Cardiology&nbsp;&nbsp;&nbsp;

What are some practical ways to incorporate cardiac POCUS in the primary care setting?

For example, do you find it most useful for outpatient disease assessment/management, consideration of further imaging or specialist referral, or tria...

What is your approach to a newly diagnosed LBBB in individuals >70 years old who are free of any signs or symptoms of heart disease and without other significant ASCVD risk factors besides age?

If the ECG was obtained prior to major orthopedic surgery (such as hip replacement) would that change your approach?

Is it worth getting a calcium score on a patient who is already on statin therapy?

(Since there is some suggestion that stains convert vulnerable plaque to stable calcified plaque and increase calcium score)

How do you counsel patients who develop DVT or atrial fibrillation requiring anticoagulation when being treated with lecanemab or donanemab?

How do you approach the use of benzodiazepines in patients with chronic medical illnesses that may be susceptible to respiratory compromise (e.g., CHF, COPD, ILD)?

Should you work to wean patients of benzodiazepines? Is your approach different for patients who have been on benzodiazepines for years? What would yo...

What is a reasonable approach to coronary calcification that is incidentally found on CT in a patient who does not have symptoms suggestive of angina?

How frequently do you obtain lipoprotein (a) levels on asymptomatic patients without a prior history of CAD?

5 Answers available

How do you decide between ordering coronary calcium scoring versus coronary CTA in asymptomatic patients with low to moderate risk for CAD?

6 Answers available

How soon after an elective, uncomplicated coronary intervention would you feel comfortable having a patient travel by air?

What is your approach to maintenance of sotalol in terms of drug monitoring and duration of therapy for outpatients who remain in normal sinus rhythm?

What is your preferred monotherapy antiplatelet agent to continue after completion of DAPT post-PCI for patients with stable ischemic heart disease?

Would coronary disease anatomy influence your selection of which type of antiplatelet agent to continue?

6 Answers available

Is there a role for aspirin 81mg daily in patients with nonischemic dilated cardiomyopathy with reduced EF?

Can a dihydropyridine calcium channel blocker (CCB) like amlodipine be prescribed in addition to a non-dihydropyridine CCB such as diltiazem or verapamil for treating hypertension?

7 Answers available

Would you consider adding niacin to the lipid lowering regimen in statin-intolerant patients who cannot afford PCSK9i or bempedoic acid?

Ferrell et al., PMID 38448791

6 Answers available

How should we approach the recommendation of intermittent fasting for weight loss in patients with pre-existing cardiovascular conditions, given the observed association of increased CV mortality with eating durations of less than 8 hrs?

Chen & Zhong, AHA/ASA Journals 2024

Is a daily prophylactic dose of aspirin appropriate for patients with coronary artery calcification by Chest CT or an elevated calcium score?

If so, is there a quantitative calcium score or a reported severity of CT coronary artery calcification that would lead you to start daily aspirin?

8 Answers available

Do you recommend transitioning elderly patients from thiazide diuretics to alternative agents when managing hypertension given the increased concern for hyponatremia in this patient population?

What are your recommendations for the long-term management of patients who have experienced Takotsubo cardiomyopathy, particularly regarding ongoing medication management and follow-up imaging?

What is the optimal BP target for patients with diabetes and hypertension to reduce their risk of MI/stroke?

What is your preferred duration for triple therapy post-PCI in patients on systemic anticoagulation?

How long should patients with atrial fibrillation who are already on systemic anticoagulation and are status post TAVR and PCI 6 months ago remain on Plavix?

Would you favor continuation of plavix or aspirin?

Are recurrent UTIs a contraindication to SGLT2i use?

Following completion of antiplatelet monotherapy (i.e., Plavix) plus oral anticoagulation in patients with AFib post-PCI, would you favor continuing antiplatelet therapy + OAC, switching from Plavix to aspirin and continuing OAC, or stopping antiplatelet therapy and continuing OAC?

Is moderate-intensity statin plus ezetimibe just as effective as high-intensity statin monotherapy in preventing major cardiovascular events?

What is your preferred beta blocker for management of arrhythmias and/or HTN during pregnancy?

Should we be more cautious with the use of GLP 1 R agonist therapy in patients with Type 1 diabetes mellitus and obesity given the increased risk of cardiovascular disease with high body weight variability?

Prattichizzo et al., PMID 39468384

How would you counsel a patient on the risk/benefit profile of preventive management such as statin initiation if they have an elevated lipoprotein (a) level, markedly elevated LDL > 200 but a CAC score of 0 without other CV risk factors?

Is there any benefit in maintaining statin or aspirin therapy in patients >75 years old with stable, multivessel ischemic heart disease in light of challenges encountered with polypharmacy?

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?

Is there any benefit to supervised PAD exercise programs in the presence of collaterals seen on angiography for patients with severe claudication and significant lesions?

Would you recommend statin initiation in a young adult patient (age < 40) with type 1 diabetes mellitus and LDL cholesterol levels greater than 100 without any cardiovascular risk factors?

For isolated and very high lipoprotein (a) levels (LDL of > 140, has an Lp(a) > 100) in a patient with no cardiac symptoms or risk factors, would you start lipid lowering treatment, such as with a PCSK9i if they develop statin intolerance?

If their calcium score and stress tests are normal, would you still treat?

In patients with resolved LV thrombus post-MI after 3-6 months of anticoagulation, would you consider surveillance imaging for thrombus recurrence if there is persistent apical akinesis?

If so, how often would you do this?

With the rise in home monitoring devices, how should we approach asymptomatic NSVT detected in healthy individuals with no prior cardiac history and with low risk cardiac profile?

For patients over 90 years old, is there any foreseeable benefit to undergoing left atrial appendage occlusion over permanent cessation of anticoagulation, particularly for those at high risk for major bleeding?

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?

Would you consider using Evenity in an elderly patient with rate controlled atrial fibrillation without history of MI or CVA?

Should systemic anticoagulation be considered for patients with a less than 1% atrial fibrillation burden on outpatient monitoring with an elevated CHADSVASc score and acceptable bleeding risk?

Do you recommend adding low-dose Aspirin for primary prevention in patients with Type 2 Diabetes on Eliquis for another indication?

Does oral semaglutide provide similar cardiovascular risk reduction benefits as injectable semaglutide?

Should all kidney transplant patients be started on statin therapy post operatively given their increased risk of CVD?

At what doses do you start? and how do you titrate therapy?

When would you consider long-term cardiac monitoring to look for atrial fibrillation in patients with mitral stenosis given their baseline elevated risk for atrial fibrillation and thrombosis?

How do the results of the ESPRIT trial, which evaluated the impact of an SBP target of <120 mmHg on preventing major cardiovascular events, influence your blood pressure management goals for hypertensive patients with diabetes or a history of stroke?

ESPRIT Trial

When would you consider genetic screening of first-degree relatives in patients with bicuspid aortic valves?

Would you favor stopping low-dose aspirin and continuing OAC alone in a patient with atrial fibrillation and mild coronary artery calcification seen on routine chest imaging?

What is the minimum duration of weeks on anticoagulation in which you would consider performing a DCCV without the need for TEE, provided the patient is an excellent historian and otherwise reliable?

Should low-intensity statins be favored to minimize the risk of diabetes onset while still offering cardiovascular benefit for patients with prediabetes where a statin is indicated?

Cholesterol Treatment Trialists' (CTT) Collaboration

For elderly patients (i.e. older than 80) with only one documented episode of paroxysmal atrial fibrillation following a stress event (such as acute illness/steroid administration) and a CHADsVASc score greater than 1, how would you counsel them on the risks/benefits of anticoagulation and subsequent monitoring for afib recurrence?

What EKG findings are most concerning when screening asymptomatic athletes in the outpatient setting?

Would you consider lifelong versus short-term (i.e. several months) course of anticoagulation for patients with elevated CHADSVASc score presenting with newly diagnosed paroxysmal atrial fibrillation triggered in the setting of acute illness (i.e. tachyarrhythmias with COVID-19 or bacterial pneumonia)?

What is your outpatient approach to monitoring paroxysmal atrial fibrillation (i.e. mobile cardiac telemetry, decision to anticoagulate if high likelihood of recurrence) in young adults with CHADsVASC score of 0, in light of potential remodeling and increased Afib burden as they age?

How is your experience with point-of-care INR systems for home monitoring of vitamin K antagonists?

Are the INRs reliable? In what scenarios would you not recommend POC INR use for warfarin monitoring? Are these typically covered by insurance? Are t...

Can sotalol initiation for atrial fibrillation be performed safely outpatient, and if so, what would be a reasonable protocol for implementing this?

Can sotalol initiation for atrial fibrillation be performed safely outpatient, and if so, what would be a reasonable approach to accomplishing this?&n...

In male patients in their 60s who had a single episode of PAF (24 hours, terminated spontaneously or with beta-blockers) without recurrence on 30-day monitoring, and without reversible triggers (such as OSA), should lifelong anticoagulation be started when they turn 65, thereby, increasing the CHA2DS2 VASc score to 1?

Do you favor aspirin or P2Y12 inhibitor monotherapy following completion of 12 months of DAPT post-PCI in patients with elevated bleeding risk?

5 Answers available

Would you recommend starting a moderate-intensity statin in a patient under the age of 40 years old with HIV and a 10-year ASCVD risk estimate below 5%?

The REPRIEVE trial included participants who were between 40 and 75 years old.

What patient population is most likely to benefit from pill in pocket strategy for management of paroxysmal atrial fibrillation in an unmonitored setting?

Do you have a preference on type of adjunct AV nodal blocker to use, and do propafenone and flecainide have similar safety profiles?

When and for whom should we consider adding bempedoic acid to the lipid lowering regimen?

What continuous duration of device defined atrial fibrillation burden warrants initiation of anticoagulation if the patient qualifies by CHA2DS2-vasc score?

In people who have had a single detected episode of atrial fibrillation, but none documented subsequently, is there any consideration for increased thrombolembolic risk just from altered atrial architecture, impaired contractility?

Do you recommend taking any unique approaches to managing patients with persistent hypertension following bilateral renal artery stenting?

If prompted as an outpatient, how do you counsel patients on the rare cardiac complications of vaccinations including myocarditis?

What is a reasonable way to treat statin-induced myalgia and what statin substitute would you consider using in the event the myalgia is not resolved?

Can bleeding risk when switching from VKA treatment to a NOAC in frail, elderly patients be accurately compared if individual times in therapeutic range while on VKA treatment are not captured?

Individual times in the therapeutic range while on VKA treatment was not registered in FRAIL-AF.

What is your target or goal lipoprotein (a) level for patients on PCSK9 inhibitors for either primary or secondary prevention?

How do you advise patients with paroxysmal atrial fibrillation regarding their caffeine consumption, given that a randomized clinical trial found no association between caffeine intake and the triggering of AF episodes?

Marcus et al., PMID 34775507

When would you consider initiating patients with CAD and aortic stenosis on PCSK9 inhibitors (as an adjunct to statin therapy), given favorable findings in the FOURIER trial?

Sabatine et al., PMID 28304224

Do you recommend bedtime administration of antihypertensives in patients who exhibit nondipping on ambulatory blood pressure monitoring?

Should all patients with a remote history of immunotherapy, chemotherapy and/or radiation therapy have a baseline TTE regardless of ASCVD risk?

How do you manage patients blood pressures while on anti-angiogenic TKIs?

Do you insist on ambulatory/home blood pressures to rule in/out white coat hypertension? Does your practice have a system to log patients' BPs to supp...

What is the optimal approach to treat isolated diastolic hypertension?

Do you recommend increasing dietary potassium intake for blood pressure management in non-CKD patients with hypertension?

When would you consider initiating GDMT for new onset HF in the geriatric population?

How do you counsel patients with non-statin associated inflammatory myopathies about statin use?

Is there enough evidence now to use injectable semaglutide as a foundational therapy for symptomatic heart failure with preserved ejection fraction in the setting of overweight or obesity?

Should we begin using bromocriptine for CVD management during pregnancy per ESC guidelines in patients with peripartum cardiomyopathy?

Is monitoring for fetal heart block recommended in pregnant patients with only slightly elevated SSA?

How do you decide on an outpatient maintenance diuretic regimen for patients approaching discharge for ADHF?

How frequently should outpatient mobile cardiac telemetry be ordered following resolution of post-CABG-related atrial fibrillation for patients off anticoagulation?

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)?

Would you change an elderly, frail patient with atrial fibrillation who is already on a NOAC to VKA treatment?

In FRAIL-AF, switching VKA therapy to a NOAC was associated with higher risk of bleeding in elderly, frail patients.

What are your outpatient surveillance strategies (biomarkers, imaging, symptoms) to monitor response to treatment for ATTR amyloidosis with cardiac involvement?

How do you determine duration of therapy for Tafamidis, or is it continued indefinitely for the patient?

When would you consider initiation of low-dose aspirin for primary prevention and/or statin therapy in patients with acceptable bleeding risk and evidence of coronary artery calcification on prior CT chest imaging?

Would you start ASA and/or statin therapy on an asymptomatic patient noted to have incidental pathologic Q waves on EKG, assuming no prior history of ischemic heart disease?

Would you consider further imaging like coronary calcium scoring or coronary CTA to further risk stratify them?

How would you approach the management of a patient with a new diagnosis of cardiomyopathy in pregnancy without clinical signs of heart failure?

What other considerations for hyperlipidemia management would you have for a patient with multiple prior PCIs whose LDL remains above goal on high intensity statin, ezetimibe, and evolocumab (assuming compliant with medications)?

Do you think that home INR monitoring is a feasible option for elderly, frail patients with atrial fibrillation on VKA treatment, given variations in socioeconomic status and access to care?

What is a reasonable amount of ventricular arrhythmia burden on outpatient remote monitoring that would prompt consideration for VT ablation in patients with normal LV function and mild symptoms?

What is a reasonable surveillance strategy and length of time to maintain patients with thrombosed bioprosthetic valves on systemic anticoagulation?

Can Droxidopa be used for augmenting orthostatic hypotension treatment in patients who are already on midodrine and/or fludrocortisone?

Is there an approach to tapering the other two medications while uptitrating Droxidopa dosing to reduce the risk of supine hypertension?

What is your outpatient approach to patients with new-onset paroxysmal atrial fibrillation in the setting of acute illness but who are otherwise asymptomatic with normal sinus rhythm post-hospital discharge?

Specifically, what is your approach to outpatient monitoring to assess atrial fibrillation burden for patients with CHADS2Vasc score>2?

What is a reasonable blood pressure goal for refractory HTN in the geriatric population?

What is your approach to correlating stenotic lesions on coronary angiography to magnitude of decline in LV systolic function or cardiomyopathy severity when deciding to intervene or medically manage stable ischemic heart disease as an outpatient?

What is your approach to postpartum screening and cardiovascular risk assessment in patients with a prior history of preeclampsia?

Recent AHA guidelines state that all women who have had a diagnosis of preeclampsia in a prior pregnancy should receive an evaluation of cardiac risk....

When would you consider initiation of bempedoic acid for statin intolerant patients (i.e. LDL threshold, comorbidities)?

How would you assess response to bempedoic acid and its safety on outpatient labs, and how frequently would you have labs monitored?

When should cardiac MRI be obtained alongside standard echocardiography for outpatient monitoring of the progression of chronic aortic regurgitation?

How often should cardiac MRI be ordered in this context?

For which patients do you prioritize ambulatory blood pressure monitoring over self-measured blood pressure?

What are high-risk clinical and echocardiographic features in pregnant patients with congenital heart disease?

Should patients of advanced maternal age (>35 years of age) undergo routine cardiovascular risk stratification with echocardiogram during pregnancy?

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?

What is a reasonable duration of time for dual anti-platelet therapy in patients who have undergone placement of a covered coronary stent?

Should a toe-brachial index be obtained in lieu of resting ABI as an initial screen for PAD in high-risk patients such as those with longstanding diabetes or advanced age with stiffened vessels?

What percentage of patients with non-sustained focal atrial tachycardia detected on an outpatient Holter develop paroxysmal atrial fibrillation, and how should we identify and treat patients at the highest risk of progressing to PAF?

When would you consider discharging post-TAVR patients on outpatient mobile cardiac telemetry with baseline right bundle branch block without further signs of conduction abnormalities 24-48 hours after the procedure, given risk of developing later-onset conduction abnormalities?

And if so, what is a reasonable length of time for outpatient cardiac monitoring?

What are your diagnostic and management approaches beyond statin therapy for hyperlipidemia in young adults with significantly elevated LDL levels in isolation (i.e. reasonable calcium score, normal lipoprotein A levels)?

When should we consider using acarbose for postprandial hypotension?

Is there emerging and compelling enough evidence to maintain patients on P2Y12i monotherapy (in lieu of aspirin) following completion of DAPT?

How frequently and when should lipoprotein A levels be monitored?

Are there any significant benefits to lowering moderately elevated lipoprotein A levels?

What is your surveillance approach for outpatient monitoring of ICI myocarditis?

(i.e. frequency of serial BNP, troponin, cMRI)

Is there any contraindication to the use of ezetimibe in patients with a history of statin induced necrotizing myopathy?

How do you manage anticoagulation bridging for outpatient ESKD patients given concerns for bleeding risk with enoxaparin in this population?

Would you bridge with enoxaparin 0.7 mg/kg/day in an ESKD patient, as described in a previous retrospective study (Pon et al., PMID: 24718051)?

Should we refer patients with nonischemic cardiomyopathy without a reversible cause for genetic screening, in the absence of any family history of heart failure or sudden cardiac death?

What is your approach to screening for complete heart block in an asymptomatic pregnant patient with negative SSA and positive SSB antibodies?

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?

What is a reasonable atrial fibrillation percentage burden that would benefit from systemic anticoagulation for a patient with an elevated CHA₂DS₂-VASc score?

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?

Would you consider coronary artery calcium scoring or coronary CTA for asymptomatic elite competitive sports athletes undergoing routine screening visits, without a family history significant for coronary artery disease?

How do you counsel high-risk women with congenital heart disease who are looking to conceive?

Among asymptomatic patients with chronic, severe primary MR, can serial global longitudinal strain measurements assist with determining timing for repeat surveillance TEEs and/or facilitate timing for MVR?

When should we integrate CT calcium scoring into routine outpatient practice to arbitrate severity of aortic stenosis?

How are PA diastolic goals established and individualized to reduce HF readmission risk post-CardioMEMs, recognizing the overall unclear clinical value of outpatient PA sensor monitoring?

Would you favor restarting anticoagulation or pursuing left atrial appendage closure in a patient with hemorrhagic stroke on anticoagulation for non-valvular atrial fibrillation?

Do you change management in patients that are taking bisphosphonates and develop atrial fibrillation?

At what heart dose would you prospectively refer a patient to cardiology due to anticipated long term risks?

If a patient had prior breast conserving treatment and now has inflammatory breast disease, would you prophylactical send the patient to a cardiologis...

Would you recommend that a patient with stable coronary artery disease and well-controlled RA on a JAK inhibitor continue on their current therapy?

Given the "LDL Paradox", in which RA patients with the highest levels of inflammation can have ultra-low levels of LDL (<70), how do you approach initiation of statin therapy in these patients?

Dr. Charles-Schoeman presented data at ACR 21 showing that, paradoxically, there is a U-shaped relationship between inflammation and LDL levels in pat...

How do you counsel patients regarding the cardiovascular risk of febuxostat?

When do you start anticoagulation for secondary prevention in patients with HFrEF and history of embolic strokes?

For a relatively young, medically compliant patient with HFrEF (EF<35%) and h/o embolic stroke, what is the consensus of starting AC for secondary ...

Is it safe to use statins in IIM patients if HMGCR antibodies are negative?

How do you manage calcium and vitamin D supplementation in patients with sarcoidosis on chronic steroids?

How do you counsel men with prostate cancer on the cardiovascular risks of androgen deprivation therapy?

How might a recent (within 6 months) myocardial infarction affect your recommendations?