Cardiology
Expert discussions on heart failure, arrhythmias, interventional procedures, and cardiovascular risk management.
Recent Discussions
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...
Do you avoid high-potency P2Y12 inhibitors in favor of clopidogrel in patients with atrial fibrillation on a DOAC who undergo PCI?
Not in all cases, favor high potency P2Y12 in high-risk coronary/complex anatomy, clopidogrel in high-risk bleeding patients.
Would you continue SAPT beyond 12 months after left main stenting in an elderly patient on DOAC for paroxysmal atrial fibrillation?
Many clinical decisions like this one require tailoring the pharmacologic regimen to the individual patient. Obviously, elderly patients on a DOAC are inherently at risk for bleeding, but the risk of a left main stent thrombosis must also be considered. Clinical trials and retrospective data help us...
How does the presence of VA-ECMO influence your interpretation of RHC numbers like mixed venous sat?
VA-ECMO fundamentally changes RHC interpretation because the circulation is no longer a single closed loop. Mostconventional hemodynamic measurements no longer reflect total systemic flow or oxygen delivery and must be interpreted in the context of ECMO flow. Mixed Venous Oxygen Saturation (SvO₂) Th...
Have you changed your approach to delaying hip surgery in the context of decompensated CHF given the findings of the HIP-ATTACK study?
That is an interesting question. Patients with a hip fracture have a high mortality, and delaying surgery could contribute to this mortality. On the other side of the pendulum is acute heart failure. Patients with acute heart failure have increased mortality in the perioperative period. Some of this...
What neurologic and hemodynamic parameters do you use to determine candidacy for emergent cath lab activation following out of hospital cardiac arrest from VT/VF in patients with NSTEMI after ROSC has been achieved?
Neurologic Futility: Immediate coronary angiography is not recommended if the patient is comatose with clinical signs of severe, irreversible brain damage or brain death. Viability Assessment: If the patient presents with refractory cardiogenic shock or ongoing ischemia, emergency catheterization is...
Will TRYNGOLZA (olezarsen), recently approved for familial chylomicronemia syndrome, also lower triglycerides due to other genetic causes of hypertriglyceridemia?
Yes, olezarsen does lower triglycerides due to other causes of hypertriglyceridemia. It is currently in trials in patients with severe hypertriglyceridemia without Familial Chylomicronemia Syndrome (FCS).
Are there instances when you recommend 48-hour ambulatory blood pressure monitoring over typical 24-hour studies for evaluation of patients with hypertensive kidney disease?
48-hour ambulatory BP monitoring can be helpful in gathering BP data for patients on hemodialysis with 3-day per week dialysis treatments. However, it is rarely done outside of research.
If a pregnant patient with a mechanical heart valve takes warfarin throughout her pregnancy, what are the chances that the fetus will be harmed?
Warfarin is effective for thromboembolic prevention in pregnant patients with mechanical valves. There is however an overwhelming evidence that warfarin taken during pregnancy is deleterious to the fetus. Its use during the first 6–12 weeks of gestation can be associated with important fetal complic...