Cardiology
Expert discussions on heart failure, arrhythmias, interventional procedures, and cardiovascular risk management.
Recent Discussions
How frequently do you obtain lipoprotein (a) levels on asymptomatic patients without a prior history of CAD?
Recent recommendations are considering that the entire population ought to be tested at least once in their lifetime given the estimated prevalence in the general population of some degree of elevation in as many as 20% of the population. That said I certainly check in most people with a family hist...
How would you manage cardiac sarcoid with intolerance/contraindications to methotrexate, azathioprine, and mycophenolate/mycophenolic acid and that has proven refractory to adalimumab and infliximab as determined by PET?
In an article by the Yale group, Gallegos et al., PMID 33997256 give a nice summary of the literature cited options for managing cardiac sarcoidosis (Non-steroidal treatment of cardiac sarcoidosis: A systematic review.Options cited here that have not been discussed include cyclophosphamide, cyclospo...
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 ...
What are your management strategies for malignant pericardial effusion with a high risk of spontaneous hemorrhage, particularly in patients requiring anticoagulation for chronic atrial fibrillation?
We have many patients with malignant pericardial effusion who tolerate anticoagulation for DVT/PE/afib. In those patients, when AC is restarted (for example after pericardiocentesis), close monitoring with serial echo in a few days would be performed to see if effusion reaccumulates faster. Also, th...
What hemodynamic parameters or RHC numbers do you use to prompt venting the LV emergently with an Impella overnight for patients on VA-ECMO?
Put simply, the role of adjunctive mechanical left ventricular unloading in a patient supported by peripheral VA ECMO is to treat left ventricular failure refractory to medical therapy (e.g., inotropes and diuretics). There are multiple clinical, imaging, and invasive hemodynamic parameters which ca...
How would you recommend using POCUS to evaluate jugular venous pressure?
I use it in essentially the exact same way I do with visualizing the JVP; put the patient at a 30-45 degree angle, and measure how far up the neck it goes. If you are able to easily visually estimate JVP, POCUS doesn't add much. However, in someone whose venous pulse is hard to see, POCUS has been h...
Should an ischemic evaluation be pursued in cases of unexplained complete heart block or high-degree AV block?
Not necessarily. There are many factors to consider including the site of block (AV nodal versus distal conduction system), the presence of previously diagnosed coronary artery disease, and symptoms at the time of the event.
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...
Is dexrazoxane recommended for cardioprotection in AYA patients with Hodgkin lymphoma who are receiving anthracyclines as part of their upfront therapy?
This is a good question that reflects the growing body of evidence in favor of dexrazoxane cardioprotection being safe and beneficial (Chow et al., PMID 26014292; Getz et al., PMID 32343641). For AYAs with Hodgkin lymphoma, doxorubicin remains a key component of therapy even for lower stage disease ...
Are there any radiation dosimetric considerations for patients with lung cancer that have had a TAVR?
No, the new valve solves a mechanical problem. It will have some metal in it, so it would be visible whether it is a mechanical or biosynthetic type. I'd suggest not having a direct beam hit it, as that is the area of the coronary arteries' origins, and avoid dose spillage to reduce late toxicity. T...