In this episode I visit with Dr. Chris Burke from the University of Washington to discuss aortic valve repair. Dr. Burke is a cardiac surgeon with an interest in complex aorta and aortic valve surgery. He provides useful insights into the evaluation of aortic valve disease and what patients may be good candidates for repair. … Continue reading Aortic Valve Repair – Dr. Chris Burke →

I am joined by Shreyas Venkataraman, MD, an internal medicine resident at Barnes-Jewish Hospital in St Louis to continue our physical exam series. In this episode we talk about mitral regurgitation and the associated physical exam findings that help increase (or decrease) your likelihood of MR. Links: Evidence-Based Physical Diagnosis The Correlates of an Abnormal … Continue reading Physical Exam Series: Mitral Regurgitation →

In this episode I visit with Dr. Melissa Robinson from the University of Washington to discuss the management of ventricular tachycardia. Our discussion focuses on decisions regarding ICD implantation, anti-arrhythmic drugs and catheter ablation. Through 3 cases that highlight the heterogeneity of VT, we talk about the nuances of these decisions. Links to articles referenced: … Continue reading Ventricular Tachycardia – Dr. Melissa Robinson →

I met with Dr. Eric Krieger from the University of Washington Adult Congenital Heart Disease group to talk about patients with the Fontan palliative shunt. This shunt is used to help infants born with single ventricle physiology survive into adulthood. We discuss the case of an infant born with tricuspid atresia, review the initial surgeries … Continue reading Caring for patients with Fontan shunts – Eric Krieger →

I am joined by co-fellow Alex Taylor, MD and we visit with Alec Moorman, MD to discuss coronary artery disease in patients with chronic kidney disease. We talk about the recent ISCHEMIA-CKD trial, the nuances of treating patients with CKD and CAD and how to handle referrals for cardiac risk assessment prior to kidney transplant. … Continue reading Coronary Artery Disease and Chronic Kidney Disease – Dr. Alec Moorman →

I visit with Dr. Gopalan from Banner University in Phoenix, AZ to discuss his experience with morbidly obese patients with heart failure. We talk about the association of obesity with heart failure, how weight loss can impact functional capacity and the role of bariatric surgery. Links: Bariatric surgery among patients with heart failure: a systematic … Continue reading Bariatric Surgery in Heart Failure – Dr. Gopalan →

I am joined by Shreyas Venkataraman to discuss the physical exam findings of aortic stenosis and how they can help us with the diagnosis and grading of aortic stenosis. We share 2 examples of heart murmurs, discuss likelihood ratios and the physical exam finding that is most consistent with severe aortic stenosis.

I visit with Dr. Jane Wilcox from Northwestern University to discuss patients with heart failure that later have normalization of their ejection fraction (HFrecEF). We discuss how this population is different from other heart failure populations and common issues in managing them. Links: TRED-HF Myocardial Recovery versus Myocardial Remission Penn Heart Failure Study

I visited with Dr Kim Williams, former president of the ACC, to discuss the cardiovascular benefits of a plant based diet. Using stories of patient encounters he shares pearls to take to the bedside and how to talk to patients about plant based diets. Links: PREDIMED International Journal of Disease Reversal and Prevention Review of current evidence and clinical recommendations on the effects of low-carbohydrate and very-low-carbohydrate (including ketogenic) diets for the...

I visit with Robert Christenson PhD about the troponin assays and how they can be falsely positive from anti-body mediated interference. I present a case and we discuss the mechanisms which create the false positives (or negatives) with the assays, how manufacturers are trying to mitigate them and the emerging challenge of biotin supplements. References (hyperlinks on apcardiology.com): Arshed et al. Elevated Troponin I in the Absence of Coronary Artery Disease: A Case Report With...

I visited with Dr. Candice Silversides at the American Heart Association Meeting in November 2019. We talk about her area of expertise, pregnancy in adults with congenital heart disease. Links: ESC Guidelines on the Management of Cardiovascular Diseases During Pregnancy AHA Management of Pregnancy in Patients With Complex Congenital Heart Disease

I met with Dr. Rick Ruberg from Boston University to discuss his talk from AHA 2019 titled “HFpEF: It’s a Diagnosis of Exclusion, So Exclude Other Causes!” We discuss what the diagnosis of HFpEF entails and then dive into cardiac amyloidosis and what populations should be screened for amyloid. Links to papers work via apcardiology.com Links: Unveiling transthyretin cardiac amyloidosis and its predictors among elderly patients with severe aortic stenosis undergoing transcatheter aortic...

I caught up with Dr. James de Lemos from UT Southwestern at the 2019 American Heart Association meeting to discuss a number of updates in acute coronary syndromes. We cover a number of recent trials that are shaping how we think about ACS management from medications, stent deployment and the mechanism we might be overlooking. Links to articles: ISAR-REACT 5 TWILIGHT POPular Genetics COMPASS

In this episode I visit with Dr. Michelle Kittleson (@MKIttlesonMD) of Cedars-Sinai to discuss evaluation and management of patients admitted with acute decompensated heart failure. We review the etiologies for decompensation, what to do with beta-blockers or RAS inhibitors and how to setup the patient for a successful discharge. Links to papers: Effects of Beta-blocker Withdrawal Meta-Analysis Early worsening renal function after initiation of ACE inhibitor, Testani Circulation...

In this episode I visit with Dr. Amber Khanna of the University of Colorado about some of the “simple” congenital heart defects. We discuss atrial septal defects (ASD) and ventricular septal defect (VSD). We review useful testing to diagnose and evaluate these defects and the indications for closure. Links: 2018 ACC/AHA Guidelines for the Management of Adults with Congenital Heart Disease Adult Congenital Heart Association

In this episode I visit with Dr. Eugene Yang to discuss the update to hypertension guidelines published in 2017 by the ACC/AHA. I asked him what were the major changes and which patients should be treated to a target of 130/80 and practical aspects to management. Links: 2017 ACC/AHA Hypertension Guidelines

Following up on our last discussion with Dr. Daniel Lenihan, we address the subject of immune checkpoint inhibitors and the associated cardio-toxicities. Immune checkpoint inhibitors “ease the brakes” of the immune system leading to dramatic improvements in some cancers, but rarely this can lead to profound cardiovascular compromise. Hyperlinks to references on apcardiology.com References: Cardiovascular toxicities associated with immune checkpoint inhibitors Fulminant myocarditis...

I visited with Dr. Daniel Lenihan and spoke with him about cardio-oncology and some of the common issues and concerns that arise. Cardio-oncology is a very broad field and revolves around managing cardiovascular toxicities associated with cancer therapies. We discuss the classic example of anthracycline toxicity and touch on some of the newer therapies (immune checkpoint inhibitors). JACC CardioOncology Journal Preparing the Cardiovascular Workforce to Care for Oncology Patients...

Dr. Caroline Kahle discussed a few cases I’ve encountered during medical training. How do we perceive end of life care or code situations in complex situations? We talk about non-beneficial medical care, physician communication and some pearls Dr. Kahle has learned in her experiences in medical ethics.

I met with Dr. Thomas Maddox, the director of the Health Systems Innovation Lab at BJC/WashU, to discuss an upcoming pilot program to remotely monitor patients with heart failure. The lab has partnered with Myia Labs using technology they have developed to monitor these patients at home. We discuss the ‘ballistocardiograph’ and how they are planning to incorporate it into clinical practice. Health Systems Innovation Lab

In 2002, NEJM published the AFFIRM trial, showing no difference in outcomes between patients with atrial fibrillation treated with rate or rhythm control strategy. But does that mean rate control should be the default treatment method? In this episode I discuss this topic with Dr. Mitch Faddis and Dr. Philip Cuculich and their approach to this decision. Articles referenced: AFFIRMMANTRA-PAFIntermountain Health StudyCASTLE-AFCABANA

I met with Dr. Alan Braverman to talk about aortic diseases (aka aortopathies) such as Marfan’s disease, Ehlers-Danlos and Loeys-Dietz. We discuss everything from clinical presentations and genetics to treatments. Articles referenced: NEJM Atenolol vs Losartan in Marfan’s

Dr Christie Ballantyne is the chief of cardiology and cardiovascular research at Baylor College of Medicine. He gave grand rounds on cardiovascular disease prevention at Washington University in St. Louis. I interviewed him about the commonly used risk calculators and how he assesses cardiovascular risk in the office. REDUCE-IT Trial on NEJM.org

AP Cardiology is coming up on one year next month and with that milestone, I wanted to ask for your participation in a short survey. There are 5 questions, and I’m just want to get an idea of who my audience is (so I can tailor the episodes better), what you enjoy and get any feedback you have for the show. Shouldn’t take more than a minute or two, and I’d greatly appreciate it! Link to survey Or copy and paste into your browser: https://goo.gl/forms/SqZerWBbd5UCbEu83