Cardiology
Expert discussions on heart failure, arrhythmias, interventional procedures, and cardiovascular risk management.
Recent Discussions
Which anticoagulant (DOAC or Warfarin) would you recommend in the case of a 70-year-old male with persistent atrial fibrillation and history of rheumatic mitral stenosis now status post bioprosthetic MVR?
There won't be perfect data on this, per the 2023 guidelines:The distinction between “valvular” and “nonvalvular “AF remains a matter of debate. Their definitions may be confusing. Recent trials comparing vitamin K antagonists with non-vitamin K antagonist oral anticoagulants in AF were performed am...
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.
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.
Could plasmapheresis be reasonably considered in pregnant patients for primary prevention in asymptomatic familial hypercholesterolemia, and if so, is there an LDL cutoff that would prompt consideration to proceed?
Plasmapheresis/LDL apheresis is considered a safe and effective option for maternal LDL-C lowering in pregnancy, especially in women with homozygous FH, where it is considered standard of care. In heterozygous FH, the use of plasmapheresis for primary prevention is reasonable in patients with a true...
In an asymptomatic patient who has had a routine TTE for non-cardiac reasons, would you order further work-up if there are any WMA or mild LVEF reduction?
Yes, I will follow up with Echo again if he develops symptoms. Yes, I will do a stress test.