Cardiology
Expert discussions on heart failure, arrhythmias, interventional procedures, and cardiovascular risk management.
Recent Discussions
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...
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...
How do you decide between using a self-expanding supraannular valve and a balloon-expandable valve for TAVR in patients with severe aortic stenosis and a small aortic annulus?
A supra-annular design intuitively allows for lower gradients on echo, so this endpoint was expected. But overall, the data thus far does indeed make a SEP an attractive choice as compared to a BEP, in patients with a small annulus. This is a fairly large subset of patients with AS. The risk of need...
With the recent trials such as SELECT and STEP-HFpEF demonstrating benefits of GLP1-agonists in terms of CV risk reduction and improved exercise function, have you begun to incorporate this class of medications into routine CV health maintenance for patients with HFpEF and/or pre-existing CAD?
I would strongly support the use of this medication. The biggest challenge is insurance coverage. When would it be approved by insurance and how many hoops we will need to jump before they approve it?
Does the presence and location of cerebral microbleeds affect your decision for antithrombotic treatment in patients with atrial fibrillation?
That is a great question. Agree, the data is observational and no firm conclusions can be made. My practice is to consider left atrial appendage occlusion in patients with suspected CAA. In patients with hypertensive microbleeds, both resuming anticoagulation and left atrial appendage occlusion are ...
What would be your threshold to offer coronary angiography for patients presenting with atypical chest pain features and Wellens syndrome on EKG without a troponin elevation or dynamic EKG changes?
In three words- very low threshold. Wellens syndrome typically presents with T-wave inversion in V 2, 3, but can be across the precordium. The patient may be asymptomatic at the time of presentation, but Wellen probably represents a pre-infarction state representing proximal LAD thrombus. The propos...
What are some device parameters and clinical scenarios in which recommendations should be made to deactivate the LV lead in patients with an existing CRT-D device following LVAD implantation?
In the context of LV lead deactivation in patients with existing CRT-D devices following LVAD implantation, I will outline a framework based on current knowledge and clinical rationale that should be considered in the context of recent advances and expert opinion in the field along with the recent l...
How do you decide between administering or deferring upstream P2Y12 inhibitor treatment until patient is in the lab for NSTEMI or STEMI cases with unknown coronary anatomy?
Unless you are using clopidogrel there’s no need to consider upstream use in STEMI. In NSTEMI, you can use heparin/lovenox or a P2Y12 no need for both. If you don’t know the anatomy you’re gambling to give upstream P2Y12. In ACS administration of a P2Y12 inhibitor before assessment of coronary anato...