Cardiology
Expert discussions on heart failure, arrhythmias, interventional procedures, and cardiovascular risk management.
Recent Discussions
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...
When would be the appropriate time to refer an asymptomatic young adult with unicuspid AV s/p valvuloplasty during adolescence for AVR following exercise stress TTE findings demonstrating increase in aortic valve mean gradient from 40mmHg to 70mmHg (achieving 15 METS)?
Great question and the correct answer is: ALWAYS feel free to refer a complex case like this to advanced pedi/ACHD centers. In terms of whether the patient will need or get a prompt AVR… it DEPENDS!First, we need to prove severe aortic stenosis (mean of 70 mmHg seems legit). As is often the case in ...
For which patients do you prioritize ambulatory blood pressure monitoring over self-measured blood pressure?
Self-measured blood pressure can be useful for anyone who has been diagnosed with hypertension or is found to have office blood pressures (BPs) above normal (120/80 mm Hg).1 Correctly measured home BPs inform my decision on when to start antihypertensive medications or when to adjust antihypertensiv...
Do you routinely use vasopressin in the management of RV failure leading to shock state in the absence of an obvious treatable cause such as infarction or PE?
It seems that there is a vasopressin dose-dependent effect on PA pressures. The doses we usually use for septic shock (0.03 or less) have some degree of pulmonary vasodilation (for example, Tsuneyoshi et al., PMID 11373409). Higher doses may have the opposite effect (Leather et al., PMID 12441768). ...
Would you consider a primary prevention ICD in a patient with hypertrophic cardiomyopathy and non-sustained ventricular tachycardia, in the absence of any other high risk predictors for sudden cardiac death?
Nonsustained ventricular tachycardia in hypertrophic cardiomyopathy without major risk factors (IIa primary prevention risk factors in 2020 ACC AHA HCM guidelines – max wall thickness >3 cm, FH SCD, LVEF <50%, unexplained syncope, LV apical aneurysm) remains a minor risk factor in adults (IIb consid...