Cardiology
Expert discussions on heart failure, arrhythmias, interventional procedures, and cardiovascular risk management.
Recent Discussions
For a platelet-transfusion-dependent elderly patient with recurrent bacteremia and a dual chamber pacemaker, and TEE with fibrin vs. possible vegetation, would you consider device removal or favoring treatment with suppressive antibiotics?
Depends on clinical situation and the patient, lead dwell time, and complexity of the extraction procedure.
Do you transcutaneously pace or cardiovert patients with DNR status who have not lost pulses?
Yes, since it would not qualify as cardiopulmonary resuscitation if they maintain a pulse.
When do you consider pacing in arrhythmogenic epilepsy?
I have seen only rare cases of it. They all had tonic-clonic seizures triggered by profound bradycardia (sinus as well as AV block). In turn, the bradyarrhythmia was triggered by EEG-documented temporal lobe absence seizures. They all resolved long-term with pacing. Regardless of the un...
What is your approach for de-escalation of antiarrhythmics for patients with a history of ventricular arrhythmias?
This is an important question. The answer depends on several factors including the type of arrhythmia being treated, the patient's underlying condition, drug intolerance and expense, and patients' expectations. Unfortunately, there is very little published information on this topic but as a general ...
How frequently and how soon after starting a patient on flecainide should they undergo exercise treadmill testing to look for QRS widening due to use-dependence?
This concept has been around, but in my training and experience is mostly theoretical. This has been looked at in a small study and found to be very rare (Vallurupalli et al., PMID 26100588).It is not located in the guidelines for AF management (it is only briefly mentioned in the 2011 guidelines).T...
Are there any indications for valve intervention in asymptomatic patients with moderate AS?
There are a few indications for this: These are Class Ila recommendations. If undergoing concomitant cardiac surgery (e.g., CABG, surgery for AA or other valves). If there is LV dysfunction (EF<50%) Rapid progression or high-risk features (e.g., high pulmonary pressure) exist.
How do you approach agitation management, especially the use of neuroleptics in hospitalized patients with a prolonged QTc?
First, I'd wonder how long the QTc actually is. Especially in tachycardic and bradycardic situations (let alone non-sinus rhythms), hand calculation (e.g. via the hodges formula) is advised since the electronic reading is often off. Also, textbook-prolonged and prolongation that would indicate conce...
What is a reasonable timeline for a left heart catheterization in a patient with newly diagnosed severe LV systolic dysfunction of unclear etiology and without an ACS presentation?
Like most problems facing cardiologists, making absolutes about any patient can be misleading. In patients with newly discovered left ventricular dysfunction, symptomatic or asymptomatic, it is important to put the entire clinical picture together to decide what would be the next diagnostic step. Pr...
For optimal GDMT for patients with HFrEF and co-existing ESRD, is there evidence to support the use of SGLT2 inhibitors and/or ARB/ARNI?
For patients with heart failure with reduced ejection fraction (HFrEF) and co-existing end-stage renal disease (ESRD), the use of sodium-glucose co-transporter-2 inhibitors SGLT2i and angiotensin receptor blocker/angiotensin receptor-neprilysin inhibitor ARB/ARNI therapies requires careful considera...
Do you routinely recommend IVIG for viral myocarditis?
I do not routinely recommend IVIG for viral myocarditis. If there is a case of immune-mediated myocarditis) - It may be recommended. In cases of severe COVID myocarditis in the past, use has been reported. However, it is not something that I routinely recommend.