...
Is there any benefit in maintaining statin or aspirin therapy in patients >75 years old with stable, multivessel ischemic heart disease in light of challenges encountered with polypharmacy?
This is a great geriatric cardiology question because it acknowledges that guidelines may not apply in an older patient with multiple medical problems and a complex medication regimen. The question further implies that treatment should be individualized and patient-centered. I agree with the questio...
What are your top takeaways for the 2026 ACC/AHA lipid guidelines?
Kudos to the writing committee for this long-awaited update! The 2026 ACC/AHA Dyslipidemia Guideline officially replaces the 2018 standards, reflecting nearly a decade of new clinical evidence.Here are the 10 biggest shifts every clinician should know: The PREVENT Era is Here: We are moving beyond t...
What are some tips for visual estimation of ejection fraction when trying to difference between low-normal (50-55%) and mildly reduced (45-50%)?
Differentiating between a low-normal (50–55%) and a mildly reduced (45–50%) ejection fraction (EF) is inherently difficult with visual estimation alone because the difference is subtle. When evaluating point-of-care ultrasound, it is important to consider the limitations of the device you are using....
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...
When do you perform routine defibrillation testing at the time of subcutaneous ICD implantation?
Perhaps the best way of answering this question may be broadly approaching why do we perform defibrillation threshold (DFT) testing and what factors affect an implanter's success (for both subcutaneous and transvenous ICD). To answer the first question, we hope that DFT will simulate real-life funct...
Has the CLOSURE-AF trial changed your threshold for referring a patient with atrial fibrillation for left atrial appendage closure?
The totality of data from recent clinical trials affirms that LAAO implantation should be viewed as a useful alternative strategy for patients at high risk of stroke and systemic embolism. Although closure can be used as a first-line treatment in select patients, I continue to recommend a trial of a...
For patients on immune checkpoint inhibitors presenting with chest pain, dyspnea, fatigue, and troponin elevation, would you recommend early initiation of high dose steroids for empiric treatment of ICI myocarditis while pursuing workup with coronary angiogram, echocardiogram, and/or cardiac MRI, or wait until alternative etiologies have been ruled out?
This question raises an important point that the clinical presentation of ICI-associated myocarditis often overlaps with other cardiovascular disorders, including acute coronary syndrome, chronic CAD, congestive heart failure, and other nonischemic cardiomyopathies. Therefore, prompt initiation of w...
Should all patients with a remote history of immunotherapy, chemotherapy and/or radiation therapy have a baseline TTE regardless of ASCVD risk?
The current ASCVD risk assessment calculators we have available do not contain cancer-specific parameters and thus are inadequate for accurate assessment of a cancer survivor's risk of developing CHF and ischemic heart disease. If patients have received mediastinal radiation therapy or high-dose ant...