Cardiology
Expert discussions on heart failure, arrhythmias, interventional procedures, and cardiovascular risk management.
Recent Discussions
How do you approach management of recurrent idiopathic pleuropericarditis?
The first line is colchicine and NSAIDs until the pain resolves, CRP normalizes, etc… After this, if the CRP tracks with the symptoms, fluid reaccumulation, and/or cMRI evidence of the pericarditis, I find il-1 inhibitors work very well.
What is a reasonable class of antihypertensive to start in patients with HCM who remain hypertensive and symptomatic in spite of maximal doses of beta blockade or calcium channel blockers?
My answer is based on the experience and not the research data per se in HCM: I will add low-dose HCTZ (12.5 mg daily). It won't cause dehydration or hypokalemia and might do wonders in managing HTN in these patients. One of the cheapest and most effective! Or I would consider Spironolactone instea...
Does oral semaglutide provide similar cardiovascular risk reduction benefits as injectable semaglutide?
Novo Nordisk, the manufacturer of oral and injectable semaglutide, just released positive topline results in its SOUL cardiovascular outcomes trial (n=9,650) for its oral semaglutide in people with T2D and established CVD and/or CKD. The trial met the primary endpoint demonstrating a statistically s...
Would you consider using DOACs as a bridge to warfarin instead of heparin or LMWH?
I would feel very comfortable bridging with apixaban, given its relatively short half-life and fairly quick absorption. I think it is very similar to bridging with Lovenox. More importantly, it usually takes at least 24 hours until heparin IV gets to therapeutic levels - it is often too high or too ...
What is the optimal anti-platelet/anticoagulant strategy and duration following a left atrial appendage occlusion with a watchmen device and is a CTA good enough to assess if the device is well seated and without any peri device leaks?
There is no guideline based answer. Based on observation: High bleeding risk patients: half dose apixaban for 45 days, then confirmation of LAA successful closure with TEE/CTA (depending on centers preference), followed by antiplatelet monotherapy (usually ASA or clopidogrel).
What would be your threshold to recommend TEE guided DCCV in a patient who has remained in atrial fibrillation in the post-operative period following CABG, who has achieved adequate amiodarone loading dose?
If not anticoagulated for a sufficient period of time, TEE would be mandatory prior to electrical cardioversion.
Do you recommend avoiding ESAs in ESKD patients with heart failure who require a left ventricular assist device?
I have not had such a patient as of yet but my sense would be to give them ESAs. We want to keep the Hgb above a certain level and avoid blood transfusions. The most logical way to accomplish that would be an ESA.
What is your approach to maintenance of sotalol in terms of drug monitoring and duration of therapy for outpatients who remain in normal sinus rhythm?
I have a healthy respect for the proarrhythmic potential of sotalol. I routinely load and increase the dose in the hospital setting. Not too dissimilar to dofetilide. I avoid as much as possible other drugs that prolong the QT interval and I use caution with other drugs that slow the HR. I monitor E...
Do you pursue a cardiac evaluation in all patients with an excised cutaneous myxoma?
I'm a dermatopathologist, not a clinician, but would note the following data points: Many things are called myxomas. Those associated with Carney complex, in which atrial myxomas also occur, are a specific variant, superficial angiomyxomas. They usually have inactivation of protein kinase regulator...
Is ABI (Ankle Brachial index) lower limb arterial doppler not recommended if patient already has arterial stents in the legs, and if so, what other imaging modality would you consider as first-line?
ABI is still helpful in follow-up of patients with arterial stents but only gives a sense of global perfusion to the distal limb and may not be helpful in patients with calcified non-compressible vessels, (e.g. CKD, diabetics), so a better assessment is arterial duplex that can visualize the entire ...