AP Cardiology

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 physiology – 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 … Continue reading Plant Based Diets with Kim Williams →

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 … Continue reading False Positive Troponins →

UPDATED: 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. Frederick 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 … Continue reading HFpEF and Amyloid – Frederick Ruberg →

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. … Continue reading ACS Update – 2019 with James de Lemos →

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 … Continue reading Decompensated heart failure with Dr. Kittleson →

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 … Continue reading ASDs and VSDs with Amber Khanna →

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

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 … Continue reading Immune Checkpoint Inhibitors →

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 … Continue reading Cardio-Oncology →

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 … Continue reading Remote Monitoring in Heart Failure →

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 … Continue reading Atrial Fibrillation →

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 … Continue reading Listener Survey →

What patients should you be testing for cardiac amyloidosis? In this episode, I talk with Dr. Daniel Lenihan, an expert in cardiac amyloidosis. We review the exciting advances in the field of cardiac amyloidosis from epidemiology to treatments. You might be surprised to hear how common this condition is. Links to articles referenced: 1) Cardiac amyloid … Continue reading Cardiac Amyloidosis – Dr Lenihan →

In this episode I visit with Dr. John Gorcsan, an expert in echocardiography and strain imaging, to discuss the utility of ejection fraction. We discuss how EF came to be used in clinical practice, the importance of it in heart failure and the variation in measurement. We introduce strain imaging and what that adds to … Continue reading Beyond Ejection Fraction with Dr John Gorcsan →

In this episode I meet with Dr Murali Chakinala, an expert in pulmonary hypertension at Washington University in St Louis. We review the groupings of pulmonary hypertension, diagnosis and management considerations.

In this episode I visit with Dr Richard Bach, the director of the Hypertrophic Cardiomyopathy Center at Washington University. We talk about everything from diagnosis, risk of exercise, medical management, indications for myectomy and alcohol ablations. Link to transcript on MedPage Today

The first patient treated with tPA in an acute myocardial infarction was at Barnes-Jewish Hospital. In this episode, I talked with one of the key players in making that happen, Dr Phil Ludbrook. It’s a great bit of medical history that I hope you enjoy! Link to original case series of 7 patients published in … Continue reading History of tPA in acute MI with Dr Phil Ludbrook →

Second part with Dr Karen Joynt Maddox discussing alternative payment models. In part one, we discussed the history of how quality measures began to be collected to being used in current reimbursement. In part two, we discuss some of the limitations of these models and the unanticipated consequences on some populations. Link to transcript on … Continue reading Alternative Payment Models Part 2 with Dr Karen Joynt Maddox →

The way we pay for medical care is changing. In this first episode of a two-part series, Dr Karen Joynt Maddox explains the history of the transition towards a quality based system. See her article in the New England Journal of Medicine here. Link to transcript on MedPage Today

I visited with Dr Linda Peterson about cardiac rehab. We review who qualifies for referral, what cardiac rehab is, the benefits and the challenges for patient participation. In the podcast, I reference a few articles regarding the mortality benefit. Links are found below: JACC 2016 Meta-analysis Mayo study of post-CABG patients Mayo study of post-PCI … Continue reading Cardiac Rehab →

In collaboration with Dr Clifford Robinson (RadOnc), Dr Phillip Cuculich helped pioneer a completely noninvasive method to identify the origin of ventricular tachycardia and treat with radiation. Dr Cuculich and I talked about the trial, how it came about, and we learn from the results. See the manuscript published in the New England Journal of … Continue reading Noninvasive radiation for VT →

I met with Dr Kathryn Lindley to talk about peripartum cardiomyopathy. Dr Lindley’s research and clinical focus is in this area, and really helped me understand this disease better. We review the risk factors, clinical manifestations, diagnostics and treatment considerations. Link to transcript on MedPage Today

I discuss an interesting case I recently encountered on the wards with a brief review of the general principles of presentation and treatment.

In this episode I talk with Dr Alan Zajarias about TAVR (transcatheter aortic valve replacement). We talk about how candidates are evaluated and current research. Link to transcript on MedPage Today

Dr David L Brown and Dr Richard Bach discuss the recent ORBITA trial. Dr Brown co-authored the accompanying editorial in the Lancet and Dr Bach is an interventional cardiologist. Link to transcript on MedPage Today

I met with the director of the Health Systems Innovation Laboratory at Washington University School of Medicine, Dr Thomas Maddox, MD, and we talked about PCSK9 inhibitors. Where did the idea for these drugs come from, how effective are they, and why are they not used more in current practice? Link to transcript on MedPage … Continue reading PCSK9 Inhibitors →

In this episode I visit with Dr Mike Rich and discuss stress testing. We review the various modalities, whom to send for stress testing and the prognostic utility of stress testing. Link to transcript on MedPage Today