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.

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...

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

Ferrell et al., PMID 38448791

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?

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 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)?

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...

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 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%)?

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

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?

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

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

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?

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?

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...

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?

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

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 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?

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?

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?

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)

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

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?

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?

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?

6 Answers available

What are your top takeaways from ISHLT 2024?

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?

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?

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?

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?

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?

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

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...

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?

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?

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

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...

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?

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?

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

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?

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...

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

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?

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

Do you obtain serial cardiac PET scans?

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?

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?

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 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.

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

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

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?

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?

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

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 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?

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 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?

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 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?

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?

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?

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?

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?

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...

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?

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?

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?

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

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?

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...

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

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?

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

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

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...

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?

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 ...

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?

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

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

Does the type of cardiac involvement impact this choice?

Do you continue hydroxychloroquine in lupus patients who develop cardiomyopathy?

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