Cardiology
Expert discussions on heart failure, arrhythmias, interventional procedures, and cardiovascular risk management.
Recent Discussions
What is the best approach in management of device related thrombus seen immediately after watchman deployment?
Continue ASA and Eliquis for several weeks and then recheck.
Should we recommend SGLT2i initiation at discharge to all patients hospitalized with acute myocardial infarction?
The strict answer to this question, including "all patients hospitalized with acute MI" is no based on the results of the recently reported EMPACT-MI trial. In this study of more than 6000 patients empagliflozin did not significantly improve a composite endpoint of hospitalization for heart failure ...
For patients who have undergone ablation for atrial fibrillation with elevated bleeding risk, what is your risk/benefit approach when deciding to continue oral anticoagulation long-term?
I would generally determine the continuation of anticoagulation based on the patient's ChADSVASC score rather than the perceived success of ablation as many will have a burden of subclinical PAF despite ablation. So, if they are at high risk for stroke/systemic embolism, based on ChADSVASC, I would ...
What percentage of patients with non-sustained focal atrial tachycardia detected on an outpatient Holter develop paroxysmal atrial fibrillation, and how should we identify and treat patients at the highest risk of progressing to PAF?
I agree with most of the points by Dr. @Dr. First Last. I'll go through my train of thought from monitoring to what the %age is (PAT progressing to PAF) to afib management/reasons we care. Apologies for the length of response:1) The right monitoring technology should balance what you are looking for...
For patients with high-risk stress test features with ischemic EKG changes and mild to no symptoms, what would be your threshold to directly admit them for coronary angiography, or pursue outpatient elective coronary angiogram?
The key is whether there is a stable clinical history. In the absence of any symptoms suggesting a change in clinical trajectory, the evaluation should be done without a direct admission particularly in order to allow patients to plan rather than create a sense of emergency. Unprovoked symptoms that...
What are your top takeaways from AHA 2024?
My top three takeaways from the American Heart Association (AHA) 2024 Scientific Sessions: SUMMIT Trial: Tirzepatide in Heart Failure with Preserved Ejection Fraction (HFpEF) The SUMMIT trial evaluated the efficacy of tirzepatide, a GLP-1 receptor agonist, in patients with obesity and HFpEF. The st...
How long do you wait before starting a non-selective beta blocker in patients with newly reduced LVEF and recent cocaine use?
Cocaine use is a well-known cause of cardiovascular complications, including acute coronary syndromes, arrhythmias, and cardiomyopathy leading to reduced left ventricular ejection fraction (LVEF). The use of beta-blockers in this context is often debated due to concerns about unopposed alpha-adrener...
What genetic testing would you consider for recurrent arterial events (cryptogenic strokes, MI) in patients with limited risk factors?
This would be a case-by-case evaluation with additional history, examination and imaging features. I would take a multidisciplinary approach and also consult with hematology and cardiology. I am assuming all other workups are negative. I would probably repeat APLS labs in 6 weeks with lupus anticoa...
When and for whom should we consider adding bempedoic acid to the lipid lowering regimen?
Bemepedoic acid is approved in the US for use as an adjunct to statin therapy in patients with established ASCVD (secondary prevention) or those with heterozygous Familial Hypercholesterolemia who require additional LDL- cholesterol reduction. More recently it has also been approved for primary prev...
Do you recommend adding low-dose Aspirin for primary prevention in patients with Type 2 Diabetes on Eliquis for another indication?
Most guidelines and standards of care do not generally recommend aspirin therapy for primary prevention in patients with type 2 diabetes. As such, I do not generally recommend it unless their 10-year ASCVD risk is > 20% then I would have a discussion with the patient about low-dose (81 mg) aspirin t...