Cardiology
Expert discussions on heart failure, arrhythmias, interventional procedures, and cardiovascular risk management.
Recent Discussions
Should presence of coronary artery calcifications on CT/CTA be considered as presence of vascular disease on CHA2DS2-VASc score?
This is a great question, not only for this aspect but also even defining as what counts as secondary prevention vs primary prevention, etc. The short answer is that it is not clarified in CHADSVASC, but at that time, they were more using the definition of "clinical CAD," so I generally do not count...
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.
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 ...
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...
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.
Do you take any special considerations when working up a pregnant patient for secondary causes of hypertension?
Pregnancy does affect the approach to secondary causes of hypertension evaluation. Because of the relatively high prevalence of pre-eclampsia (3-5% of pregnancies), hypertension occurring after the 20th week of gestation with new proteinuria often does not require additional workup. Patients could b...
How do you decide on the speed and target of blood pressure reduction for spontaneous intracranial hemorrhage?
I think the target and speed of blood pressure reduction in ICH depend on several variables, including initial SBP, clinical stability, hematoma size, and renal function. For patients presenting with SBP >220, I typically aim to lower the pressure to around SBP 160 over the first 12 hours, then grad...