Cardiology
Expert discussions on heart failure, arrhythmias, interventional procedures, and cardiovascular risk management.
Recent Discussions
How would you counsel patients with type 1 or type 2 diabetes mellitus and heart failure on the use of SGLT-2 inhibitors when they have a history of DKA?
Making a recommendation to prescribe this class will really require a case-by-case clinical assessment. It is clear that SGLT-2 inhibitors are very effective in preventing hospitalization for heart failure, and so we will want to suggest their use whenever possible. But it is also clear that DKA (mo...
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...
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...
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...
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...