Cardiology&nbsp;&nbsp;&nbsp;

What has been your stepwise approach to oxygenation, including when to consider the use of inhaled nitric oxide or epoprostenol, in refractory hypoxemia due to cardiogenic pulmonary edema in patients who are otherwise not ECMO candidates?

How soon would you repeat PET/CT in a patient with cardiac sarcoid after starting treatment with infliximab?

Pre-treatment troponin was mildly elevated, while ILR2 receptor, ACE, CRP, ESR were normal.

How frequently do you opt to use IVUS as opposed to OCT or invasive hemodynamic assessment when evaluating coronary lesions?

For patients presenting with ACS and severe aortic stenosis with critical left main disease, would you consider BAV prior to PCI to the left main?

What genetic testing would you consider for recurrent arterial events (cryptogenic strokes, MI) in patients with limited risk factors?

Family history is notable for CVA and early onset MI in nonsmokers, but no personal or family history of VTE. APLS testing is negative. Previously fou...

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

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

Does the presence of diastolic dysfunction guide subsequent pharmacological, pacing and ablative therapies for atrial fibrillation?

If so, what diastolic parameters do you look at?

How would you decide between conservative management vs. ILR or pacemaker for asymptomatic nocturnal bradycardia/pauses (as an example rates in the 30s, pauses ranging 4-12 seconds) in the absence of bradyarrhythmias during the day and ECG with normal intervals, and not otherwise on medications to slow down HR?

For additional context, work up with TTE and exercise stress testing have all been reassuring and normal.

How many days prior to surgery do you recommend stopping SGLT2 inhibitors and when is it safe to resume therapy?

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?

For patients with high-risk stress test features with ischemic EKG changes and mild to no symptoms, what would be your threshold to directly admit them for coronary angiography, or pursue outpatient elective coronary angiogram?

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

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

How do you decide between using a self-expanding supraannular valve and a balloon-expandable valve for TAVR in patients with severe aortic stenosis and a small aortic annulus?

Hermann, et al., SMART Trial, PMID 38587261

Is there a specific INR cut-off value that would prompt you to consider administering vitamin K for patients with mechanical valves requiring urgent non-cardiac surgery and if so, what would be your starting dose?

With the recent trials such as SELECT and STEP-HFpEF demonstrating benefits of GLP1-agonists in terms of CV risk reduction and improved exercise function, have you begun to incorporate this class of medications into routine CV health maintenance for patients with HFpEF and/or pre-existing CAD?

Based on most current research regarding the more widespread use of class IC antiarrhythmic drugs, what are your prescribing practices in patients with coronary artery disease?

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 ...

For which stroke patients, if any, do you recommend implantable loop recorder for long-term cardiac monitoring and why?

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...

Do you recommend avoiding radial artery access for cardiac catheterization to preserve potential future dialysis access sites in patients with advanced CKD?

7 Answers available

In patients with Tetralogy of Fallot and an indication for primary prevention ICD (NSVT, induced VT during EPS, or Low LVEF), should pulmonary valve interventions be offered PRIOR to ICD to assess if improvement in VT burden/EF?

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 routine use of protamine for hemostasis at the end of a transfemoral TAVI?

Do shorter door-to-balloon (D2B) times impact outcomes in STEMI, if it's already less than 90 minutes, and to what degree (i.e., 30 vs 60 minutes would have a more significant impact)?

Is active cocaine or methamphetamine use a contraindication to implanting defibrillators?

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

In patients who are on 3 of the 4 pillars of HF therapy for HFrEF, would you add the 4th pillar if they are no longer in symptomatic HF and LVEF normalizes?

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...

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

What techniques do you use in the lab to reduce the amount of contrast that needs to be used in patients with CKD?

How do you decide between manual pressure versus opting for a specific vascular closure device at the conclusion of a femoral access case?

How do you decide between administering or deferring upstream P2Y12 inhibitor treatment until patient is in the lab for NSTEMI or STEMI cases with unknown coronary anatomy?

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

How do you manage patients with atrial fibrillation having a thromboembolic infarct despite being on adequate anticoagulation?

Would you recommend left atrial appendage occlusion with or without continuing anticoagulation? In light of Maarse et al., JAMA Neurology 2024.

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?

What factors do you consider for patients on an individual basis when establishing a post-cardiac arrest MAP goal after ROSC is achieved, considering some may benefit from higher MAP goals for optimal cerebral perfusion?

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?

What is your approach to GDMT uptitration (particularly dosing for ARBs/ARNIs/MRA) if there is further evidence of renal dysfunction, especially in situations with worsening AKI on CKD?

Would a decrease in eGFR by more than 30% prompt you to consider decreasing or discontinuing these medications?

How do you manage patients with central sleep apnea due to heart failure with reduced ejection fraction?

Are there specific scenarios in which you employ BPAP with a back up rate?

How do you approach revascularization in patients over 75 years with NSTEMI, given recent evidence from the SENIOR-RITA trial that an invasive strategy does not significantly reduce cardiovascular events compared to a conservative strategy?

Kunadian, et al., PMID 39225274

What is your approach to weaning dialysis in a patient with AKI on CKD and CHF who now has resolved AKI but a history of recurrent episodes of decompensated heart failure?

In ischemic stroke patients with low LDL levels (<30-50 mg/dl), would you consider lowering LDL levels to lower values without concern for any side effects?

How would you adjust statin therapy in these patients?

What is your approach to evaluating a patient with a suspected myocardial contusion?

What factors would influence your decision to use or avoid heparin bridging in patients with mechanical heart valves resuming anticoagulation after intracerebral hemorrhage?

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...

What clinical parameters or CV imaging considerations would prompt you to consider AV nodal ablation for patients with cardiac amyloidosis and symptomatic atrial fibrillation?

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

How do you choose between finerenone and traditional steroidal MRAs for patients with heart failure and mildly reduced or preserved EF, considering recent results showing finerenone's efficacy in reducing heart failure events?

Soloman, et al., PMID 39225278

What is your approach to secondary stroke prevention in patients with atrial fibrillation and intracranial stenosis (>70%)?

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

Are recurrent UTIs a contraindication to SGLT2i use?

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?

What is your preferred imaging modality--cMR vs. TTE--to evaluate for myocardial strain if concerned for chemotherapy-induced cardiomyopathies?

What are some potential etiologies to consider for isolated, mildly elevated BNP levels with normal TTE findings in an asymptomatic, elderly patient?

What factors influence your choice between low-dose DOAC therapy and dual antiplatelet therapy for the first 3 months after percutaneous left atrial appendage occlusion?

Freixa, et al., PMID 39110427

What are your top 5 reasons to choose between a TAVI valve Edwards SAPIEN 3 (Edwards Lifesciences) vs an Evolut FX (Medtronic) and what favors one over the other?

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

How do you approach long-term blood pressure parameters in ischemic stroke patients with severe symptomatic intracranial stenosis?

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...

Do you routinely perform echocardiography in patients with Staphylococcus aureus bacteremia deemed low risk for metastatic infection, or do you selectively omit it based on specific clinical criteria?

Hendriks, et al., PMID 38576380

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 are first-line choices for vasopressors/inotropes to use in hypotensive patients with Eisenmenger Syndrome?

For how long would you hold anticoagulation before percutaneous left atrial appendage closure with Watchman or Amulet devices?

For SVG graft stenting, do you consider routinely embolic protection devices (EPD), and do you factor lesion location (prox vs distal) for decision making?

When would be your threshold to consider obtaining an exercise RHC for undifferentiated dyspnea to help diagnose HFpEF?

How do you manage asymptomatic non-sustained atrial arrhythmia in patients with single ventricle and Fontan physiology?

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

Can cardioversion be safely performed for recurrent atrial fibrillation in patients who have undergone left atrial appendage clipping during CABG, if they are not on chronic anticoagulation anymore?

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 approach to using beta-blockers in patients with acute myocardial infarction with preserved LV ejection fraction who undergo early coronary angiography in light of the REDUCE-AMI trial findings?

REDUCE-AMI trial

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 do you advise patients on cardiotoxicity when they are expected to receive a low mean heart dose and low cardiac substructure doses with their radiation plan?

Such as breast plans with < 200 cGy mean heart dose

What is your approach to initiating spironolactone in patients with end stage kidney disease and heart failure?

For patients who have previously undergone MAZE ligation presenting with paroxysmal atrial fibrillation, how would you counsel them on the risk of stroke long-term when deciding whether or not to start or continue anticoagulation?

What is your preferred, first-line class of anti-anginals for MINOCA with proven epicardial coronary vasospasm?

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?

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?

Would you initiate anti-arrhythmic drug therapy in patients who are asymptomatic and have normal LV function but with a PVC burden > 20 percent?

When would you consider offering PVC ablation for otherwise healthy patients with preserved LV systolic function?

If PVC burden exceeded 10-15%, would you offer ablation in the absence of specific symptoms?

Should presence of coronary artery calcifications on CT/CTA be considered as presence of vascular disease on CHA2DS2-VASc score?

Do you routinely check digoxin levels, and if so, when would you consider using Digibind in chronic digoxin use patients?

Is your pattern for drug monitoring different if digoxin is being given for afib vs HFrEF?

How do you identify the subset of heart failure patients who are likely to benefit from cardiac resynchronization therapy in the setting of an RBBB pattern?

What patient characteristics prompt you to prescribe vericiguat for patients with heart failure with reduced ejection fraction who are already on standard therapy?

Would you recommend normal saline for pre- and post-LHC hydration in patients with CKD stage III to IV with reduced LV systolic function, and if so, what is a reasonable amount of volume?

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?

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?

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...

What is your intraprocedural approach to reducing time to reperfusion in STEMI cases: opting for culprit lesion PCI first then complete angiography, or complete angiography followed by culprit lesion PCI?

Levi et al., PMID 38551563

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...

What is a reasonable inpatient imaging modality alternative to evaluate for infective endocarditis in a morbidly obese patient with poor acoustic windows on TTE and persistent bacteremia if TEE is not feasible or contraindicated?

In light of the NOAH-AFNET6 and ARTESiA trials, how would you approach the decision regarding anticoagulation for patients with incidentally-detected AF <24 hrs on pacemakers/defibrillators?

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 ...

When would you consider AV nodal ablation in CRT-non-responders with persistent atrial fibrillation?

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?

How would you manage cardiac sarcoid with intolerance/contraindications to methotrexate, azathioprine, and mycophenolate/mycophenolic acid and that has proven refractory to adalimumab and infliximab as determined by PET?

When would you consider using Ibutilide for rapid pharmacologic cardioversion of atrial fibrillation?

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

When pursuing complex PCI of the RCA (especially when lesion preparation is required), when do you consider placing a transvenous pacemaker in anticipation of conduction abnormalities?

What are your management strategies for malignant pericardial effusion with a high risk of spontaneous hemorrhage, particularly in patients requiring anticoagulation for chronic atrial fibrillation?

Should there be a role for sacubitril-valsartan in the management of patients with heart failure with preserved ejection fraction?

PARAGON HF trial, PMID: 31475794

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.

Are there any circumstances in which you would consider PCI for CAV, especially for focal/tubular lesions, if the patient is a candidate for re-transplantation?

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?

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?

Would you consider opting for beta blocker withdrawal to improve exercise capacity in patients with heart failure with preserved ejection fraction and chronotropic incompetence?

What is your approach to anticoagulation in patients with hypertrophic cardiomyopathy and an apical aneurysm?

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?

Do you prefer a loading dose of 300mg or 600mg plavix for patients presenting with NSTEMI or unstable angina about to undergo LHC?

Does your preferred dose change if this were in a non-ACS setting with elective outpatient PCI?

What is your approach during DCCV if you have an obese patient with atrial fibrillation refractory to up to 3, 360 J shocks?

Would you then opt for double vector DCCV to deliver 2, 360J shocks simultaneously, and/or bolus with amiodarone?

Should CT coronary calcium score be avoided in dialysis patients in light of presumed high prevalence of CAC in this population?

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?

How do you determine which atrial fibrillation patients with a high thromboembolic risk and a contraindication for oral anticoagulation should undergo left atrial appendage occlusion?

Marcus et al., PMID 34775507

What would be your advice to providers who are wary of QTc prolongation after starting an amiodarone load and wish to discontinue it?

Is there a percent change in QTc in which you would consider stopping amiodarone, especially in patients who have baseline wide QRS complexes?

What treatments options may be considered in patients with POTS who also need daily diuretics to treat heart failure and are already wearing compression garments?

Following left main bifurcation stenting, do you routinely proceed with kissing balloon inflation of the side branch, either LCx or LAD?

How do you view the balance between opting for percutaneous coronary intervention and prioritizing optimal medical therapy as the initial treatment choice for patients with stable angina?

ORBITA-2 Trial

What are your top takeaways from ACC 2024?

Should we recommend SGLT2i initiation at discharge to all patients hospitalized with acute myocardial infarction?

Butler et al., PMID 38587237

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)

What would be your threshold to recommend TEE guided DCCV in a patient who has remained in atrial fibrillation in the post-operative period following CABG, who has achieved adequate amiodarone loading dose?

What is your standard approach (i.e. choice of medication, type of sheath) in the cath lab to reduce the likelihood of radial artery spasm?

Is there a role of maximizing GDMT medications for patients with durable VADs?

What is your approach for de-escalation of antiarrhythmics for patients with a history of ventricular arrhythmias?

For example, for younger patients on amiodarone or those who wish to come off antiarrhythmics because of medication side effects.

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

What is a reasonable class of antihypertensive to start in patients with HCM who remain hypertensive and symptomatic in spite of maximal doses of beta blockade or calcium channel blockers?

What is your approach to patient selection for cardioneuroablation for vasovagal syncope?

How do you determine the feasibility of doing a valve-in-valve for patients requiring AVR with index surgical aortic valve replacement?

How do you decide the right time for MitraClip intervention in patients with symptomatic heart failure and severe mitral regurgitation who are on maximally tolerated GDMT?

When would you consider performing direct implantation versus prior dilatation with balloon aortic valvuloplasty during TAVR?

How do you choose between spironolactone and finerenone for patients with proteinuric diabetic kidney disease and heart failure?

Would you recommend delaying left heart catheterization until development of ESKD in a patient with CKD Stage 5 and stable coronary artery disease given concern for contrast-induced nephropathy?

How long would you treat a patient with recent history of TAVR presenting with E faecalis bacteremia with unclear source with TEE showing thickened valves but no obvious vegetation?

Is ABI (Ankle Brachial index) lower limb arterial doppler not recommended if patient already has arterial stents in the legs, and if so, what other imaging modality would you consider as first-line?

What are alternate approaches to medical therapy and/or interventions to consider in patients with refractory, severe coronary vasospasm despite short-acting nitrates, calcium channel blockers, L-arginine, and clonidine?

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

What criteria do you utilize in deciding when to treat or not treat frequent VPC’s?

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?

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

What is your preferred method for subclinical CAD screening prior to initiation of class IC antiarrhythmic drugs for atrial fibrillation?

What are your top takeaways from ISHLT 2024?

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?

What is your approach to counseling a patient with stable but severe multivessel coronary disease if the patient does not wish to undergo bypass surgery?

And when would you consider referral for staged/complex PCI instead?

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?

Which factors would prompt empirical lead extraction in bacteremic patients without TEE evidence of lead vegetation?

How soon following pacemaker implantation can patients safely undergo elective cardioversion?

Given that high coronary calcium scores portend significantly increased cardiac mortality rates over 5-6 years, is there any data to support performing coronary angiography when the score is very high, e.g. over 1000, even in asymptomatic patients with no objective evidence of ischemia?

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.

In patients with concurrent, CAD and atrial fibrillation, more than 1 year post-PCI, the most recent AHA/ACC guidelines state that “oral anticoagulation monotherapy is recommended over the continuation of oral anticoagulant therapy and a single antiplatelet therapy.” If this individual undergoes surgery, the anticoagulant will be held. Would you then bridge with aspirin?

Joglar et al., PMID 38033089

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

What is the right approach in terms of GDMT and device consideration for patients with intermittent LBBB (QRS duration exceeding 150ms) and HFrEF?

Besides HR variability how can we explain resolution of the intermittent LBBB with HF GDMT (especially with ARNI use)?

Is there a role for repeat surveillance blood cultures in patients with prosthetic valve endocarditis without associated cardiac abscess after a 6 week course of antibiotic treatment without surgical intervention?

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

Following cardiac MRI, what imaging modality would you consider to further evaluate mild aortic regurgitation (regurgitant fraction on cardiac MRI of 26%) and mild to moderate mitral regurgitation secondary to mild bi-leaflet mitral valve prolapse (RF 30%) with low-normal LVEF and incomplete RBBB?

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

What are your criteria for deciding if a patient who had VF arrest in the setting of subacute myocarditis requires ICD or long term WCD?

For pregnant patients in their first trimester presenting with acute MI with plan for emergent angiogram, who then subsequently have resolution of chest pain and EKG changes following initiation of heparin gtt, DAPT, would you still consider proceeding with LHC or treat medically with presumptive diagnosis of SCAD?

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?

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?

In what clinical scenarios do you utilize post-cardiac arrest targeted temperature management (TTM)?

In the span between the HACA trial and the Targeted Temperature Management in Out-of-Hospital Cardiac Arrest study (Dankiewicz et al., PMID 34133859),...

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

What is the best approach for single vessel mid-LAD CTO in patient with preserved EF and no anginal symptoms?

7 Answers available

How will you decide between using paclitaxel-coated balloons versus conventional uncoated balloons for managing in-stent restenosis?

For patients who have undergone ablation for atrial fibrillation with elevated bleeding risk, what is your risk/benefit approach when deciding to continue oral anticoagulation long-term?

What are some device parameters and clinical scenarios in which recommendations should be made to deactivate the LV lead in patients with an existing CRT-D device following LVAD implantation?

Would you recommend hospitalization for surgery for a large papillary fibroelastoma or atrial myxoma discovered on an outpatient echocardiogram?

Would the context of prior stroke/TIA impact the decision to hospitalize or pursue expedited outpatient evaluation?

How do you manage severe hypertriglyceridemia in the adolescent & young adult population receiving chemotherapy for ALL, in the absence of complications related to hypertriglyceridemia?

What is your preferred anticoagulation/antiplatelet regimen for younger patients presenting with ACS, found to have an acute thrombotic event requiring aspiration thrombectomy without need for stent deployment?

How would you lead a goals of care discussion in terms of prognosis/survival likelihood for patients with inotropic dependent HFrEF with CRT-D on maximally tolerated GDMT?

What is your approach to diagnosis and evaluation of nonbacterial thrombotic endocarditis (Libman-Sacks)?

Patient with negative blood cultures, completed 6 weeks of IV antibiotics and vegetation persists. CT imaging without evidence of malignancy. No evide...

What is your preferred method for subclinical CAD screening prior to initiation of class IA antiarrhythmic drugs for atrial fibrillation?

How would you manage a patient with CML in chronic phase with a significant cardiac history, such as heart failure with reduced ejection fraction or arrhythmia?

Is there a specific tyrosine kinase inhibitor that you would prefer to use?

Would you consider switching choice of P2Y12 inhibitor for patients with ISR (non-ACS presentation), with acceptable bleeding risk?

What is your preferred mechanism for venting the left ventricle in patients on VA-ECMO?

What is a reasonable hemoglobin goal for patients with chronic anemia presenting with acute MI?

How do you risk stratify patients with different WHO groups of pulmonary hypertension prior to non-cardiac surgeries?

And who would you not recommend to undergo surgeries?

What would be your second pressor of choice if patients with LVOT obstruction remain persistently hypotensive on phenylephrine?

Would you favor PCI or CABG for younger patients with radiation-associated cardiac disease in the absence of any significant valvular abnormalities?

For radiation oncologists, how do you ameliorate the risk for radiation-related injury to epicardial coronaries during treatment sessions?

How do you decide when to refer patients with obstructive hypertrophic cardiomyopathy for alcohol septal ablation versus septal myectomy?

How do you approach a patient at intermediate ASCVD risk who has been referred to you because of an abnormal coronary CTA (obstructive lesion ~90%) but an excellent exercise capacity on treadmill without angina and a negative MPI?

Had you seen the patient immediately after the coronary CTA results, would you have directly proceeded with cath or also ordered an noninvasive functi...

Should colchicine be considered in patients with ischemic heart disease and persistently elevated hsCRP despite statin and aspirin therapy and appropriate physical activity?

0 Answers available

Given that there are a fair number of myocarditis cases without a troponin elevation, how do you clinically approach the diagnosis of myocarditis?

When would you consider using hypertonic saline for patients with refractory acute decompensated heart failure and diuretic resistance?

What would be your threshold to offer coronary angiography for patients presenting with atypical chest pain features and Wellens syndrome on EKG without a troponin elevation or dynamic EKG changes?

Can CAR T cell therapy be considered for heart transplant recipients with concurrent lymphoproliferative disorders?

What is your typical approach to the use of beta blockers in the setting of recent cocaine use amongst patients presenting with cocaine-related MI, arrhythmias, or new-onset heart failure?

If these patients were already prescribed non-selective beta blockers outpatient, do you recommend withholding these medications in the acute phase?&n...

Are there standardized, discrete cut-off values in T1/T2 mapping and extracellular volume fraction to aid in the diagnosis of various cardiomyopathies, or are these values largely scanner/institution specific?

Is there a role in regional analyses with T1/T2 mapping, such as in the case of RV cardiomyopathies?

How do you approach treatment planning for lung SBRT in a patient with a lesion within 1 cm of a defibrillator?

The patient is not pacemaker dependent.

What is your preferred choice of anticoagulant (VKA vs. DOAC) in patients with an LV thrombus and apical infarct?

Would you extend length of time for anticoagulation if the apex remained akinetic on surveillance TTEs?

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?

Would you recommend that hematologists test for clonal hematopoiesis of indeterminate potential (CHIP) in patients with an intermediate 10-year risk of ASCVD?

Is the data compelling enough to merit intensifying or initiating primary prevention if the patient has CHIP?

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

Do you routinely use vasopressin in the management of RV failure leading to shock state in the absence of an obvious treatable cause such as infarction or PE?

In patients presenting with ACS and multivessel disease, when do you favor immediate versus delayed complete revascularization?

If delayed complete revascularization is favored, would you consider staged PCI during that same admission or PCI outpatient?

Which class(es) of antihypertensives do you recommend for first-line therapy for hypertension in severe aortic stenosis?

What is a reasonable length of time for systemic anticoagulation in patients presenting with MI in the setting of coronary artery aneurysm with large thrombus formation?

What is the preferred imaging modality to evaluate subaortic membranes in patients with aortic valve disease?

Among patients with recovered LVEF on GDMT with a reversible cause for heart failure (i.e., tachycardia-mediated or alcohol-mediated cardiomyopathy), would you consider de-escalation of GDMT?

Based on results from the VOYAGER PAD trial, when would you consider the primary use of rivaroxaban with aspirin +/- clopidogrel as opposed to conventional aspirin +/- clopidogrel in patients undergoing lower extremity revascularization?

When would you consider CT aortic valve calcium score over TEE to further delineate the severity of LFLG aortic stenosis?

How reliable is an exercise stress echo in the diagnosis of exercise-induced heart failure with preserved ejection fraction?

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...

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

What are the current clinical practices for TEE to guide cardioversion and anticoagulation duration post-cardioversion for Afib/flutter in patients following left atrial appendage closure?

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?

Should intervention be considered for an intermediate flow-limiting coronary lesion that does not correlate with perfusion defects on stress testing in a patient with atypical anginal symptoms?

7 Answers available

What is your approach to considering geriatric patients for complex PCI given their overall frailty and increased risk of complications such as bleeding and stroke?

In what situations/patient population would you consider placing an implantable cardiac monitor in favor of external monitors for long-term dynamic monitoring of atrial fibrillation?

What are the real-life implications of the MONITOR-AF study to the routine management of AF?

What is your approach to monitoring patients with cardiac sarcoid while tapering immunosuppression?

Do you obtain serial cardiac PET scans?

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)?

Are there any indications to close a PFO during pregnancy if a woman had a cryptogenic stroke in her first trimester?

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 is your loading dose goal and typical loading regimen for PO amiodarone in patients with atrial fibrillation?

Do you include the amount of IV amiodarone already administered as part of the loading dose?

Is there a particular PVC/NSVT burden on inpatient telemetry in which you would consider discharging a patient with a LifeVest post-STEMI with newly reduced LVEF <35% while optimizing GDMT?

How do you calculate QTc intervals in patients being admitted for AAD drug loading who remain in atrial fibrillation or atrial flutter?

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?

What are your top takeaways from AHA 2023?

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?

What is your approach to counseling an octogenarian on the risks and benefits of LHC in the context of NSTEMI complicated by new-onset heart failure and AKI on CKD?

If LHC is deferred, would you consider loading with plavix and treating for ACS for 48 hours (assuming acceptable bleeding risk) and optimizing GDMT p...

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 burden of PVCs/NSVT in an inpatient post-MI cardiomyopathy patient would prompt an EP study-guided ICD implantation prior to discharge?

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)?

What would be your approach to a patient with new diagnosis of seropositive rheumatoid arthritis manifesting as a constrictive pericarditis with no joint pain complaints?

Would you begin with DMARD therapy like MTX or would you consider starting with an IL-1 antagonist such as Acralyst?

Do you recommend continuing SGLT2 inhibitors in patients with diabetic kidney disease and congestive heart failure who have been taking the medication for several years and later develop end stage kidney disease?

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?

Do you consider bleeding risk in elderly, frail patients with atrial fibrillation to be similar for all NOACs?

In FRAIL-AF, participants were switched from VKA to dabigatran, rivaroxaban, apixaban, and edoxaban.

Given recent trials for the management of atrial fibrillation with an early ablation strategy (for example, EAST-AFNET 4, EARLY-AF, PROGRESSIVE-AF, STOP-AF), what is your approach to determining the appropriate timing for ablation in patients with atrial fibrillation?

And how do patient characteristics affect your decisions?

When would you consider using acetazolamide to augment diuresis in patients with ADHF?

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?

Should bare metal stents be favored over drug eluting stents for pregnant patients presenting with acute coronary syndrome?

Do you usually recommend PFO closure for patients with frequent migraines with aura?

In what clinical context would you consider offering first time catheter ablation for symptomatic atrial fibrillation in patients with advanced heart failure, as opposed to a trial of antiarrhythmics and/or cardioversion?

Do you recommend checking urine sodium 2 hours after loop diuretic administration to determine the need for dose adjustment in a patient with acute decompensated heart failure?

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

What is your approach to a patient who has a cardiac PET scan suggestive of sarcoid but no other supporting evidence of a diagnosis of sarcoid?

Do you typically push for myocardial biopsy in this case?

How often and when do you consider trending NT-proBNP levels for patients with HFrEF admitted for acute decompensated heart failure?

When would you consider proceeding with antiarrhythmic drug load concurrently with DCCV as opposed to DCCV alone in patients with new-onset atrial fibrillation?

What is your preferred method of lesion interrogation for intermediate left main coronary artery stenosis?

In which situations do you preferentially use an MCOT in lieu of a standard event monitor?

How can hepatic venous pressure gradients in patients with cirrhosis be used to differentiate between cardiac cirrhosis and portopulmonary hypertension?

In which clinical scenario(s) would you consider checking HVPG?

Would you start an amiodarone load for new onset atrial fibrillation with RVR intermittently in normal sinus rhythm to further suppress AF recurrence in the acute setting?

What is your approach to volume resuscitation in patients with obvious septic shock but also with a component of suspected cardiogenic shock?

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?

Should we routinely include geriatric functional assessments to determine candidacy for TAVR?

(ie., assessing gait speed, cognition, physical function, fall history, orthostatic vital signs, etc.)

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 approach to pacemaker lead thromboses in terms of threshold for lead extraction and initiation of systemic anticoagulation?

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?

For patients maintained on antiplatelet monotherapy post-DAPT following PCI, what is your recommendation for holding antiplatelet therapy prior to non-cardiac surgery?

Do you ever recommend "bridging" with low-dose aspirin?

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

Do you recommend noninvasive testing or coronary angiography as the initial test for pre-kidney transplant evaluation of an asymptomatic patient older than 50 years of age with ESKD secondary to diabetic nephropathy and no known history of CAD?

Should all pregnant patients with newly reduced LVEF <45% be referred as soon as possible to advanced heart failure given high risk for maternal morbidity/mortality in setting of suspected peripartum cardiomyopathy?

If PPCM is suspected, what are your targeted hemodynamic goals during the delivery phase?

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?

Would you consider adding an SGLT2 inhibitor to augment diuresis in patients with worsening renal function presenting with acute decompensated heart failure and AKI on CKD?

Is it reasonable to consider the use of DOACs for LV thrombus management instead of coumadin?

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?

Would you consider a primary prevention ICD in a patient with hypertrophic cardiomyopathy and non-sustained ventricular tachycardia, in the absence of any other high risk predictors for sudden cardiac death?

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

What is the appropriate cardiac work-up and management for an otherwise healthy individual who has experienced immersion pulmonary edema while scuba diving?

For the first time in my 27-year career, I was asked to consult on a patient in his early 40s with immersion pulmonary edema from scuba diving. &...

What is your preferred pharmacologic agent for recurrent VT suppression in arrhythmogenic right ventricular cardiomyopathy?

How do you approach mitral valve endocarditis associated with a large vegetation size and severe mitral regurgitation, but without any heart failure, hemodynamic instability or valve destruction?

While the current guidelines favor early surgery (within 48 hrs of diagnosis) for this population based on the results of the EASE trial (link attache...

When would you consider percutaneous mechanical aspiration of vegetation in right-sided endocarditis?

What would be the utility of calcium scoring for the evaluation of low-flow low-gradient aortic stenosis, and what cut-off values typically fall within the severe range?

What is your approach to abbreviated DAPT in post-PCI patients (ACS and non-ACS) with high bleeding risk?

What strategies do you employ to minimize the risk of cardiovascular collapse when intubating a patient with severe pulmonary hypertension?

Do you favor awake intubation in these cases?

Should patients with co-existing moderate-severe valvular disease (particularly AS and MS) and malignancy requiring radiation therapy undergo more frequent surveillance surface echocardiograms?

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 consideration be taken to defer using PW to calculate aortic valve area if LVOT pulsed wave is greater than 1.7 m/s (aliasing velocity)?

What are the preferred inotropes/vasopressors agents for cardiogenic shock in situations with and without LVOT obstruction?

Is there literature to support superiority of levophed over dobutamine, or vice versa?

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 is your preferred PO afterload-reducing agent immediately after being weaned off inotropic support in cardiogenic shock?

Would testing for ATTR cardiac amyloidosis be considered in an older patient with bilateral carpal tunnel surgeries and multiple spinal stenosis surgeries, but no obvious cardiac symptoms?

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?

What structural features preclude a transcatheter edge-to-edge repair in a patient with severe symptomatic tricuspid regurgitation?

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?

Do you ever utilize lacosimide in patients with atrial fibrillation?

Would you recommend giving N-acetylcysteine in addition to holding diuretics in a patient with chronic kidney disease and mild hypervolemia who is planned to have a contrast study?

For patients on immune checkpoint inhibitors presenting with chest pain, dyspnea, fatigue, and troponin elevation, would you recommend early initiation of high dose steroids for empiric treatment of ICI myocarditis while pursuing workup with coronary angiogram, echocardiogram, and/or cardiac MRI, or wait until alternative etiologies have been ruled out?

What would be your index of suspicion for AL amyloidosis with cardiac involvement in a patient with MGUS to prompt further imaging (and which modality would be preferred)?

Which clinical and echocardiographic parameters (i.e. LVEF, AVA) do you use when determining patient candidacy for LV device-assisted percutaneous balloon aortic valvuloplasty in patients with cardiogenic shock and severe AS?

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)?

What would be a reasonable means of mechanical circulatory support as a bridge to AVR for patients with severe aortic regurgitation complicated by cardiogenic shock?

What is your approach to risk stratification of asymptomatic patients with pre-excitation syndrome?

When should we consider using acarbose for postprandial hypotension?

Should vasodilatory therapies be considered first-line in the management of hypertension in patients with severe aortic regurgitation?

Which hemodynamic parameters can be used to titrate positive pressure ventilation in preload dependent settings such as RV failure, cardiac tamponade, HOCM or hemodynamically significant PE?

Is there any role for palliative radiation in the treatment of pericardial metastases?

Assuming the patient is symptomatic and/or has compression of ventricles, what field design and dose-fractionation would you use?

Do you ever initiate on degarelix and then switch to leuprolide for patients with prostate cancer and cardiac risk factors receiving ADT?

If so, how long are they on degarelix before the switch?

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

How do you approach a patient with atrial fibrillation on apixaban who has a new cardioembolic stroke?

In patients with Afib on anticoagulation and concurrent intracranial atherosclerotic disease, would you consider adding an anti-platelet to anticoagulation if there are recurrent events that could be related to the ICAD?

How frequently and when should lipoprotein A levels be monitored?

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

Is it sufficient to maintain patients with atrial fibrillation and established PAD on a DOAC or VKA alone, or is there an additional benefit to adding an antiplatelet agent for CVD benefit?

If so, would you prefer a P2Y12i over low-dose aspirin?

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

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

Given recent studies investigating ICI myocarditis biomarkers such as Temra CD8+ cells, is there now a growing selection of clinical biomarkers, besides BNP and troponin, being measured routinely in ICI myocarditis cases?

When would you consider tapering glucocorticoids in a patient with ICI-associated myocarditis?

For patients presenting with spontaneous coronary artery dissection, what other non-cardiac/vascular work-up can be considered to further risk stratify them as a predictor for any future cardiovascular events?

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

Does the presence and location of cerebral microbleeds affect your decision for antithrombotic treatment in patients with atrial fibrillation?

Do you distinguish between primary and secondary prevention? Wilson et al., PMID 31130428 is helpful, but curious how people apply this data in practi...

Should we have a lower threshold to consider revascularization of coronary lesions in athletes, compared to non-athletes?

Is there a validated risk prediction model you favor to risk stratify patients for cardiotoxicity prior to initiation of chemotherapy?

What radiation dose is a risk for damaging function or active leads from a pacemaker?

If the pacemaker receives no dose, what dose are the leads allowed to receive and still function? Should interrogation(s) be done weekly?Does dose per...

What is a reasonable approach to monitoring mechanical valve function if systemic anticoagulation needs to be held in the setting of an acute intracranial hemorrhage?

Do you use tolvaptan for management of hyponatremia related to heart failure given the side effect profile and lack of mortality benefit seen in a previous trial?

The EVEREST Outcome trial (Konstam et al., PMID 17384437)

When you send for molecular studies for polycythemia vera, what are the mutations that predict increased cardiovascular risk?

How do you use this information in clinical practice?

When would it be reasonable to consider enhanced external counter-pulsation therapy in patients with refractory angina despite maximally tolerated anti-anginal therapy?

How do you re-stratify patients with a primary prevention ICD in need of a generator change if their LVEF has improved to >40% and they have not previously required any device therapies?

Would you give doxorubicin and cisplatin for localized chondroblastic osteosarcoma in a patient with prior childhood anthracycline exposure and resultant cardiomyopathy with EF 50%?

Which factors favor extended dual antiplatelet therapy beyond one year in ACS patients with low bleeding risk?

How do you approach radiation therapy for a target volume adjacent to a WATCHMAN atrial appendage closure device?

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)?

Would you recommend PFO closure in patients >60 years old with presumed paradoxical embolism as their mechanism of stroke?

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?

When is an appropriate time to consider endomyocardial biopsy for non-ischemic cardiomyopathy?

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?

Should we routinely incorporate iron studies into admissions for acute decompensated heart failure?

If so, how frequently should we measure iron saturation/ferritin levels post-iron infusion?

Are there situations where you would start treatment for cardiac amyloid in a patient with amyloid seen on biopsy, but still pending mass spectrometry results?

E.g. in a patient with tenuous cardiac function, would starting treatment several weeks earlier potentially improve outcomes?

Would you consider starting an ACE inhibitor on a patient without CVD or heart failure prior to initiation of anthracyclines to reduce the overall risk of myocardial toxicity?

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

When should we consider screening patients with systemic sarcoidosis for cardiac involvement using cardiac MRI or PET given their high risk for sudden cardiac death and discrepancies between reported cardiac symptoms (2-5%) and evidence of cardiac inflammation on advanced imaging and autopsy findings (>25% of cases)?

What are your top takeaways from ACC 2023?

What is your stepwise approach to initiating GDMT in the inpatient setting for newly diagnosed HFrEF?

Is there a preferred heart rate range for patients with moderate to severe paravalvular leak post-TAVR?

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?

What is your approach to weaning IABPs?

When would you consider implantable loop recorders for athletes with nonspecific complaints of palpitations/dizziness, without known history of arrhythmias?

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?

For CLL patients with high-risk cytogenetics on ibrutinib who develop a cardiac event such as an MI, would you continue ibrutinib?

Would you continue ibrutinib even if they are placed on anti-platelet therapy such as clopidogrel or ticagrelor? When do you switch to an altern...

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?

How would you choose between left bundle pacing and CRT-P in a patient with a new high-degree AV block and pre-existing reduced LVEF, who does not otherwise meet the criteria for CRT-D?

(Assuming that the patient would require V-pacing almost all the time)

Is there utility in obtaining pericardial fluid autoimmune labs such as ANA or RF in patients with recurrent idiopathic pericardial effusions, but no other clinical or serologic evidence of rheumatic disease?

What is your preferred rate control agent for atrial fibrillation with rapid ventricular rate, and why?

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

When would you consider obtaining a cardiac CT in lieu of standard TEE for the detection of a left atrial appendage thrombus in atrial fibrillation?

Would you empirically elective to anticoagulate patients with a remote (i.e. >10 year) history of paroxysmal atrial fibrillation presenting with newly diagnosed CVA, presumed cardioembolic in etiology, without any documented recurrence of AF?

What precautions do you take prior to CABG in a patient with sickle cell trait?

Please comment on temperature recommendations and role of exchange transfusion.

Would you consider using DOACs in a young patient with SLE and Libman-Sacks endocarditis, who is negative for APS?

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?

What is your approach to initiating and titrating midodrine for both inpatient and ambulatory settings?

When is an appropriate time to consider genetic testing for cardiomyopathies for athletes as part of risk stratification for sudden cardiac death, in light of heightened prevalence of cardiac remodeling confounded by exercise and athletic conditioning?

What are your preferred ventilatory settings/mode(s) for patients with acute hypoxic respiratory failure presenting with severe biventricular dysfunction in cardiogenic shock?

Which molecular biomarkers do you favor to risk stratify patients (without CV risk factors) before and after undergoing treatment with cardiotoxic cancer treatments?

Among asymptomatic patients with structurally normal TTE undergoing treatment with anthracyclines or alkylating agents that develop mildly elevated BNP and/or troponin levels, would you consider referring them for cardiac MRI to evaluate for subclinical cardiotoxicity?

What is your approach to tapering therapy in a patient with recurrent pericarditis now well-controlled on rilonacept?

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?

Do you consider the use of bevacizumab in patients with HHT who have high output cardiac failure related to liver AVMs who also have cerebral AVMs?

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?

When do you start anticoagulation in a patient with cardioembolic CVA secondary to new onset atrial fibrillation with hemorrhagic conversion?

What are the alternatives to anticoagulation in an individual with an atrial thrombus and absolute contraindications to anticoagulation?

How does evidence of cerebral amyloid angiopathy/microbleeds affect choices for secondary stroke prevention in patients with a history of ischemic stroke and atrial fibrillation?

How do you approach secondary stroke prevention for patients with ischemic stroke, atrial fibrillation, and signs of cerebral amyloid angiopathy/micro...

How would you treat an elderly patient with borderline cardiac dysfunction who has stage 3 HR+ HER2- breast cancer?

Do you start anticoagulation in a patient with infective endocarditis who also has atrial fibrillation and stroke?

What are your considerations for peri-operative anticoagulation in patients with a mechanical heart valve undergoing a major noncardiac surgery?

Please comment on bridging.

For patients with atrial fibrillation on DOAC, when should they resume DOAC after a thalamic bleed without intraventricular bleed?

How does presence of intraventricular hemorrhage change your recommendations?

Do you consider 10MV beams safe in a patient with an implantable cardiac device?

Recent Japanese guidelines recommend <10MV beams, heart rhythm society and AAPM suggest up to 10MV beams are safe, recommending ≤10MV beams. Giv...

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?

What is your approach to CLL in patients with atrial fibrillation and/or on anticoagulation?

Do you feel comfortable with BTK inhibitors in these patients? In ELEVATE-RR patients on a/c were excluded, and rate of atrial fibrillation in the ac...

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 ...

What criteria do you use on echocardiogram and PFT to determine who needs further evaluation for CTD-associated pulmonary hypertension?

When is the best time to consider left atrial appendage closure for secondary stroke prevention in patients with atrial fibrillation?

For example, with a Watchman device? What is the evidence behind this?

When do you restart anticoagulation in patients with atrial fibrillation who just had an ischemic stroke?

How do you determine the timing of anticoagulation for patients with large MCA strokes secondary to atrial fibrillation?

For a patient with cardiac sarcoma, is there a minimum ejection fraction to proceed with adjuvant radiation therapy?

When is it necessary to monitor the QTc interval in patients on hydroxychloroquine?

Is dexrazoxane recommended for cardioprotection in AYA patients with Hodgkin lymphoma who are receiving anthracyclines as part of their upfront therapy?

Would you give anthracycline chemotherapy to a patient with HR+, HER2 negative inflammatory breast cancer who has history of cardiomyopathy with LVH and moderately reduced EF but most recent echo shows improvement to normal or near normal ejection fraction?

If no anthracycline, what alternative regimen would you consider?

Would you modify your initial treatment for a patient with de novo metastatic HR- HER2+ breast CA who has cardiomyopathy at baseline (EF < 35)?

Is there any safety data to proceed with TKIs/TDM-1 or to proceed as standard with THP?

What steroid sparing agent do you use for treatment of cardiac sarcoidosis?

Does the type of cardiac involvement impact this choice?

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

How do you balance short-course ADT in unfavorable intermediate risk prostate cancer patients with cardiac comorbidities?

Do you continue hydroxychloroquine in lupus patients who develop cardiomyopathy?

What is the utility and recommendation for adding troponin and/or BNP to echocardiograms to screen for cardiac dysfunction In breast cancer patients receiving anthracycline based regimens?

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

How do you approach the re-challenge with trastuzumab in metastatic HER2+ patients who develop cardiomyopathy on trastuzumab/pertuzumab with subsequent improvement with discontinuation?

Do you repeat the loading dose of trastuzumab?

What frontline treatment would you offer a patient with AITL who is not a candidate for an anthracycline due to baseline cardiomyopathy?

Would you recommend cardiac radiotherapy for malignant pericardial effusion refractory to pericardial fenestration?

Would you consider using radiotherapy for persistent malignant pericardial effusion? What dose-fractionation would you use, and what would your ...

What therapy would you recommend for metastatic myxoid liposarcoma in a young patient with anthracycline cardiomyopathy with EF 25% who failed eribulin?

Would you even consider trabectedin in this case given its cardiotoxicity?

Would you discontinue dabrafenib/trametinib in a patient with BRAF mutant metastatic lung cancer if you see mild cardiomyopathy which could be related to the drugs?

Patient does not want chemo but is tolerating these well otherwise.

Are the cardiac risks of LHRH agonists also seen in patients undergoing bilateral orchiectomy for ADT in hormone-sensitive prostate cancer?

Do you refer patients to cardiology if they have no history of cardiac disease but will be receiving XRT with high mean doses to the heart?

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...

How would you approach the management of newly diagnosed metastatic colon cancer in a patient who experienced infusional 5FU-related cardiotoxicity with initial chemotherapy?

When 5FU is a backbone to so many regimens, when (if ever) do you consider re-challenging so as not to abandon an entire line of therapy?

How would you modify therapy for a metastatic HER2+ breast CA who develops persistent cardiomyopathy after dual HER2 blockade with trastuzumab + pertuzumab?

What is your approach to adjuvant HER-2 directed therapy in a patient who developed cardiotoxicity following neoadjuvant TC-HP?

Can these patients be re-challenged with Herceptin?

How do you assess the risk of cardiotoxicity from HER2+ agents?

What is the rate of a cardiac events that you quote to a patient with preexisting heart disease going on trastuzumab for metastatic Her2+ breast cancer?

How does it vary for patients with a history of hypertension, diabetes, CHF, and coronary artery disease?

How do you minimize the risk of cardiotoxicity in metastatic Her2 + breast cancer patients who are receiving trastuzumab and have a history of pre-existing cardiac disease?

How are you using the data on cardiac morbidity in regards to the LV-V5 in breast cancer patients?

Is there a dose constraint you are using for LV-V5?https://www.ncbi.nlm.nih.gov/pubmed/28095159?dopt=Abstract

When would you consider using radiation for cardiac metastases?

Would you treat if the patient is asymptomatic? If you do treat with RT, what dose-fractionation would you use, and what volumes do you target?

For a young patient with stage 4 endometrial cancer with an excellent response to anthracyclines, would you continue to give anthracyclines beyond the standard dosage cap if cardiac function remains normal by echocardiogram?

What is your approach to left sided PMRT in patients with on-going cardiac issues (ie. cardiomyopathy, heart failure, coronary heart disease)?

How do you best counsel their radiation risks?

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?

Should we be more concerned about cardiac toxicity following breast radiotherapy?

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...