Cardiology
Expert discussions on heart failure, arrhythmias, interventional procedures, and cardiovascular risk management.
Recent Discussions
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...
How do you counsel patients who develop DVT or atrial fibrillation requiring anticoagulation when being treated with lecanemab or donanemab?
I believe until further data/studies are available, I would prefer not to use anticoagulation (at least long term) without comprehensive discussion among other treating physicians depending on the indication. The lecanemab appropriate use recommendations (Cummings et al., PMID 37357276) recommend ag...
What is your approach to a newly diagnosed LBBB in individuals >70 years old who are free of any signs or symptoms of heart disease and without other significant ASCVD risk factors besides age?
The presence of BBB; whether IVCD or RBBB or LBBB, signifies infranodal conduction delay from a myopathy. That myopathy may be hypertensive (LVH) or ischemic (LAD disease) or something less common (inflammatory etc). The ideal test would evaluate anterior septal LV thickness and vascular flow; it’s ...
In a patient with decompensated heart failure requiring urgent non-cardiac surgery, how much volume optimization do you pursue preoperatively, and at what point does the risk of further surgical delay outweigh the benefit of continued diuresis?
This is an interesting question and a challenging situation for a patient. I think that the ideal scenario would be for the patient to be euvolemic clinically prior to surgery. I am very aggressive with intravenous diuretics. I think that a discussion with the patient, with the surgeon, and with ane...
Similar to the HFA-ICOS risk stratification tool for patients on chemotherapy, are there cardiac risk calculators available for use in patients starting immunotherapy?
Currently, there are no validated risk calculators available for predicting ICI-induced cardiovascular immune-related adverse events (irAEs). Several risk factors have been reported to be associated with a higher risk of experiencing cardiac irAEs. These risk factors include a history of preexisting...
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....