Cardiology
Expert discussions on heart failure, arrhythmias, interventional procedures, and cardiovascular risk management.
Recent Discussions
Following cardiac MRI, what imaging modality would you consider to further evaluate mild aortic regurgitation (regurgitant fraction on cardiac MRI of 26%) and mild to moderate mitral regurgitation secondary to mild bi-leaflet mitral valve prolapse (RF 30%) with low-normal LVEF and incomplete RBBB?
Consider an exercise echo if the patient is asymptomatic and continue to follow with echo-Doppler.
Do you ever utilize lacosimide in patients with atrial fibrillation?
Yes. I would get screening ECG to look for P-R interval if there is history of conduction abnormalities such as bradycardia, fainting, cardiomyopathy etc.
What criteria do you use on echocardiogram and PFT to determine who needs further evaluation for CTD-associated pulmonary hypertension?
PFTs are often obtained in patients with systemic sclerosis to evaluate for interstitial lung disease. Low DLCO on PFTs can signify an increased probability of PH, but it is by no means specific. Echocardiograms are readily available, offer additional information about possible causes of PH (e.g. LV...
What are your criteria for deciding if a patient who had VF arrest in the setting of subacute myocarditis requires ICD or long term WCD?
This is a complex question with multiple variables. In general, if the patient had a VF arrest, then we are no longer talking about primary prevention, this would be a secondary prevention indication. For me, I would want to identify a reversible cause with reasonable expectation that the VF episode...
How long would you treat a patient with recent history of TAVR presenting with E faecalis bacteremia with unclear source with TEE showing thickened valves but no obvious vegetation?
Treatment duration depends on other additional factors.TEE showed leaflet thickening- a non-specific finding, not a feature per Duke's major imaging criteria. Another feature to consider would be an associated new-onset valvular insufficiency that might increase the likelihood of IE. In such cases, ...
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, ...