Cardiology
Expert discussions on heart failure, arrhythmias, interventional procedures, and cardiovascular risk management.
Recent Discussions
Should we be more cautious with the use of GLP 1 R agonist therapy in patients with Type 1 diabetes mellitus and obesity given the increased risk of cardiovascular disease with high body weight variability?
There doesn't seem to be any evidence that GLP-1 RA would increase the risk of CV disease. Biologically, the benefits that have been shown in patients without Diabetes (the SELECT trial) should still be applicable for patients with Diabetes Type 1.The trials that didn't show much efficacy in glucose...
How do you advise patients on cardiotoxicity when they are expected to receive a low mean heart dose and low cardiac substructure doses with their radiation plan?
I would say something along the lines of: "Radiation therapy is an effective tool for treating your cancer. However, whenever we give radiation therapy, there is always some incidental dose delivered to the adjacent normal tissues. We cannot make the dose zero to all of the normal tissues. Thus, we ...
What is your preferred method for subclinical CAD screening prior to initiation of class IC antiarrhythmic drugs for atrial fibrillation?
Flecainide and propafenone are the IC agents in use for atrial fibrillation. Encainide and moricizine were predominantly used for ventricular arrhythmias and encainide was pulled a long time ago due to proarrhythmia concerns and I believe Ethmozine stopped being marked many years ago.The CAST trial ...
Is there a particular PVC/NSVT burden on inpatient telemetry in which you would consider discharging a patient with a LifeVest post-STEMI with newly reduced LVEF <35% while optimizing GDMT?
The PVC/NSVT burden is not part of the equation for post-STEMI LifeVest. The guidelines clearly state that if you have an EF of <35% and are within 40 days of an MI, or any revascularization within the past 90 days, the wearable defibrillator is a class IIb indication while optimizing GDMT. If the p...
What is your preferred intervention for diffuse severe ISR involving two layers of stent?
Drug coated balloons
How do you approach the use of benzodiazepines in patients with chronic medical illnesses that may be susceptible to respiratory compromise (e.g., CHF, COPD, ILD)?
It’s a very good question and answers may vary among different specialty providers. Yes, a slow or gradual weaning of the benzodiazepines would be advisable. When they reach lower doses the taper should be even slower over weeks or longer. There is a risk for not weaning them off benzodiazepines inc...
Which regimen would you recommend for a young patient with node-positive, triple-negative breast cancer with significant anthracycline-induced cardiomyopathy?
I would consider the NeoPact regimen, consisting of 6 cycles of docetaxel, carboplatin, and pembrolizumab, which is currently being directly compared to the Keynote-522 regimen in the SCARLET trial. Given some immune-related cardiac risks of pembrolizumab, I would strongly recommend that the patient...
What are standard selection criteria for patients who are eligible for heart transplantation?
Some of the selection criteria for isolated heart transplant are age </= 70 years, controlled DM (Hba1c </=7.5, BMI </=35 kg/m2 (may vary according to institution), absence of irreversible fixed pulmonary hypertension (PASP> 50 mm Hg and either TPG > 15 mm Hg or PVR > 3 WU), no illicit drug use in t...
What is your preferred mechanism for venting the left ventricle in patients on VA-ECMO?
Based on recent studies and evidence in the literature, my preferred approach for venting the left ventricle in patients on VA-ECMO would be guided by the individual patient's clinical scenario, with a cautious inclination towards using the intra-aortic balloon pump (IABP) over Impella. This prefere...
Would you recommend giving N-acetylcysteine in addition to holding diuretics in a patient with chronic kidney disease and mild hypervolemia who is planned to have a contrast study?
There are several meta-analyses showing conflicting evidence on the use of N-acetylcysteine to prevent contrast-associated AKI. However, the largest randomized trial (PRESERVE) did not show any benefit from using oral N-acetylcysteine in 4993 high-risk patients undergoing scheduled angiography (Weis...