Cardiology
Expert discussions on heart failure, arrhythmias, interventional procedures, and cardiovascular risk management.
Recent Discussions
Are there specific types/brands of drug-eluting stent you prefer that perform well in terms of lower ISR rates or ones that are better for patients with high bleeding risk?
That is a great question. All of the currently available drug-eluting stents are very safe, and you can now get away with just one month of dual antiplatelet therapy (DAPT) in a patient with high bleeding risk. There is more and more evidence of using clopidogrel only monotherapy instead of using DA...
When would you consider PPM implantation for intermittent episodes of high-degree AVB that persist following a successful PCI in a patient presenting with an inferior STEMI?
AV block that occurs with an inferior STEMI is not usually caused by interruption of the distal conduction system and is often reversible. The key term in the question is "persistent." How long after the MI has AV block been observed, what is the heart rate, and is the escape rhythm wide or narrow? ...
What is your approach to anticoagulation in cirrhotic patients with platelet count loss than 50 in the setting of atrial fibrillation and elevated CHADSVASC?
First of all, we have no high-quality data to address this question since patients with this profile were not well represented in the DOAC pivotal trials. Consequently, we need to individualize the decision-making, taking into account variables such as patient age and co-morbidities, vascular risk s...
How do you determine which patient may be a good candidate for the Aurora EV-ICD and its smart sense algorithm?
The Aurora Extra-Vascular ICD (EV-ICD) was approved by the FDA in October 2023. The system consists of a lead that is tunneled beneath the sternum, with the lead tip positioned around the level of the carina, and a generator that is placed in the axillary area. The lead is anchored through a small i...
What is a reasonable protocol for how long to hold warfarin and/or DOACs before cardiac catheterization?
Thanks for bringing up this question Dr. @Dr. First Last. This is one of the most common questions my nurses ask me when scheduling cardiac catheterizations and other procedures. Here is my answer based on experience and literature. As such, there is no formal study, but the risk of thromboembolism ...
What clinical features drive your decision to use prophylactic mechanical circulatory support in a patient with severe left ventricular dysfunction undergoing complex PCI following the CHIP-BCIS3 trial?
This is a great question for the interventional cardiology community. I have been very reserved in using prophylactic mechanical circulatory support in very high-risk PCI patients (particularly microaxial flow pump). It has been my observation that mechanical circulatory support is more and more wid...
What is your stepwise approach to the management of culprit STEMI lesions with very high thrombotic burden in spite of multiple runs of mechanical thrombectomy?
We would typically add a double bolus of Integrilin in such a case.
Is there a role for measuring plasma aldosterone to guide the treatment of heart failure in specific populations?
My answer would be yes. RAAS stimulation is a well-known mechanism in the pathophysiologic mechanisms that drive heart failure. This would be most relevant for HFrEF in black individuals as well as those with hypertension to exclude primary aldosteronism, since hypertension is a major risk factor fo...
What is the clinical significance of newly appreciated left atrial enlargement following atrial fibrillation ablation and approach to monitoring for atrial fibrillation recurrence post-ablation in that setting?
An enlarged left atrium is a risk factor for recurrent AF after ablation or during antiarrhythmic drug treatment. How much it increases risk is not completely understood. While LA size or volume can be used to help decide about post-treatment monitoring, the most important element is vascular risk, ...
How do you counsel patients on wearable heart monitor devices when they ask about specific products and diagnostic accuracy of these devices available on the market?
It depends on the device. If a patient is experiencing palpitations infrequently, or there is an ongoing need to identify the cause of palpitations, I typically recommend a consumer-facing ambulatory ECG device that is FDA-cleared. They are quite accurate for detecting AFib and ectopic beats such as...