Cardiology
Expert discussions on heart failure, arrhythmias, interventional procedures, and cardiovascular risk management.
Recent Discussions
Is there enough evidence now to use injectable semaglutide as a foundational therapy for symptomatic heart failure with preserved ejection fraction in the setting of overweight or obesity?
While the evidence for using injectable semaglutide in the setting of heart failure with preserved ejection fraction (HFpEF) and overweight/obesity is promising, it's still considered emerging! STEP-HFpEF trial: This large, well-designed study showed that semaglutide significantly improved symptoms,...
Can bleeding risk when switching from VKA treatment to a NOAC in frail, elderly patients be accurately compared if individual times in therapeutic range while on VKA treatment are not captured?
It has been postulated that, among patients who do not have an INR within therapeutic range, about half have subtherapeutic values and half have supratherapeutic values. Therefore, the latter are at higher risk of bleeding complications. Time in therapeutic range (TTR) ranges around 60-70% in random...
In people who have had a single detected episode of atrial fibrillation, but none documented subsequently, is there any consideration for increased thrombolembolic risk just from altered atrial architecture, impaired contractility?
Clarification, impaired left atrial contractility
What are your top takeaways from ISHLT 2024?
I had the privilege of attending ISHLT 2024, and I am delighted to share insights from three standout presentations that I believe will significantly influence our field.1. Trifecta Heart Study by Dr. Philip HalloranImpact: This presentation explored innovative blood-based techniques such as cell-fr...
Do you recommend taking any unique approaches to managing patients with persistent hypertension following bilateral renal artery stenting?
Yes, I will be more aggressive with lipid management, sometimes using PCSK9-INH in addition to a statin, if the cause of the renal artery stenosis was atherosclerotic-related. Also, I typically get yearly ultrasounds to evaluate the patency of the renal artery stents. From a management perspective, ...
What is your approach to counseling a patient with stable but severe multivessel coronary disease if the patient does not wish to undergo bypass surgery?
The question assumes that a stable patient with multivessel disease would do better with bypass surgery. If the ejection fraction is less than 35% then the long-term outcome from the STITCH trial showed a reduction in mortality. There is no comparable data for angioplasty. If the patient refuses sur...
What is a reasonable way to treat statin-induced myalgia and what statin substitute would you consider using in the event the myalgia is not resolved?
Qunol co administration Vytorin - lower doses PCSK9
How do you advise patients with paroxysmal atrial fibrillation regarding their caffeine consumption, given that a randomized clinical trial found no association between caffeine intake and the triggering of AF episodes?
There is no data to support that limited caffeine consumption should not be forced upon patients for AF prevention because it does not cause AF. Then again, there are patients who are sensitive to it and they should avoid it. I think patients are told to stop it because we want to blame something fo...
Which factors would prompt empirical lead extraction in bacteremic patients without TEE evidence of lead vegetation?
My point of view is to have a very low threshold to extract a device where infection is likely. The presence or absence of lead vegetation may be a bit misleading as lead thrombi are not uncommon. I think the presence of a thrombus may make us feel more resolute in the removal plan though this may b...
What is the right approach in terms of GDMT and device consideration for patients with intermittent LBBB (QRS duration exceeding 150ms) and HFrEF?
I would not consider an intermittent left bundle as criteria for BiV pacing. I would actually not consider it in my assessment of heart failure gdmt or device therapy in isolation, whatsoever.