Cardiology
Expert discussions on heart failure, arrhythmias, interventional procedures, and cardiovascular risk management.
Recent Discussions
Do you prefer TTE, CMR, or cardiac CT for the evaluation of PFOs?
In my experience, CMR does not have the spatial resolutions required to assess for a PFO, and cardiac CT (CCTA), while it has the spatial resolution, cannot reliably be performed with provocative maneuvers to increase RA pressure and induce right-to-left shunting as needed to visualize most PFOs. So...
Do you always give 325 mg aspirin if not already loaded with antiplatelets prior to the start of every LHC, even just for diagnostics in the absence of ACS?
Yes. I favor loading almost all patients prior to a LHC even if only diagnostic. That includes those on a DOAC as well. The reason I favor this is in case there was a complication and need for PCI that the patient at least has one anti-platelet in their system.
Do you prescribe hydroxychloroquine to patients who are on other medications that can prolong the QT interval?
First, I'll remind everyone that before COVID-19, case reports of QT-prolongation-associated arrhythmias were rare. It wasn't until COVID that we all at once saw cases with the caveats that these were in patients treated with higher doses of HCQ, commonly loading doses of 800 mg daily, plus COVID-1...
For SVG graft stenting, do you consider routinely embolic protection devices (EPD), and do you factor lesion location (prox vs distal) for decision making?
I would prefer to use an embolic protection device, provided it can be easily deployed and the lesion is suitable for it. Avoid, if the lesion is a very distal graft or attachment site. In most cases, I prefer to do direct stenting of the SVG graft to avoid any embolization even with a protection de...
Should low-intensity statins be favored to minimize the risk of diabetes onset while still offering cardiovascular benefit for patients with prediabetes where a statin is indicated?
While higher-intensity statins are associated with a slightly higher incidence of diabetes, it would not be recommended to start with low-intensity statins as there are no data to support this. Essentially, all of the CV outcomes trials with statins have been with moderate and high-intensity statins...
How do you determine which atrial fibrillation patients with a high thromboembolic risk and a contraindication for oral anticoagulation should undergo left atrial appendage occlusion?
If the contraindication is absolute, all high risk patients need to be informed about the availability of LAAO devices. If the patient cannot take an anticoagulant or antiplatelet for a short period after implant, an epicardial approach could be considered.
How will you decide between using paclitaxel-coated balloons versus conventional uncoated balloons for managing in-stent restenosis?
Recent data (AGENT IDE trial) have suggested that target vessel failure rates are significantly lower in paclitaxel-coated balloons versus conventional balloon angioplasties when used to treat in-stent restenosis (ISR). The drug-coated balloon for managing in-stent restenosis is a major step forward...
For patients over 70 with elevated ASCVD risk but no prior cardiovascular events, do you ever recommend continuing or initiating low-dose aspirin?
Yes, I might still recommend low-dose ASA for primary prevention for someone over 70 if the patient is very functional.
How do you weigh the benefit of urinary catheter placement for strict I/O measurement with the risk of avoidable CAUTI?
Our hospital's approach, which is consistent with CDC guidance, limits urinary catheters (UC) for I/O measurement to critically ill patients. We clarify that the information from the UC should be used at least q1-2 hours, otherwise it can be obtained in other ways (noninvasive collection, bladder sc...
What is your approach during DCCV if you have an obese patient with atrial fibrillation refractory to up to 3, 360 J shocks?
To some degree it depends on what happened with the first three shocks, (I would have applied pressure to shorten the AP diameter for the second and/or third). If the patient converted but it didn't stick, I would consider AAD loading followed by a repeat procedure. If the patient did not appear to...