Cardiology
Expert discussions on heart failure, arrhythmias, interventional procedures, and cardiovascular risk management.
Recent Discussions
How have the findings from DanGer Shock RCT changed your perspective on which patients presenting with acute MI complicated by cardiogenic shock would benefit from Impella for additional hemodynamic support?
First and foremost, it is notable that DanGer Shock (Møller et al., PMID 38587239) was the first randomized trial to show a mortality benefit with the use of a microaxial flow pump in acute MI-associated cardiogenic shock - a practice that proliferated based upon promising outcomes in non-randomized...
Do you recommend initiating treatment with an SGLT2 inhibitor or semaglutide first for a patient with obesity and heart failure with preserved ejection fraction?
Irrespective of body weight status, my first line of treatment for patients with HFpEF is with SGLT2 inhibitors if there are no contraindications (DELIVER trial and EMPEROR preserved trial). For patients with obesity (cardiometabolic) phenotype HFpEF, who qualify for GLP1 receptor agonists, I add on...
Under what circumstances would you consider withdrawing aspirin and continuing with potent P2Y12 inhibitor monotherapy after successful PCI in patients with acute coronary syndromes, based on the findings of the NEO-MINDSET trial?
The NEO-MINDSET trial suggests that aspirin may not be essential after STEMI treated with PCI in selected patients. Its findings indicate that early aspirin withdrawal, continued with potent P2Y12 inhibitor monotherapy, can be safe, particularly when bleeding risk is elevated and ischemic risk is ty...
How do you approach the management of aortic stenosis in an elderly, frail patient with multiple comorbidities who is symptomatic but considered high risk for surgical aortic valve replacement?
In an older patient with severe aortic stenosis (AS) who is not a candidate for surgery, there are 3 treatment options – TAVR, balloon aortic valvuloplasty (BAV), and medical management.In the original PARTNER trial, 358 patients with severe AS who, in the judgement of at least 2 cardiac surgeons, w...
How do you approach management of recurrent idiopathic pleuropericarditis?
The first line is colchicine and NSAIDs until the pain resolves, CRP normalizes, etc… After this, if the CRP tracks with the symptoms, fluid reaccumulation, and/or cMRI evidence of the pericarditis, I find il-1 inhibitors work very well.
Do you use particular cutoffs of troponin and BNP that you deem indicative of a hemodynamically significant/high-risk PE, or do you see any abnormal value as indicative?
Biomarkers are contributory variables in a multivariable assessment of any patient with pulmonary embolism. In light of the multiple factors that influence biomarker levels in a given patient, it is challenging to define one-size-fits-all cut points for meaning. It is also important to recognize tha...
How frequently do you obtain lipoprotein (a) levels on asymptomatic patients without a prior history of CAD?
Recent recommendations are considering that the entire population ought to be tested at least once in their lifetime given the estimated prevalence in the general population of some degree of elevation in as many as 20% of the population. That said I certainly check in most people with a family hist...
How would you approach the management of a patient who develops an accelerated junctional rhythm who exhibits no symptoms and has no prior history of cardiac issues, aside from consulting a cardiologist?
There would be many clinical factors to consider before making a decision to treat to suppress such an arrhythmia including the age of the patient, presence of associated structural heart disease, symptoms associated with the arrhythmia, its rate and putative mechanism, and its pattern and persisten...
What is the optimal BP target for patients with diabetes and hypertension to reduce their risk of MI/stroke?
From the 2025 ADA Standards of Care, section 10 discusses Cardiovascular Disease and Risk Management. With proper blood pressure technique, the recommended blood pressure treatment goal is less than 130/80 mmHg if this can be achieved safely. Several randomized controlled trials are referenced with ...
Do you counsel patients to take antihypertensives at specific times of day to maximize efficacy or minimize side effects?
Generally, I emphasize medication adherence over the time of day. As long as it is a once-a-day medication and they are not having other side effects, I tell them that the best time to take their medication is the time that they will always remember.