Cardiology
Expert discussions on heart failure, arrhythmias, interventional procedures, and cardiovascular risk management.
Recent Discussions
What are your top takeaways from AHA 2023?
SELECT trial ARIES-HM3 trial SPEC-AI trial
What is your approach to postpartum screening and cardiovascular risk assessment in patients with a prior history of preeclampsia?
Hypertensive disorders during pregnancy, including preeclampsia and gestational hypertension, elevate a woman's long-term risk of cardiovascular disease. The American College of Cardiology (ACC) and the American Heart Association (AHA) now recognize preeclampsia as a risk-enhancing factor for heart ...
What is your approach to correlating stenotic lesions on coronary angiography to magnitude of decline in LV systolic function or cardiomyopathy severity when deciding to intervene or medically manage stable ischemic heart disease as an outpatient?
I use a combination of EKG, ECHO, Stress test, and viability (nuclear or MRI) to correlate the stenotic lesion to ischemic/hibernating/infarcted myocardium. I would only intervene if there is a large amount of ischemic/hibernating myocardium in the area supplied by the stenotic artery. I also use FF...
In patients with Afib on anticoagulation and concurrent intracranial atherosclerotic disease, would you consider adding an anti-platelet to anticoagulation if there are recurrent events that could be related to the ICAD?
This is a difficult clinical situation. If the new stroke was clearly in the vascular territory related to the ICAD, I would consider adding low-dose aspirin to the anticoagulant. I would also consider using the 2.5 mg dose of apixaban as the anticoagulant to reduce the risk of major bleeding associ...
Would you recommend that a patient with stable coronary artery disease and well-controlled RA on a JAK inhibitor continue on their current therapy?
There is no simple answer for this. It is a difficult situation and I would consider a few things in making a decision about what to recommend. These include the course of the patient’s disease, e.g., duration and severity of disease, their current and previous medication history, and the severity o...
In patients with concurrent, CAD and atrial fibrillation, more than 1 year post-PCI, the most recent AHA/ACC guidelines state that “oral anticoagulation monotherapy is recommended over the continuation of oral anticoagulant therapy and a single antiplatelet therapy.” If this individual undergoes surgery, the anticoagulant will be held. Would you then bridge with aspirin?
This depends on the surgery and for how long anti-coagulation needs to be held. For example, if the patient is undergoing CABG, then the answer is yes, and aspirin seems reasonable. But for some surgeries, all 3 drugs would need to be held (ophtho or some neurosurgical/spinal procedures for example)...
Would you favor restarting anticoagulation or pursuing left atrial appendage closure in a patient with hemorrhagic stroke on anticoagulation for non-valvular atrial fibrillation?
That is a great question, thank you for bringing it up. The answer really depends on the likely etiology of the intracerebral hemorrhage. For example, if the hemorrhage is subcortical and the etiology is thought to be likely related to hypertension, it is reasonable to resume anticoagulation when sa...
Do you start anticoagulation in a patient with infective endocarditis who also has atrial fibrillation and stroke?
In the acute phase, no. You have to get CTA or MRI/MRA with contrast to evaluate for hemorrhagic risk associated with mycotic aneurysms. Even without aneurysms, there is an increased risk of hemorrhage. I normally recommend aspirin in atrial fibrillation patients while the infection is being treated...
When do you start anticoagulation in a patient with cardioembolic CVA secondary to new onset atrial fibrillation with hemorrhagic conversion?
Those are great questions and there is no right answer. My general practice is to delay anticoagulation beyond the standard 3-14 days initiation period when there is hemorrhage. I would wait longer if the hemorrhage is parenchymal as opposed to petechial but in both cases, I performed follow up scan...
When do you start anticoagulation for secondary prevention in patients with HFrEF and history of embolic strokes?
Current guidelines consider anticoagulation in patients with reduced EF as class III (no benefit and possibility of harm), which has not changed significantly since WARCEF was published. The most recent randomized large trial, COMMANDER HF, looked at primary stroke prevention (among other thrombotic...