Cardiology
Expert discussions on heart failure, arrhythmias, interventional procedures, and cardiovascular risk management.
Recent Discussions
How would you counsel patients with Type 1 or Type 2 diabetes mellitus and heart failure on the use of SGLT-2 inhibitors when they have a history of DKA?
Making a recommendation to prescribe this class will really require a case-by-case clinical assessment. It is clear that SGLT-2 inhibitors are very effective in preventing hospitalization for heart failure, and so we will want to suggest their use whenever possible. But it is also clear that DKA (mo...
Do you accept a decline in eGFR during aggressive diuresis for heart failure if the patient is successfully decongesting, given data suggesting modest eGFR decline with improved congestion may still be associated with lower mortality?
Yes, I accept a modest decline in eGFR during diuresis in patients with heart failure. Previous studies of patients hospitalized with acute decompensated heart failure have shown that mortality and readmission rates are reduced by effective decongestion even if the creatinine rises. The study by Oka...
What is your approach to performing outpatient hemodialysis in patients with LVADs, particularly regarding blood pressure assessment and ultrafiltration management when Doppler measurements are required due to low pulsatility?
Doppler-based MAP monitoring via Doppler ultrasound with a sphygmomanometer is the primary method for blood pressure monitoring during hemodialysis in these patients with LVAD. Crit-Line monitoring during hemodialysis may potentially be useful in guiding the rate of ultrafiltration in these patients...
How frequently have you seen hypokalemia play a role in ventricular arrhythmias, and is there a baseline goal K level to aim for in these patients to lower the risk of arrhythmia recurrence?
I was very impressed with the results of the POTCAST study, which showed that, in patients who had an ICD and were at high risk for ventricular arrhythmias, a treatment-induced increase in plasma potassium levels led to a significantly lower risk of appropriate ICD therapy, unplanned hospitalization...
Are there robust clinical data on the safety of IV amiodarone for atrial fibrillation of unclear duration and very difficult to control HR in the current era of widespread DOAC use, as opposed to older data with warfarin?
In the current DOAC era, there are no prospective or randomized data specifically evaluating IV amiodarone administered for rate control in atrial fibrillation of uncertain duration. The principal safety concern is not the agent itself but the possibility of unintended pharmacologic cardioversion, w...
What are your top takeaways for the 2026 ACC/AHA lipid guidelines?
Kudos to the writing committee for this long-awaited update! The 2026 ACC/AHA Dyslipidemia Guideline officially replaces the 2018 standards, reflecting nearly a decade of new clinical evidence.Here are the 10 biggest shifts every clinician should know: The PREVENT Era is Here: We are moving beyond t...
What has been your approach to percutaneous intervention for calcified nodules and threshold for intervention?
Very high threshold for intervention in these cases. Generally, there is severe calcification all around and sometimes multiple calcified nodules. There has to be a strong indication for me to consider such cases. I generally start with rotational atherectomy (multiple runs) followed by angioplasty ...
Are there still clinical situations in which you deliberately treat patients with a DOAC besides apixaban?
Thank you for your question. Apixaban has been my preferred agent for a long time for patients requiring therapeutic anticoagulation. Apixaban’s lower bleeding risk was shown prior to and now has additional evidence to support this with the COBRRA trial. The risk is also ameliorated by the safety in...
What is your approach to treating patients with decompensated heart failure when their hypervolemia is refractory to oral furosemide?
Depending on the oral dose, it may just be a problem of underdosing or even perhaps non-adherence. We would typically transition to intermittent IV Lasix dosing with close monitoring, if minimal response, we can double the dose to try and get to the ceiling effect of Lasix, depending on the renal fu...
Is there a potential role that hormonal replacement therapy can play in contributing to the development of SCAD?
Spontaneous coronary artery dissection (SCAD) is an infrequent if not rare cause of acute coronary syndrome (ACS). SCAD is estimated to occur in 0.7-1.1% of acute infarctions. In patients, especially female, who present with an ACS but have a low risk profile for coronary disease, SCAD should be con...