Cardiology
Expert discussions on heart failure, arrhythmias, interventional procedures, and cardiovascular risk management.
Recent Discussions
Are there instances where TAVR should be considered for patients with moderate AS and HFrEF?
Perhaps this is better asked provocatively; did AS (with less than severely elevated gradients) result in a decline in LVEF, or did moderate AS cause HFrEF? In the absence of an alternate cause of LV dysfunction, AS may be the only causative elephant in the room. Other subtle markers of AS severity,...
What is your preferred beta blocker for management of arrhythmias and/or HTN during pregnancy?
Per ACOG guidelines, labetalol is the main beta-blocker for the treatment of hypertension and other cardiovascular indications in pregnancy.
What is your preferred imaging modality--cMR vs. TTE--to evaluate for myocardial strain if concerned for chemotherapy-induced cardiomyopathies?
Per American guidelines, TTE with strain would be indicated at baseline and then every 3-6 months while on chemotherapy. No cMR per American guidelines for routine screening/follow-up to the best of my knowledge.
How do you approach long-term blood pressure parameters in ischemic stroke patients with severe symptomatic intracranial stenosis?
Every patient is unique and I just try to be as low and slow as possible. 4-6 weeks seems to be where most people do well with others tolerating more (I'm able to get them to under 140 or even 120 during their hospitalization over a few days). In the acute setting, I've found it helpful to make sure...
What would be a reasonable threshold to recommend epicardial CRT-D intra-op in a patient post-ACS with LVEF< 35%, QRS duration > 120, and breakthrough VT undergoing emergent CABG?
In answering this question, one should keep in mind that CRT-D provides 2 primary benefits: resynchronization therapy to treat systolic heart failure in appropriate patients and defibrillation in patients at risk for malignant arrhythmia. We NEVER implant a defibrillator in a patient having active V...
What is your surveillance approach for outpatient monitoring of ICI myocarditis?
At Memorial Sloan Kettering, we do not use surveillance approach for standard ICI therapy. Troponins may be drawn as part of protocols/clinical trials. We do advocate for baseline troponin, especially if high sensitivity troponin is the assay being used. This helps when patients come in with symptom...
What are some potential etiologies to consider for isolated, mildly elevated BNP levels with normal TTE findings in an asymptomatic, elderly patient?
BNP and pro-BNP both increase with age, especially in women, and must therefore be interpreted in that context. Pro-BNP less than 300 pg/mL indicates low likelihood for acute heart failure at all ages (though there are exceptions). The recommended age-based thresholds for diagnosing heart failure/vo...
What are your top takeaways from ACC 2025?
PAD – Great data highlighting the unmet need and disability in this population and data from STRIDE showing we can improve function, symptoms, and quality of life. WARRIOR – We need better ways to understand and treat INOCA and provide care for women. Lipids – New data on an oral PCSK9i! More ways ...
For pregnant patients in their first trimester presenting with acute MI with plan for emergent angiogram, who then subsequently have resolution of chest pain and EKG changes following initiation of heparin gtt, DAPT, would you still consider proceeding with LHC or treat medically with presumptive diagnosis of SCAD?
Great question and a highly debatable topic. I would consider a coronary angiogram to define the coronary anatomy as there are many differentials for pregnancy-associated acute myocardial infarction with ST elevation and treatment can differ accordingly. A conservative approach is acceptable for a l...
What has been your approach to minimizing the risk of vascular complications when placing Impella support devices?
I am assuming that you're question is specific for Impella CP (as Impella 5.5 is typically implanted surgically via a subclavian artery graft). As with obtaining any form of large vessel arterial access, minimizing complications will be based on a combination of patient/vessel selection and techniqu...