Cardiology
Expert discussions on heart failure, arrhythmias, interventional procedures, and cardiovascular risk management.
Recent Discussions
Is there utility in obtaining pericardial fluid autoimmune labs such as ANA or RF in patients with recurrent idiopathic pericardial effusions, but no other clinical or serologic evidence of rheumatic disease?
There seems not to be a consensus literature on this topic, so my answer is based on common sense rather than science. The first step is a detailed history (including family history) and physical examination looking for evidence of inflammatory joint disease with/without other findings that might fo...
When would it be reasonable to consider enhanced external counter-pulsation therapy in patients with refractory angina despite maximally tolerated anti-anginal therapy?
I would exhaust all options for coronary revascularization first.
When would you consider percutaneous mechanical aspiration of vegetation in right-sided endocarditis?
Percutaneous options for right-sided endocarditis is a growing field. We have utilized it at our institution with the AngioVac in complex ACHD (Eilers et al., PMID 36448943); others have utilized Inari (Whitbeck and Chambers, PMID 35880845 and Bisleri et al., PMID 33155779). Some have even ventured ...
How would you manage a patient with CML in chronic phase with a significant cardiac history, such as heart failure with reduced ejection fraction or arrhythmia?
The management of a patient with Chronic Myeloid Leukemia (CML) in the chronic phase who also has a significant cardiac history, such as heart failure with reduced ejection fraction (HFrEF) or arrhythmia, involves a multidisciplinary approach that includes both hematologic and cardiac care (cardio-o...
What is a reasonable atrial fibrillation percentage burden that would benefit from systemic anticoagulation for a patient with an elevated CHA₂DS₂-VASc score?
Patients with implanted devices can have an accurate measure of their AF load which has raised the question of whether ANY AF should be anticoagulated. Healey et al., PMID 22236222 is often erroneously quoted as saying that 6 minutes is all that is needed. That was their cutoff for inclusion as subc...
What are your top takeaways from ACC 2023?
My “top 3” takeaways from ACC23 are; CLEAR Outcomes trial which demonstrated that bempedoic acid reduced LDL by about 20% and improves long-term CV outcomes compared with placebo among patients with established ASCVD or high risk for it, and intolerance to statin therapy (though a minority of patien...
How do you manage anticoagulation bridging for outpatient ESKD patients given concerns for bleeding risk with enoxaparin in this population?
I don't think we know what is the best route to take. Personally I still usually give lower doses of enoxaparin but it all depends on the circumstances. Why the patient needs anticoagulation? Does the risk of hospitalization out way the risk of increased bleeding from enoxaparin? Can the patient get...
What would be the utility of calcium scoring for the evaluation of low-flow low-gradient aortic stenosis, and what cut-off values typically fall within the severe range?
Echo findings can be equivocal in as many as 40% of patients. Multiple studies have demonstrated a good correlation of calcium score and the severity of AS. A calcium score of 1300 in females and 2000 in men are defined cutoffs. In low flow low gradient AS with diminished EF a dobutamine echo should...
What structural features preclude a transcatheter edge-to-edge repair in a patient with severe symptomatic tricuspid regurgitation?
Evidence of severe calcification in the annulus or subvalvular apparatus Evidence of moderate to severe calcification in the grasping area Excessive chordae structure in the grasping area Presence of perforation in the grasping area Leaflet length < 8 mm Septolateral coaptation gap > 10 mm Severe l...
What is your approach to abbreviated DAPT in post-PCI patients (ACS and non-ACS) with high bleeding risk?
Current guidelines suggest dual antiplatelet therapy (DAPT) for a minimum of 6 months after PCI for patients undergoing PCI for stable CAD (non-ACS) and 1 year of DAPT after PCI for patients undergoing PCI for ACS. Patients at higher bleeding risk (HBR) after PCI, however, may not be able to tolerat...