Cardiology
Expert discussions on heart failure, arrhythmias, interventional procedures, and cardiovascular risk management.
Recent Discussions
When would you consider genetic screening of first-degree relatives in patients with bicuspid aortic valves?
We commonly screen first degree relatives with echo and offer the BAV patient genetic screening. If the patient was found to have a genetic mutation, we would further offer genetic family screening.
Which factors favor extended dual antiplatelet therapy beyond one year in ACS patients with low bleeding risk?
Selecting an optimal duration of dual antiplatelet therapy (DAPT) for a given patient (whether "extended" or "short" in comparison to one year) must be personalized, with a calculus that considers an individual's competing risks of bleeding and thrombosis as a function of time.Accordingly, without b...
What is a reasonable surveillance strategy in terms of preferred imaging modality and frequency of monitoring for suspected AV bioprosthetic stenosis in patients status post SAVR?
Echocardiography is the best way to monitor the valve. Obtain baseline images in the first year after implantation. If baseline function is normal and access to care is good, it is not necessary to image every year in the first 5-7 years. The exception to this would be young individuals in whom the ...
How do you explain the use of an AI scribe to patients the first time it is used in their care?
I use an AI scribe in my outpatient clinic, and around 90–95% of my patients agree to it. I obtain consent at the start of each visit and make it clear that it's completely optional—that they can say no at the start or change their mind at any point in the visit, with no impact on their care. I also...
What hemodynamic parameters or RHC numbers do you use to prompt venting the LV emergently with an Impella overnight for patients on VA-ECMO?
Put simply, the role of adjunctive mechanical left ventricular unloading in a patient supported by peripheral VA ECMO is to treat left ventricular failure refractory to medical therapy (e.g., inotropes and diuretics). There are multiple clinical, imaging, and invasive hemodynamic parameters which ca...
What is your approach to performing outpatient hemodialysis in patients with LVADs, particularly regarding blood pressure assessment and ultrafiltration management when Doppler measurements are required due to low pulsatility?
Doppler-based MAP monitoring via Doppler ultrasound with a sphygmomanometer is the primary method for blood pressure monitoring during hemodialysis in these patients with LVAD. Crit-Line monitoring during hemodialysis may potentially be useful in guiding the rate of ultrafiltration in these patients...
How does the presence of VA-ECMO influence your interpretation of RHC numbers like mixed venous sat?
VA-ECMO fundamentally changes RHC interpretation because the circulation is no longer a single closed loop. Mostconventional hemodynamic measurements no longer reflect total systemic flow or oxygen delivery and must be interpreted in the context of ECMO flow. Mixed Venous Oxygen Saturation (SvO₂) Th...
Is there any evidence to support further uptitration of dobutamine beyond 5 mcg/kg/min for patients with advanced HF and/or cardiogenic shock, or should further investigation into potential MCS be considered at that point?
When a patient with acutely decompensated heart failure and shock is exhibiting insufficient perfusion in spite of a given level of support, whether pharmacologic or mechanical, it is appropriate to pause and ask why. Options at this point could include an escalation of inotropic therapy (dose escal...
How often do you recommend performing an advanced lipid panel for monitoring of lipid lowering therapy?
I am late to the responses, but I do not ever order an advanced lipid panel. Our institution does not have it on the lab menu either (one has to go to an outside lab to get it done). Anything needed for CV risk assessment can be gleaned from the history, including family history and a standard lipid...
How are you incorporating the newer RCT data suggesting no mortality benefit to indefinite beta-blocker therapy for patients who are several years out from an MI with preserved LVEF and no angina or arrhythmia?
I have been de-prescribing after counseling once the patient is a couple of years out. This reduces symptoms, pill burden, drug interactions, etc., so I see an active benefit even if the patient seems to be tolerating medication. Obviously, they would have no other indication for BB, mainly arrhythm...