Cardiology
Expert discussions on heart failure, arrhythmias, interventional procedures, and cardiovascular risk management.
Recent Discussions
What are reasonable alternatives to invasive angiography for CAV surveillance in patients who are a few years out from cardiac transplant with impaired renal function?
In our practice, we move to PET-CT on Year 3 if the prior 2 angiograms with IVUS did not show accelerating disease. The issue with CAV is that there is not much to do about it reactively. The best you can do, is switch to an mTORi regimen early and optimize lipids. IVUS is useful for that reason. Be...
What are your top takeaways from ACC 2024?
In the field of critical care cardiology, DanGer Shock stands out as a key trial presented at ACC 2024 and simultaneously published in NEJM (Møller et al., PMID 38587239). The “splash” of DanGer Shock comes as it is the first randomized controlled trial to demonstrate a mortality benefit from a temp...
How do you decide the right time for MitraClip intervention in patients with symptomatic heart failure and severe mitral regurgitation who are on maximally tolerated GDMT?
When evaluating these patients, it is always important to consider a multidisciplinary approach inclusive of general cardiologists, imaging experts for MR quantification, and most importantly, heart failure and electrophysiology colleagues. I ensure that the patient is seen by our HF colleagues to t...
How long should patients with atrial fibrillation who are already on systemic anticoagulation and are status post TAVR and PCI 6 months ago remain on Plavix?
If PCI was done for a plaque rupture event I.e. ACS, then DOAC + plavix for a year is the current SOC. For non ACS PCI, DOAC + plavix for 6 months, followed by DOAC mono Rx is a reasonable option.
Which class(es) of antihypertensives do you recommend for first-line therapy for hypertension in severe aortic stenosis?
Most beneficial data on ACE inhibitors.B blockers are to be avoided if associated AR but prior apparent contradiction is no longer valid and some benefit in outcomes based on their effects. Exact Aortic Stenosis substrate and comorbidities to determine which drugs to benefit. ARB's role is probably ...
What would be your approach to percutaneous intervention for acute plaque rupture and cardiogenic shock for a patient with cirrhosis and severe thrombocytopenia?
Thrombocytopenia is not an absolute contraindication to indicated percutaneous coronary intervention (PCI) and the antiplatelet therapy which it obligates. In a scenario such as this one -- cardiogenic shock complicating an acute myocardial infarction -- PCI is indicated as a life-saving procedure. ...
Should there be a role for sacubitril-valsartan in the management of patients with heart failure with preserved ejection fraction?
When it comes to HFpEF, we don't have a lot of effective therapies in our armamentarium. SGLT2 inhibitors have known cardiovascular benefits and were shown primarily to reduce hospitalization in EMPEROR-Preserved and DELIVER. Arguably, spironolactone can be included here despite a trial (TOPCAT) tha...
Is there a specific INR cut-off value that would prompt you to consider administering vitamin K for patients with mechanical valves requiring urgent non-cardiac surgery and if so, what would be your starting dose?
For urgent surgery that could result in significant bleeding, I would give vitamin K if the INR was 1.6 or higher. I would avoid high doses of vitamin K so as to allow more rapid anticoagulation post-op. Usually one dose of 5mg is enough. I would start low molecular weight heparin post op until INR ...
Should we routinely include geriatric functional assessments to determine candidacy for TAVR?
Studies have shown that 40-50% of older patients with severe AS and high (≥8%) or prohibitive (≥15%) risk for perioperative mortality with surgical aortic valve replacement (based on the STS score) fail to survive with improved quality of life 1 year after undergoing TAVR. This suggests that TAVR ma...
Is there any difference between colchicine 0.5mg vs 0.6 mg for high risk coronary artery disease?
Based on my subjective practice, no significant difference (have used both formulations). Any others have any different/similar experiences?