Cardiology
Expert discussions on heart failure, arrhythmias, interventional procedures, and cardiovascular risk management.
Recent Discussions
What frontline treatment would you offer a patient with AITL who is not a candidate for an anthracycline due to baseline cardiomyopathy?
I would probably offer this patient CEOP. No data to back this up, however. Incorporation of etoposide in addition to CHOP confers a progression-free survival advantage in younger patients with PTCL, so it's reasonable to assume the etoposide would have activity.
Do you continue hydroxychloroquine in lupus patients who develop cardiomyopathy?
The short answer is yes, in that most lupus patients with cardiomyopathy do not have hydroxychloroquine drug induced cardiac injury. That is to say most of these patients either have ischemic cardiomyopathy or non-drug NICM. With that said, antimalarials can produce adverse effects both on the cardi...
What is the utility and recommendation for adding troponin and/or BNP to echocardiograms to screen for cardiac dysfunction In breast cancer patients receiving anthracycline based regimens?
For a healthy woman who received a total cumulative dose of 240 mg/m2 of doxorubicin, nothing more than a baseline echocardiogram is needed. JCO put out a clinical practice guideline in 2017 (Armenian et al., PMID 27918725) that covers the prevention and monitoring of cardiac dysfunction in survivor...
How do you balance short-course ADT in unfavorable intermediate risk prostate cancer patients with cardiac comorbidities?
One paper that addresses the topic was published in the Red Journal in 2016 (Rose et al., PMID 27788950). This retrospective analysis attempted to answer the question of which patients would derive disease-specific mortality benefit from the addition of ADT. Patients included in this analysis were f...
Is it safe to use statins in IIM patients if HMGCR antibodies are negative?
Absolutely, yes. Statins are a very important drug for patients with cardiovascular disease and should be given to most patients with myositis except patients with known immune-mediated statin myopathy or HMGCR Positive antibody. I would monitor CK levels before and 3 and 6 months post statin, as we...
Would you modify your initial treatment for a patient with de novo metastatic HR- HER2+ breast CA who has cardiomyopathy at baseline (EF < 35)?
Fortunately, the incidence of cardiotoxicity with the combination of a taxane, trastuzumab, and pertuzumab is very low, and thus I would be comfortable starting with this treatment (preferably with weekly paclitaxel) and monitoring her with periodic echocardiograms (every 4-6 cycles, in the absence ...
When is it necessary to monitor the QTc interval in patients on hydroxychloroquine?
The answer to this question is not straightforward mainly because there are limited data in this area. Hydroxychloroquine and Chloroquine directly affect cardiac repolarization and are associated with QT prolongation. Given this, there is an argument for getting a baseline ECG for patients initiatin...
For a patient with cardiac sarcoma, is there a minimum ejection fraction to proceed with adjuvant radiation therapy?
Adjuvant radiation therapy is often indicated for cardiac sarcoma because tumor resections are often incomplete or done with close margins. However, cardiotoxicity is a major issue, especially since patients will often receive doxorubicin-based chemotherapy, which has inherent cardiotoxicity. That b...
How does evidence of cerebral amyloid angiopathy/microbleeds affect choices for secondary stroke prevention in patients with a history of ischemic stroke and atrial fibrillation?
This is a discussion I have with the patient, mentioning that the positive predictive value of cortically based cerebral microhemorrhages is not absolute, especially when there is a small number of them and there are no other signs of small vessel disease (such as FLAIR changes or enlarged peri-vasc...
What is your approach to CLL in patients with atrial fibrillation and/or on anticoagulation?
Before the availability of venetoclax, the only approved targeted oral therapy for patients with CLL was ibrutinib. Given the lack of alternative options, patients with atrial fibrillation and/or patients on anticoagulation were treated with ibrutinib. Use of anticoagulation with ibrutinib can incre...