Cardiology
Expert discussions on heart failure, arrhythmias, interventional procedures, and cardiovascular risk management.
Recent Discussions
What are your top takeaways from ACC 2026?
From the arrhythmia perspective, and in my opinion, there were 3 studies of note at the ACC: Champion-AF that demonstrated non-inferiority for LAAO closure devices versus NOACs for stroke prevention and superiority in terms of bleeding (but not of major bleeding). Although the topline results were e...
When do you think physicians should seriously consider prescribing PCSK9 inhibitors for the prevention of heart attack and stroke in people with ASCVD or diabetes, based on the results of the VESALIUS-CV trial?
Although I checked 'high lipoprotein (a) as a reason to go with a PCSK9 first, I would almost never do it is practice. Statins first and then add a PCSK9 if LDL is above my goal for the patient. I might use a lower dose of the statin to get 35% lowering and then add the inhibitor if the patient was ...
Would you perform a diagnostic paracentesis for first-time ascites in a patient with established CHF or pulmonary hypertension, but without apparent liver or other intra-abdominal disease?
Great question. Yes, we should perform a diagnostic paracentesis for first-time ascites, even in patients with established CHF or pulmonary hypertension, unless there is an obvious alternative explanation and the procedure is unsafe or technically not feasible. After the etiology is established, rep...
What aspects of HF management do you think hospitalists should prioritize before discharge in order to optimize HF admission care if there are limited resources available for specialized HF care, both inpatient and outpatient?
This is straightforward - many patients have poor discharge education on fluid and salt management. Recommendations for 50 oz and 2 gm/day salt are given, but what is this truly like in practice? Our article (Sharma & Goswami, PMID 38486616) suggests that we may need to focus on the basics for salt ...
Do you discontinue amlodipine or use an alternative approach to manage peripheral edema when it occurs as a side effect of the medication?
Peripheral edema is a common complaint and can be exacerbated by any vasodilator therapy, including hydralazine and minoxidil. My initial approach to swelling is to 1) make sure there is no proteinuria, which can be easily overlooked in a diabetic who infrequently sees doctors; 2) assess heart and l...
How do you decide between stereotactic arrhythmia radiation (STAR) and repeat catheter ablation in patients with refractory ventricular tachycardia who have already failed one prior ablation?
This is a great question and something that the ongoing RADIATE-VT trial is working to answer (NCT05765175). In this phase III RCT trial, recurrent VT patients who have had at least one prior catheter ablation, are considered to be candidates for a repeat catheter ablation by their electrophysiologi...
What clinical features drive your decision to use prophylactic mechanical circulatory support in a patient with severe left ventricular dysfunction undergoing complex PCI following the CHIP-BCIS3 trial?
I will start by acknowledging that CHIP-BCIS3 did not provide evidence to support the routine use of a prophylactic microaxial flow pump (mAFP) device in complex, high-risk interventional procedures for adults with severely reduced left ventricular ejection fraction.The relatively small size of the ...
Is there a role for measuring plasma aldosterone to guide the treatment of heart failure in specific populations?
Typically, there is no role in measuring aldosterone to guide therapy. In patients with HFpEF, the use of Aldactone is to help with membrane stabilization and management of RAAS inhibition. There are some reports of prior research supporting LV remodeling and reduction in myocardial fibrosis.
When should you consider adding clonidine to an antihypertensive regimen for patients with advanced CKD?
Clonidine patch is useful in severely uncontrolled hypertension. In patients with CKD, not responding to conventional medications - like calcium blockers. Though the side effect profile is not great, it is less expensive and practical.
When would you consider endomyocardial biopsy for newly noted LVH with genetic testing significant for MYH7 mutation but also a TTR VUS also present?
This is an interesting question. However, it is important to know further information about the patient, such as age, sex, family, history, and the specific variant of unknown significance in the TTR gene (since some so called variants of unknown significance have descriptions in the literature that...