Cardiology
Expert discussions on heart failure, arrhythmias, interventional procedures, and cardiovascular risk management.
Recent Discussions
What would be a reasonable next-step approach to the evaluation of mild LV systolic dysfunction with regional wall motion abnormalities on TTE in a patient receiving carboplatin/paclitaxel for ovarian cancer without any cardiac symptoms?
Given the regional abnormalities observed, I would obtain stress testing to determine if an ischemic component may be contributing. If stress testing is negative, I would start low-dose GDMT for presumed non-ischemic cardiomyopathy.
What is the minimum duration of weeks on anticoagulation in which you would consider performing a DCCV without the need for TEE, provided the patient is an excellent historian and otherwise reliable?
If this were a board question, I agree with the guideline-listed answers here - it's 3 weeks. The most recent 2023 ACC AHA hours Atrial Fibrillation Guidelines by Joglar et al., PMID 38033089 are consistent: In patients with AF duration of ≥48 hours, a 3-week duration of uninterrupted therapeutic an...
What parameters would you use to decide whether to stop hydroxychloroquine in a patient whose lupus is well controlled but is found to have a prolonged QT interval on routine EKG?
This is an excellent question for which there is no one-size-fits-all answer. The first question is how prolonged the QT is, and if there is another drug they are on that is contributing to the prolonged QT. Obviously, it is important to avoid prescribing other medications that prolong the QT. It is...
Is there a role for aspirin 81 mg daily in patients with nonischemic dilated cardiomyopathy with reduced EF?
When there are other indications for antiplatelet therapy such as history of stroke, PVD, etc., Aspirin has a role in pharmacological therapy of patients with non-ischemic dilated cardiomyopathy and a reduced left ventricular ejection fraction. However, in the absence of coexisting indications, ther...
Do you recommend checking urine sodium 2 hours after loop diuretic administration to determine the need for dose adjustment in a patient with acute decompensated heart failure?
I know that is maybe a more physiologic way, but I can tell if it is working just by the urine output. The urine output is not going to increase following a loop diuretic without a natriuresis. And what good id an increased urine Na if the volume of urine is insufficient? If I am diuresing in decom...
Do you prefer CTA or MRA for further imaging in patients with ascending aortic dilatation detected on TTE?
The first question you need to ask yourself is whether or not any further evaluation of the aorta is needed at all. Depending on why the echo was ordered in the first place, the finding of the dilated aorta may be a serendipitous finding unrelated to the indication for the echo, and easily explainab...
What is a reasonable length of time to pass before considering TEE guided DCCV for atrial fibrillation in a patient with a suspected acute cardioembolic stroke and concerns for tachycardia-mediated cardiomyopathy?
There are many issues to consider before proceeding with DCCV. We need to make sure the patient is neurologically stable following the stroke and can be anticoagulated. We seek the opinion of a knowledgeable stroke neurologist in that regard. As soon as anticoagulation can be initiated with a DOAC t...
Would you recommend holding anticoagulation in a patient with persistent atrial fibrillation presenting with a mechanical fall and found to have a scalp hematoma in the absence of intracranial bleeding?
I would not hold anticoagulation in this situation, particularly if the patient has high vascular risk. However, there are a few caveats. First, I would seek an expert opinion about the strength of evidence that an intracranial bleed had not occurred and that it was unlikely to occur later. I would ...
In a patient with IABP set on 1:1, do you always maintain them on systemic heparin, and if so, is there a goal ACT range?
No, never been a problem.
Would it be reasonable to refer an otherwise healthy patient in their 40s for LHC after CCTA findings note significant proximal RCA stenosis, which was obtained following a transient episode of resting substernal chest pain but without subsequent reproducible symptoms with exercise?
I would favor a nuclear stress test to see if the lesion was associated with myocardial ischemia during exercise. If there was substantial evidence of ischemia, then I would proceed to LHC. If minimal or no myocardial ischemia, I would proceed with aggressive medical and lifestyle therapy.