Cardiology
Expert discussions on heart failure, arrhythmias, interventional procedures, and cardiovascular risk management.
Recent Discussions
When would you consider referring a patient with resistant hypertension for renal denervation?
I consider renal denervation in patients who have 2 kidneys without renal artery pathology, eGFR > 40, a negative secondary workup (including exclusion of primary aldosteronism), uncontrolled BP, and who can return for follow-up monitoring after the procedure. Some of my referrals have been in patie...
Do you recommend starting a statin in patients above 75 years old with diabetes but no known ASCVD?
The time to benefit (TTB) for statins in primary prevention of cardiovascular events is generally about 1.5 to 3 years. This means that adults aged 50 to 75 years typically need to take statins for at least 2.5 years to achieve a meaningful reduction in major adverse cardiovascular events (MACE), su...
What is your systolic blood pressure target for patients over 80 with frailty and multiple comorbidities?
The target of 150/90 mmHg for adults over 80 primarily comes from the HYVET study, which demonstrated benefit in reducing stroke and mortality in this age group. However, as with all decisions in geriatric care, treatment should be individualized and guided by the patient’s functional status and goa...
How often do you have worsening hypoxia with patients started on sotatercept?
I have not observed hypoxia with sotatercept. I have seen in a proportion of patients on IV Remodulin as they are titrated in the ICU, usually those with borderline wedge pressures and diastolic dysfunction.
What are your top takeaways for the 2026 ACC/AHA lipid guidelines?
Kudos to the writing committee for this long-awaited update! The 2026 ACC/AHA Dyslipidemia Guideline officially replaces the 2018 standards, reflecting nearly a decade of new clinical evidence.Here are the 10 biggest shifts every clinician should know: The PREVENT Era is Here: We are moving beyond t...
What are your top takeaways from ACC 2026?
From the arrhythmia perspective, and in my opinion, there were 3 studies of note at the ACC: Champion-AF that demonstrated non-inferiority for LAAO closure devices versus NOACs for stroke prevention and superiority in terms of bleeding (but not of major bleeding). Although the topline results were e...
What is the appropriate cardiac work-up and management for an otherwise healthy individual who has experienced immersion pulmonary edema while scuba diving?
Immersion pulmonary edema (IPE) is rare in the general population, but does occur in approximately 1% of triathletes and more frequently among military recruits (Kumar and Thompson, PMID 30403902). IPE is due to acute increases in pulmonary capillary wedge pressure (PCWP), which can flood the alveol...
Have you changed your approach to delaying hip surgery in the context of decompensated CHF given the findings of the HIP-ATTACK study?
That is an interesting question. Patients with a hip fracture have a high mortality, and delaying surgery could contribute to this mortality. On the other side of the pendulum is acute heart failure. Patients with acute heart failure have increased mortality in the perioperative period. Some of this...
How do you use IVC caliber and collapsibility to guide decisions about diuresis?
I use IVC caliber in conjunction with my lung exam to assist with the assessment of right and left atrial pressures respectively. The IVC assessment has many caveats in different patient populations, and evaluation with POCUS can be done in two planes to better understand IVC shape.Caveats - IVC siz...
When do you opt to administer IV iron for patients with heart failure who may also have anemia of chronic disease or at risk for iron deposition disease?
I do not hesitate to administer IV iron in a patient with heart failure (chronic inflammation) if serum ferritin levels are <30 ng/ml and TSAT is under 20%. This is the only way, besides blood transfusions, to improve Hgb levels in this patient population.