Cardiology
Expert discussions on heart failure, arrhythmias, interventional procedures, and cardiovascular risk management.
Recent Discussions
What advice would you give to patients who are concerned about statin use and its controversies around brain health and dementia risk, based on previous studies?
I cannot think of any class of medications in cardiology that has undergone such scrutiny and investigation to try to find a reason not to take such an effective medication. From the earliest days of its use, one concern after another has arisen; from muscle deterioration, to increasing the risk of ...
What is a reasonable management strategy for severely symptomatic atrial fibrillation with persistent LAA thrombus in spite of compliance with several different anticoagulation agents?
Typically, with an appropriate anticoagulation regimen, it is not common to see a thrombus develop. However, there are sometimes cases, such as the scenario posed that LAA thrombus is noted despite compliance with anticoagulation. In my practice, if a thrombus develops despite compliance with a part...
Does theophylline have a role in bradyarrhythmias, and if so, in what patient population(s) can this be considered?
I do not have a lot of experience with theophylline, but since there are no other answers will take a stab.I would only consider it if something acute was happening, such as in the hospital setting with an easily reversible issue. Otherwise, a pacer (either transvenous or leadless) would be better f...
When should you suspect TR related to pacemaker lead placement as a cause of RV dysfunction rather than pulmonary HTN or other etiologies for RV failure associated with tricuspid regurgitation?
It would be patient-specific but would need to include RHC to rule out pHTN (of any group). That should point you in the right direction. I suspect this would be pretty rare and would have to have very severe TR. We know there is a magic amount of slack to put in the RV lead to minimize TR, but this...
How do you counsel patients with postural orthostatic tachycardia syndrome (POTS) regarding safe and effective exercise regimens?
It depends on where they're starting from. If they're starting from scratch, I give them two recommendations: first is the Children's Hospital of Philadelphia protocol, and if they live in town, I refer them to our PT facility at Vanderbilt (The Dayani Center) to have our PT folks help them get star...
How long do you continue aspirin and clopidogrel after and uncomplicated transfemoral carotid stent?
Typically one month, but many of our carotid patients have concomitant disease in other vascular beds and are often treated with prolonged anti-platelet therapy.
What is the most updated consensus regarding the use of pill in the pocket oral anticoagulation in paroxysmal atrial fibrillation, and populations of patients who are most likely to be considered for enrollment in clinical trials?
I'm not sure that there is a consensus. The best available large trial data would recommend anticoagulation based on a CHADS2Vasc score of 2 or higher, while a score of 0 patients could be off anticoagulation, and if the score is 1, patients would benefit from shared decision-making. For the CHADS2V...
How do you decide the duration of DAPT following TAVR, especially for patients already on a DOAC?
ASA mono Rx usually suffices after TAVR. If PCI + TAVR is performed, then triple Rx for 2-4 weeks, followed by Clopidogrel + DOAC therefore.
At what cumulative anthracycline dose is it recommended to use dexrazoxane for cardioprotection?
Typically considered in patients with anticipated >300 mg/m2 doxorubicin, as has been mentioned, which is most commonly seen in patients with sarcoma or recurrent lymphomas. Great discussion re: evidence and considerations in this piece in JACC Cardio-Oncology Upshaw et al., PMID 38773999.In practic...
Do you prefer TTE, CMR, or cardiac CT for the evaluation of PFOs?
In my experience, CMR does not have the spatial resolutions required to assess for a PFO, and cardiac CT (CCTA), while it has the spatial resolution, cannot reliably be performed with provocative maneuvers to increase RA pressure and induce right-to-left shunting as needed to visualize most PFOs. So...