Cardiology
Expert discussions on heart failure, arrhythmias, interventional procedures, and cardiovascular risk management.
Recent Discussions
What are your outpatient surveillance strategies (biomarkers, imaging, symptoms) to monitor response to treatment for ATTR amyloidosis with cardiac involvement?
I continue it indefinitely. Limited survival data shows a beneficial effect for at least 5 years with survival on the drug of 55% compared to 37% on placebo.Elliot et al., PMID 34923848However, if patients deteriorate dramatically on therapy and are class IV NYHA, I discuss with patients and family ...
How do you re-stratify patients with a primary prevention ICD in need of a generator change if their LVEF has improved to >40% and they have not previously required any device therapies?
This is an important question on which there remains a lack of consensus. We had tried to address this through an observational study which was published a few years back:(Appropriateness of primary prevention implantable cardioverter-defibrillators at the time of generator replacement: are indicati...
How do you manage patients blood pressures while on anti-angiogenic TKIs?
Advise patients to take BP daily, and inform us if the BP is high.
What is your approach to considering geriatric patients for complex PCI given their overall frailty and increased risk of complications such as bleeding and stroke?
I would do everything I could with respect to medical and lifestyle therapy for such a patient. They are at very high risk for a bad outcome in the cath lab.
When would you consider initiating GDMT for new onset HF in the geriatric population?
I would always treat with GDMT but would start low and slowly advance watching for AE's.
What is a reasonable blood pressure goal for refractory HTN in the geriatric population?
Resistant hypertension is defined as a blood pressure that remains above goal despite concurrent use of three antihypertensive agents of different classes taken at maximally tolerated doses, one of which should be a diuretic. Refractory hypertension is defined as uncontrolled blood pressure despite ...
How do you decide on an outpatient maintenance diuretic regimen for patients approaching discharge for ADHF?
There is a lot of complexity involved in these situations. The first thing to consider is the chronicity of the disease. If the patient has recently developed heart failure and has relatively healthy kidneys, they will likely respond well to a low dose of oral loop diuretic after decongestion. Howev...
Should we be more concerned about cardiac toxicity following breast radiotherapy?
RT-induced cardiac injury is real. Nevertheless, RT in the post-lumpectomy and post-mastectomy settings typically increases overall survival. So, in the balance, the positive effects of RT on survival outweigh the cardiac effects. Indeed, the increase in the absolute incidence of cardiac disease is ...
How do you counsel men with prostate cancer on the cardiovascular risks of androgen deprivation therapy?
This is a complex issue and depends on the specific setting (concurrent with XRT), the risk of the patient, and the specific CV risks of that patient. In the metastatic setting, there is almost never a contraindication to hormonal therapy given that prostate cancer is the likely cause of death in th...
What is your approach to left sided PMRT in patients with on-going cardiac issues (ie. cardiomyopathy, heart failure, coronary heart disease)?
In this circumstance, like for any medical intervention, we need to carefully weigh the risks and benefits of treatment. The likelihood of radiotherapy-induced cardiac injury appears to dependent on two variables: 1) Cardiac dose. This is variably defined - I think mean heart dose may be the best su...