Cardiology
Expert discussions on heart failure, arrhythmias, interventional procedures, and cardiovascular risk management.
Recent Discussions
How often and when do you consider trending NT-proBNP levels for patients with HFrEF admitted for acute decompensated heart failure?
NT-proBNP would normally be assessed upon admission for acute decompensated heart failure, and this is a Class 1 recommendation in the 2022 HF guidelines. I do not routinely re-check or trend NT-proBNP during the hospitalization until immediately prior to discharge. However, a predischarge NT-proBNP...
Do you ever initiate on degarelix and then switch to leuprolide for patients with prostate cancer and cardiac risk factors receiving ADT?
I do not believe that there is a major differential in cardiotoxicity between LHRH antagonists and agonists. The key issue is metabolic syndrome associated with long-term androgen deprivation. Randomized trials have not shown convincing evidence of a difference in cardiotoxicity between agonists and...
Are there any indications to close a PFO during pregnancy if a woman had a cryptogenic stroke in her first trimester?
In general, PFO closure is a secondary prevention procedure for PFO-associated stroke. In a pregnant patient, our usual preference would be to treat her stroke, continue ASA therapy (or therapy recommended by neurology) and ensure air filters on IVs (and all other stroke prevention) throughout any h...
What are the preferred inotropes/vasopressors agents for cardiogenic shock in situations with and without LVOT obstruction?
Randomized evidence to support an answer to this question is lacking. As the question recognizes, "cardiogenic shock" encompasses a diversity of anatomic and hemodynamic substrates of disease. Left ventricular outflow tract obstruction, which may be fixed or dynamic, a baseline feature or acutely ac...
Should consideration be taken to defer using PW to calculate aortic valve area if LVOT pulsed wave is greater than 1.7 m/s (aliasing velocity)?
Yes, I would not recommend using LVOT PW velocities when there is aliasing present. When LVOT velocities are this elevated, it is likely due to obstruction (subaortic membrane, SAM etc). The LVOT value has been inflated due to that obstruction which can lead to an overestimation of the aortic valve ...
What is a reasonable duration of time for dual anti-platelet therapy in patients who have undergone placement of a covered coronary stent?
First of all, this question hasn't been studied and second, few of us have a huge experience. Based on a series of exactly 2 patients, the possibility of thrombosis is ever present. I personally continue DAPT indefinitely in this circumstance. I am reluctant to stop it entirely; for elective procedu...
How do you manage severe hypertriglyceridemia in the adolescent & young adult population receiving chemotherapy for ALL, in the absence of complications related to hypertriglyceridemia?
Not sure what the adults do but in the pediatric/AYA population, I stop the drugs most likely to cause this - often a combination of steroids and asparaginase, consult one of our cardiologists who has a major interest in hyperlipidemia and in the asymptomatic patient, he almost always cautions again...
Should patients of advanced maternal age (>35 years of age) undergo routine cardiovascular risk stratification with echocardiogram during pregnancy?
More and more women over 40 are becoming pregnant. Unfortunately, they experience an alarming maternal mortality rate nearly seven times higher than their counterparts under 25. In the United States, cardiovascular disease is the leading contributor to mortality. These statistics underscore the nece...
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...
When would you consider initiation of bempedoic acid for statin intolerant patients (i.e. LDL threshold, comorbidities)?
Monitor bempedoic acic as you would a statin. I will usually check LDL-C response as well as LFTs within 3 months of starting.