Cardiology
Expert discussions on heart failure, arrhythmias, interventional procedures, and cardiovascular risk management.
Recent Discussions
When would you consider CT aortic valve calcium score over TEE to further delineate the severity of LFLG aortic stenosis?
If the concern is for classical low flow low gradient severe AS (LVEF < 50%, AVA < 1 cm2 by echocardiogram with peak velocity < 4 m/s or mean gradient < 40 mmHg coupled with low stroke volume index, < 35 ml/m2), would recommend dobutamine stress echocardiography to distinguish between pseudo severe ...
Do you usually recommend PFO closure for patients with frequent migraines with aura?
No, I do not. If in need of preventive treatment, also those patients should be treated with the current standard-of-care preventive medications, that is, gepants or CGRP antibodies.
Based on results from the VOYAGER PAD trial, when would you consider the primary use of rivaroxaban with aspirin +/- clopidogrel as opposed to conventional aspirin +/- clopidogrel in patients undergoing lower extremity revascularization?
Based on the results of the VOYAGER PAD trial, I would consider using rivaroxaban with ASA before undergoing revascularization.
What is the preferred imaging modality to evaluate subaortic membranes in patients with aortic valve disease?
Transesophageal echocardiography is the preferred modality for evaluating subaortic membranes, especially if transthoracic echo is equivocal.
Is monitoring for fetal heart block recommended in pregnant patients with only slightly elevated SSA?
At this time, we don't have a consensus on the titer that causes heart block and how that changes across different labs. Dr. Buyon's group did present this at ACR. So I would recommend HCQ and monitoring for this patient.
What is your approach to monitoring patients with cardiac sarcoid while tapering immunosuppression?
Monitoring of patients with cardiac sarcoidosis (CS) is critical to optimizing therapy and improving outcomes. Once a decision has been made to institute immunosuppressive therapy, it is important that the efficacy of therapy is demonstrated and that the duration of therapy is guided by the response...
Should colchicine be considered in patients with ischemic heart disease and persistently elevated hsCRP despite statin and aspirin therapy and appropriate physical activity?
When would you consider using hypertonic saline for patients with refractory acute decompensated heart failure and diuretic resistance?
In patients with acute decompensated heart failure (ADHF) and diuretic resistance, hypertonic saline combined with furosemide has shown potential in improving clinical outcomes. This combination can decrease mortality, reduce hospital stay and readmission rates, and enhance diuretic effectiveness by...
What is your preferred method for subclinical CAD screening prior to initiation of class IA antiarrhythmic drugs for atrial fibrillation?
This is a somewhat unique question in that I rarely use IA agents for atrial fibrillation. In my training and early practice, they were used but not so recently. I believe oral procainamide is not readily available, though the IV form is. Quinidine doesn't have a great efficacy adverse event ratio a...