General Internal Medicine
Questions discussed in this category
How would you adjust statin therapy in these patients?
Butt et al., PMID 39818225
The basis of the question is that HFrEF trials enroll patients who have Class II-IV symptoms. If their LV systolic function recovers and they become a...
Is there any utility in ACE levels and/or IL-2 levels in the diagnostic work-up of cardiac sarcoidosis?
For example, would you consider this method in an ESRD/HD patient with antiphospholipid syndrome who had a major bleed requiring reversal of warfarin ...
Is your pattern for drug monitoring different if digoxin is being given for afib vs HFrEF?
Should we then investigate for alternative syncopal etiologies before considering therapy (i.e. ICD implant)?
For additional context, work up with TTE and exercise stress testing have all been reassuring and normal.
To further elaborate, what level of obstruction with a normal stress test would be acceptable, and what would be too high risk? Would you consider an ...
In light of a publication by Sakusic et al., PMID 39102615 suggests an increased risk of ICH expansion in patients with heparin bridge compared to sta...
Assume the patient does not have another indication for AC like VTE or AFib. Could this be suggestive of a hypercoagulable state?
European trials used 0.5mg dosing, whereas we have 0.6mg widely available in the US (but significantly less expensive than the 0.5mg dosing).
Especially if cMRI is not possible in the presence of non-MRI conditional devices and abandoned leads.
Or should they be continued on maximally tolerated GDMT?
Pre-treatment troponin was mildly elevated, while ILR2 receptor, ACE, CRP, ESR were normal.
If so, what diastolic parameters do you look at?
It seems clear that longer monitoring yields more AF detected. What is less clear to me is whether all ILR-detected AF is relevant and merits anticoag...
Would you recommend left atrial appendage occlusion with or without continuing anticoagulation? In light of Maarse et al., JAMA Neurology 2024.
Would a decrease in eGFR by more than 30% prompt you to consider decreasing or discontinuing these medications?
Are there specific scenarios in which you employ BPAP with a back up rate?
Soloman, et al., PMID 39225278
Freixa, et al., PMID 39110427
How do you balance between having a higher long-term blood pressure to prevent flow failure and leading to worsening of stenosis or occlusion from the...
If PVC burden exceeded 10-15%, would you offer ablation in the absence of specific symptoms?
How would you balance the stroke risk against the bleeding risk? And how would the AF burden play into your decision- would you treat 6 minutes of AF ...
PARAGON HF trial, PMID: 31475794
Marcus et al., PMID 34775507
For example, for younger patients on amiodarone or those who wish to come off antiarrhythmics because of medication side effects.
And when would you consider referral for staged/complex PCI instead?
Joglar et al., PMID 38033089
Besides HR variability how can we explain resolution of the intermittent LBBB with HF GDMT (especially with ARNI use)?
Patient with negative blood cultures, completed 6 weeks of IV antibiotics and vegetation persists. CT imaging without evidence of malignancy. No evide...
And who would you not recommend to undergo surgeries?
Had you seen the patient immediately after the coronary CTA results, would you have directly proceeded with cath or also ordered an noninvasive functi...
Would you extend length of time for anticoagulation if the apex remained akinetic on surveillance TTEs?
Do you have a specific protocol you follow during the stress echo, and if so, what echo parameters are you using to evaluate for exercised-induced hea...
What are the real-life implications of the MONITOR-AF study to the routine management of AF?
Do you obtain serial cardiac PET scans?
Would you begin with DMARD therapy like MTX or would you consider starting with an IL-1 antagonist such as Acralyst?
And how do patient characteristics affect your decisions?
Do you typically push for myocardial biopsy in this case?
In which clinical scenario(s) would you consider checking HVPG?
(ie., assessing gait speed, cognition, physical function, fall history, orthostatic vital signs, etc.)
Do you ever recommend "bridging" with low-dose aspirin?
If so, would you prefer a P2Y12i over low-dose aspirin?
Do you distinguish between primary and secondary prevention? Wilson et al., PMID 31130428 is helpful, but curious how people apply this data in practi...
How do you approach secondary stroke prevention for patients with ischemic stroke, atrial fibrillation, and signs of cerebral amyloid angiopathy/micro...
Please comment on bridging.
How does presence of intraventricular hemorrhage change your recommendations?
For example, with a Watchman device? What is the evidence behind this?
Is there an established benefit for this? For instance if your patient has cardiac calcifications on imaging but no history of cardiac disease are the...
In a case-control study by Darby et al in the New England Journal of Medicine, patients treated for breast cancer with radiation were found to have an...
17887224892114922233231992314423217183612291122673224951893717875224941838320549222502257322076212102131922459213062090922505216501796719814223442228422216223421949813785222321923618814221612057722074214152202321965218432190419125181481083819634207252142917066193052125520130208742099221019209402076020386181491726420761202492069618941205321981719963192621941220017199761965016964196821959918991171281934419534194461930117517194991574218018180021868418861187131874718709185181859317883138021829318013179751784117664173231547413789173151826316562180501726115878177121730617679153301379017469163441705416576152351583515978163141682316699162911605713803133501659613808152381640413108138211377015477161851620711520137801376513822154371382513762137731244913801138241377214469124771007611556105451050110284953173274687317
Papers discussed in this category
The New England journal of medicine, 2013-03-14
Int J Clin Pract, 2021 Mar 24
Mod Rheumatol, 2021 Feb 09
Heart Rhythm, 2020 Jun 28
J Am Coll Cardiol,
Eur Heart J, 2015 Aug 29
Eur Respir J, 2019 Jan 24
American heart journal, 2010-07
Lancet, 2021 Aug 27
The New England journal of medicine, 2013-03-21
Neurology, 2013-08-13
The New England journal of medicine, 2017-09-14
Circ Cardiovasc Interv, 2022 Jun 23
JAMA, 2021 Dec 14
JAMA Neurol, 2020 Jul 01
JAMA Neurol, 2022 Nov 01
Circulation, 2012-09-25
BMJ, 2021 Jun 09
JAMA neurology, 2019-04-01
Lancet Neurol, 2019 May 23
JAMA Neurol,
Lancet Neurol, 2018 Jan 10
Journal of oncology practice, 2017-04
J Am Coll Cardiol, 2019 Jan 28
Stroke, 2019-06
Circulation, 2016-11-22
JAMA, 2022 Apr 26
Journal of the American College of Cardiology, 2023 Nov 21
The New England journal of medicine, 2023 Aug 26
JACC. Cardiovascular interventions, 2014-07
Journal of cardiovascular imaging, 2018 Jun 22
N Engl J Med, 2020 Nov 16
Circulation, 2020 Dec 17
Herz, 2014 Dec
Eur Heart J, 2022 Nov 01
JACC CardioOncol, 2022 Dec 20
Circulation, 2021 Oct 28
JAMA, 2020 Dec 15
J Am Coll Cardiol, 2020 Jun 09
Clinical medicine & research, 2013-12
Journal of the American College of Cardiology, 2013-07-23
N Engl J Med, 2018 Feb 01
Cardiovasc Drugs Ther, 2021 Sep 07
Circulation. Arrhythmia and electrophysiology, 2014-04
Circulation. Arrhythmia and electrophysiology, 2015-12
Heart Rhythm, 2020 Jun 01
J Geriatr Cardiol, 2017 Oct
Journal of the American College of Cardiology, 2014-09-09
J Am Coll Cardiol, 2014 Apr 09
J Am Heart Assoc, 2019 Oct 02
Circulation, 2022 Nov 07
Blood advances, 2018-05-22
JACC CardioOncol, 2020 Mar 17
Mayo Clin Proc, 2010 Aug 16
ESC Heart Fail, 2021 Dec 08
J Thorac Cardiovasc Surg, 2021 May 08
JACC CardioOncol, 2021 Sep 21
JAMA Cardiol,
Eur Heart J Cardiovasc Pharmacother, 2022 Sep 29
Eur Heart J Cardiovasc Pharmacother, 2021 Sep 21
ESC Heart Fail, 2020 Jun 25
The New England journal of medicine, 2018-02-15
Journal of cardiac failure, 2023 Jun 22
Lancet (London, England), 2015 Jul 15
The New England journal of medicine, 2020 Mar 30
The New England journal of medicine, 2015 Sep 17
The New England journal of medicine, 2020 Sep 24
Heart rhythm, 2020 Jul 25
JACC. Clinical electrophysiology, 2022 Apr 28
The New England journal of medicine, 2011-09-15
The New England journal of medicine, 2011 Aug 10
The New England journal of medicine, 2009 Aug 30
Circulation, 2011 Jul 25
Circulation, 2015 Sep 15
The Annals of thoracic surgery, 2017 Feb 04
European heart journal, 2023 Oct 14
Sarcoidosis, vasculitis, and diffuse lung diseases : official journal of WASOG, 2014-04-18
Heart rhythm, 2014-07
Circulation journal : official journal of the Japanese Circulation Society, 2019 Oct 09
Circulation. Cardiovascular imaging, 2018-03
N Engl J Med, 2005 Mar 31
Circulation, 2020 May 21
The New England journal of medicine, 2020 Mar 28
Lupus, 2018 Oct 05
The New England journal of medicine, 2001-11-15
International journal of cardiology, 2023 Aug 01
Arrhythmia & electrophysiology review, 2020 Dec
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions, 2020 Sep 09
Circulation research, 2019 Feb
Journal of the American College of Cardiology, 2020 Aug 11
Lancet (London, England), 2018 Nov 11
British journal of haematology, 2024 Sep 02
Circulation, 2016-09-06
Circulation, 2023 Mar 16
Journal of the American College of Cardiology, 2022 May 03
Circulation, 2020 Apr 27
Indian pacing and electrophysiology journal, 2019 Feb 26
Heart rhythm O2, 2021 Feb 26
Heart rhythm O2, 2021 Feb 26
Clinical cardiology, 2020 Feb 19
PloS one, 2023 Nov 16
European heart journal, 2017-05-01
Heart rhythm, 2019-01
Pacing and clinical electrophysiology : PACE, 2019-07
The New England journal of medicine, 2023 Aug 25
Heart rhythm, 2015 Apr 11
Circulation, 2023 Nov 30
The New England journal of medicine, 2023 Nov 12
Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 2012 Mar
The New England journal of medicine, 1991-03-21
Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing, 2022 Apr 02
Journal of clinical medicine, 2021 Apr 02
The European respiratory journal, 2023 Feb 09
Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 2017 Nov 15
Current cardiology reviews, 2021
Interactive cardiovascular and thoracic surgery, 2013 Nov 19
The American journal of cardiology, 2021 Aug 11
The New England journal of medicine, 2019 Sep 01
JACC. Heart failure, 2020 Mar 30
Circulation, 2021 Nov 15
The New England journal of medicine, 2022 Aug 27
The New England journal of medicine, 2021 May 15
Journal of the American Heart Association, 2023 May 15
International journal of cardiology. Heart & vasculature, 2021 Apr 29
The New England journal of medicine, 2010 Sep 22
JACC. Cardiovascular interventions, 2020 Feb 12
Journal of the American College of Cardiology, 2013-01-29
European journal of heart failure, 2019 Dec 09
The New England journal of medicine, 2020 Mar 28
Kidney international, 2019-04
Kidney360, 2023 Feb 10
Frontiers in medicine, 2022 Mar 17
The international journal of cardiovascular imaging, 2021 Feb 05
JAMA cardiology, 2024 Aug 07
Circulation. Heart failure, 2010-09
Circulation, 2010-08-10
European heart journal, 2016 May 20
JACC. Heart failure, 2018 May 23
Journal of chromatography. A, 2013 Aug 01
Stroke, 2007-12
The New England journal of medicine, 2006 Aug 10
European heart journal, 2020 Jan 01
Journal of the American Heart Association, 2023 Sep 08
The New England journal of medicine, 2011-12-01
Circulation, 2019-08-20
European heart journal, 2021 Sep 14
Neurology, 2024 Aug 05
Neurology, 2024 Aug 05
The New England journal of medicine, 2023 Nov 11
The New England journal of medicine, 2024 Sep 01
Journal of cardiac failure, 2023 Apr 05
Circulation. Cardiovascular interventions, 2012-04
Journal of cardiovascular pharmacology and therapeutics, 2018 Jun 18
Lancet (London, England), 2019 Mar 22
Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists, 2018-04
Atherosclerosis, 2021 Nov 08
Circulation, 2021 Dec 09
Current cardiology reports, 2022 Oct 24
Circulation, 2016-05-17
The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation, 2016-08
European heart journal, 2021 Dec 21
Heart rhythm, 2014 Oct 13
Journal of arrhythmia, 2023 Jan 31