Cardiology
Expert discussions on heart failure, arrhythmias, interventional procedures, and cardiovascular risk management.
Recent Discussions
Which hemodynamic parameters can be used to titrate positive pressure ventilation in preload dependent settings such as RV failure, cardiac tamponade, HOCM or hemodynamically significant PE?
As this question alludes, the application of positive pressure ventilation influences cardiac hemodynamics. Key principles of these cardiopulmonary interactions are outlined nicely by Alviar and colleagues (1) in a well-done review. In contemplating this question, it is important to consider the sep...
Would you consider coronary artery calcium scoring or coronary CTA for asymptomatic elite competitive sports athletes undergoing routine screening visits, without a family history significant for coronary artery disease?
I think that would be a "bridge too far" given no family history of premature CAD if we are speaking about a young athlete. If we are speaking about an obese 65-year-old who recently retired and has decided to train for a marathon which has been his/her goal for many years, then yes, coronary calciu...
Should we have a lower threshold to consider revascularization of coronary lesions in athletes, compared to non-athletes?
Broad question, that may be best asked slightly differently; does CABG or PCI reduce cardiac events in asymptomatic athletes? My approach would be to treadmill stress (preferably MPI) and assess the arrhythmic, ischemic, symptomatic, and hemodynamic burden of disease with exercise stress. And, decid...
When would you consider implantable loop recorders for athletes with nonspecific complaints of palpitations/dizziness, without known history of arrhythmias?
I first do a maximum ECG stress test to see if any arrhythmias could be induced with max exercise. One might also consider a 30-day MCOT monitoring session. The ECG exercise test would also give us some information about the BP response during and after exercise. And, of course, I would start with m...
When is an appropriate time to consider genetic testing for cardiomyopathies for athletes as part of risk stratification for sudden cardiac death, in light of heightened prevalence of cardiac remodeling confounded by exercise and athletic conditioning?
Genetic testing for cardiomyopathies in athletes may be appropriate in the presence of structural cardiac abnormalities with known genetic basis documented by imaging or a family history of an index case of sudden cardiac death with documented genetic basis in a relative preferable first or second d...
For young adults (20-39 years of age) with moderate hypercholesterolemia, should we aim to reduce LDL-C levels by > or equal to 50% and maintain them on long-term statin therapy?
Cumulative lifetime exposure to elevated LDL levels is associated with cardiovascular events. That is, even modest elevations of LDL, if present for a long time, can contribute just as much if not more to risk than late-life, elevated LDL. In observational studies, the cumulative lifetime exposure t...
Can DOACs be a reasonable alternative (instead of VKA) for management of LV thrombus post-MI and what is a reasonable follow-up time for surveillance outpatient imaging and subsequent duration of therapy outpatient?
DOAC use is reasonable and would reecho at 6 months. Further therapy is dependent on echo results.
Should statin initiation be considered in young adult patients with autoimmune disease or chronic inflammatory conditions without an elevated ASCVD risk score given risk of underestimation of underlying CVD?
I would if the cholesterol/LDL is elevated or if there is a family history of premature CAD. Otherwise, additional risk stratification with a CT coronary calcium score would be appropriate.
Would you recommend that hematologists test for clonal hematopoiesis of indeterminate potential (CHIP) in patients with an intermediate 10-year risk of ASCVD?
Clonal hematopoiesis of indeterminate potential (CHIP) is a condition where blood cells acquire genetic mutations that give them a growth advantage without causing hematologic abnormalities sufficient to be classified as a blood cancer. It's more common with age and has been associated with an incre...
What is your approach to tapering therapy in a patient with recurrent pericarditis now well-controlled on rilonacept?
Good question, since rilonacept was only approved 1.5 years ago, a lot of this is gleaned (i.e. expert opinion) from those that participated in the Rhapsody clinical trial.In terms of actual data, the long-term follow-up from Rhapsody was just presented at AHA.2022. Of those in the extension that de...