Podcasts about Cardiology

Listener feedback on valvular heart disease, statins and frailty, left atrial posterior wall ablation fails again, interpreting medical tests and AI ECG reading are the topics John Mandrola, MD, discusses in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I Listener Feedback PREVUE-VALVE Study https://www.jacc.org/doi/10.1016/j.jacc.2026.02.5137 II Statins and Frailty Statin Initiation Tied to Lower Frailty Risk in Older Adults https://www.medscape.com/viewarticle/statin-initiation-tied-lower-frailty-risk-older-adults-2026a1000lec Statins and Survival Free of Incident Frailty  https://doi.org/10.1093/eurheartj/ehag451 III LA Posterior Wall Isolation Fails Again CORNERSTONE Trial https://doi.org/10.1093/eurheartj/ehag486 CAPLA Trial https://jamanetwork.com/journals/jama/fullarticle/2800186 IV Does the Display of Test Results Improve Clinical Decisions? Interval Likelihood Ratios for Clinical Decsion-Making https://evidence.nejm.org/doi/full/10.1056/EVIDoa2500249 Making Sense of Health Statistics https://journals.sagepub.com/doi/full/10.1111/j.1539-6053.2008.00033.x V AI and the ECG and Saving Doctors Case Report — AI-Enhanced Diagnostics https://www.nature.com/articles/s41591-026-04454-y The New York Times article https://www.nytimes.com/2026/06/22/health/artificial-intelligence-heart-damage.html You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

This week we review a recent meta-analysis of studies assessing efficacy of adenosine in children to terminate SVT. Does the PALS recommendation of 100 mcg/kg as a starting dose for SVT management make scientific sense given what we know about the efficacy rates of this dose? Why might inadequate doses be potentially dangerous for children with acute SVT? Is there adequate data to consider changes to the recommended starting dose in this situation? Dose adenosine work well for all forms of tachycardia involving the AV node? Pediatric emergency physician and family medicine physician, Dr. Lais dos Santos of Mossoro', Brazil shares the results of a large scale meta-analysis that she performed and offers some answers to these and other questions. DOI: 10.1007/s00246-026-04281-5

The newest AHA and ACC guidelines for treating dyslipidemia are here — and according to Dr. Kim Williams, they mark a powerful shift toward prevention, earlier testing, and whole-food, plant-based nutrition as the foundation of cardiovascular care.Rip welcomes back Dr. Kim Williams, past president of the American College of Cardiology, for a practical and deeply encouraging breakdown of what these updated cholesterol guidelines mean for everyday people.Dr. Williams explains why cardiovascular risk is no longer just about one cholesterol number. Instead, clinicians are being encouraged to look at the whole picture: LDL cholesterol, ApoB, Lp(a), inflammation, blood pressure, blood sugar, kidney function, family history, lifestyle, and coronary artery calcium when appropriate.The most exciting part for the PlantStrong community? Lifestyle optimization is now treated as the clinical foundation — and Dr. Williams is clear about what that means: a whole-food, plant-based diet built around beans, grains, nuts, seeds, fruits, vegetables, and mushrooms, along with exercise, sleep, mindfulness, strong social connections, and avoidance of tobacco, alcohol, and other harmful substances.This conversation also tackles statins, PCSK9 inhibitors, Lp(a), coronary calcium scoring, and the new philosophy of treating risk lower, earlier, and longer — always with food first, and medication when needed.Key TakeawaysThe new cholesterol guidelines emphasize lifestyle first, not lifestyle as an afterthought.Dr. Williams says a whole-food, plant-based diet should be built around beans, grains, nuts, seeds, fruits, vegetables, and mushrooms.LDL cholesterol is still important, but it is no longer the only number that matters.ApoB may give a clearer picture of risk in some people, especially those with diabetes, high triglycerides, or central obesity.Lp(a) is largely genetic and should be measured at least once in adulthood; the 2026 guideline includes updated recommendations for elevated Lp(a).Coronary artery calcium scoring can help personalize risk and guide LDL targets.Dr. Williams emphasizes that the goal is not “plants versus statins.” It is whole plant foods first, medications when needed.The overall prevention philosophy is: lower, earlier, longer.Watch the Episode on YouTube: https://youtu.be/6cD8tGpsAggLearn More About our 2026 Live PLANTSTRONG Events: https://plantstrongevents.com/ Let Us Help Your PLANTSTRONG JourneyLearn More About Our Corporate Wellness Program: https://liveplantstrong.com/corporate-wellness/ COMPLEMENT: Use code PLANTSTRONG for 30% off at https://lovecomplement.com/pages/plantstrong-special-offer Follow PLANTSTRONG and Rip Esselstynhttps://plantstrong.com/ https://www.facebook.com/GoPlantstrong https://www.instagram.com/goplantstrong/https://www.instagram.com/ripesselstyn/ Follow the PLANTSTRONG Podcast and Give the Show a 5-star RatingApple PodcastsSpotify

This episode is part of our comprehensive Decipher the Guidelines Series covering the 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes.  The following question refers to Section 5.2.1 of the 2025 ACS Guidelines. The question is asked by Thomas Jefferson medical student and CardioNerds Academy Intern Dr. Grace Qiu, answered first by Henry Ford Interventional cardiology fellow and member of the CardioNerds Interventional Cardiology Council Dr. Li Pang, and then by expert faculty Dr. Michelle O'Donoghue. Dr. O'Donoghue is a cardiologist, senior investigator with the TIMI Study Group, and Associate Professor of Medicine at Harvard Medical School who holds the McGillycuddy-Logue Endowed Chair in Cardiology at Brigham and Women's Hospital. She was the Vice Chair of the Writing Committee for the 2025 ACS Guidelines. Question #2 A 63-year-old woman presented to the emergency room for chest pain. She described having exertional chest pain for the past two months and had an episode of severe pain after dinner 3 days ago. She went to bed and slept it off.  She told her children today at a family gathering, and was immediately brought to the ED by her daughter. She has a history of hypertension and hyperlipidemia. She was asymptomatic and normotensive in the ED. Labs show a down-trending troponin and an elevated NT-proBNP but are otherwise unremarkable. Her ECG showed Q waves with ST elevation in V2-V4. She was treated with aspirin and heparin drip, and taken to the cath lab. Coronary angiogram showed complete proximal LAD occlusion with right-to-left collaterals, without significant residual disease elsewhere. She remains asymptomatic and is stable, both hemodynamically and electrically. What is the next best step with regard to reperfusion and anti-thrombotic management? A Proceed with primary PCI to LAD  B Medical management with aspirin and enoxaparin  C Medical management with aspirin and clopidogrel D Medical management with aspirin and ticagrelor   Answer #2 Explanation  The Correct answer is D In patients who are stable with STEMI and have a totally occluded infarct-related artery >24 hours after symptom onset and are without evidence of ongoing ischemia, acute severe HF, or life-threatening arrhythmia, PPCI should not be performed due to lack of benefit. (Class 3, LOE B-R) The benefit of PPCI begins to diminish after >12 hours from symptom onset, but there appears to be continued benefit through approximately 24 hours.  In stable asymptomatic patients with an occluded artery >48 hours after symptom onset, routine PCI has not been shown to be beneficial in the absence of ongoing ischemia. The relative utility of routine PCI for asymptomatic patients with STEMI between 24 and 48 hours from symptom onset is less rigorously tested. PCI is not recommended for an occluded infarct-related artery if the patient is asymptomatic and has a completed infarct. MACE outcomes were similar in those with an occluded infarct-related artery who underwent medical therapy versus those who underwent PCI 3 to 28 days after an MI (Occluded Artery Trial [OAT]), and results were no different at 7-year follow-up. Similar findings were noted in the DECOPI (Desobstruction Coronaire en Post-Infarctus) trial, which enrolled patients with an occluded artery and Q waves on the ECG presenting 2 to 15 days after symptom onset. However, coronary revascularization should be considered for patients with late presentations with continued signs and symptoms of ischemia, including cardiogenic shock, acute severe HF, persistent angina, and life-threatening arrhythmias.  Main Takeaway In patients who are stable with STEMI who have a totally occluded infarct-related artery >24 hours after symptom onset and are without evidence of ongoing ischemia, acute severe HF, or life-threatening arrhythmia, PPCI should not be performed due to lack of benefit. Guideline Loc. Section 5.2.1 

CardioNerds (Amit and Dan), Billy Joe Mullinax, and Saahil Jumkhawala discuss the long term management of pulmonary embolism with Dr. Soophia Naydenov.  The episode focuses on the approach to patients who struggle with persistent symptoms like dyspnea and fatigue even after completing the acute phase of anticoagulation. This spectrum of disease, ranging from mild post-PE impairment to chronic thromboembolic pulmonary hypertension (CTEPH), requires a structured follow-up. The discussion covers the critical importance of identifying CTEPH early, the necessary timelines for follow-up, and the appropriate objective screening tools and invasive testing to guide patient care toward full functional recovery. Audio editing by CardioNerds academy intern, Grace Qiu. Dr. Dinu Balanescu and Dr. Billy-Joe Mullinax are Co-chairs for the CardioNerds PE Series, developed in collaboration with the PERT Consortium.   Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. CardioNerds Pulmonary Embolism PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Acronyms PE: Pulmonary Embolism PERT: Pulmonary Embolism Response Team CTEPH: Chronic Thromboembolic Pulmonary Hypertension QL: Quality of Life VTE: Venous Thromboembolism DASH: D-dimer, Age, Sex, History of non-provoked PE (a risk score) CPET: Cardiopulmonary Exercise Testing PFTs: Pulmonary Function Tests VQ Scan: Ventilation-Perfusion Scan DOACs: Direct Oral Anticoagulants TPA: Tissue Plasminogen Activator (Thrombolytics) ECMO: Extracorporeal Membrane Oxygenation Pearls: Post-PE “Syndrome” is a Spectrum: It is more accurately a spectrum of disease (sequelae of PE) rather than a single syndrome, ranging from mild fatigue/dyspnea to the most severe form, CTEPH. Structured Follow-up is Mandatory: All PE survivors need a structured follow-up, typically with checkpoints at 3, 6, 12, and 16–24 months, with the primary goal being to detect CTEPH, the deadliest, yet potentially curable, disease on the spectrum. Screening Should Be Objective and Practical: When screening for persistent symptoms, use objective assessment tools like the Post-VTE Functional Status (PVFS) scale or the Modified Medical Research Council (MMR-C) scale, as highly comprehensive but cumbersome tools (like the PE Quality of Life questionnaire) may not be practical for routine clinical use. Recurrence Risk Scores Aid in Anticoagulation Duration: Simple scores like the DASH score or the HERDO2 score (for women) can provide guidance when considering the continuation versus discontinuation of anticoagulation after the initial treatment phase. Invasive Testing for Persistent Symptoms: If a patient remains symptomatic at the 6-month mark despite normal non-invasive testing (chest X-ray, ECG, PFTs, six-minute walk, echo, VQ scan, CPET), consider invasive testing such as Right Heart Catheterization (RHC) at rest or with exercise, or an invasive CPET. Notes: Notes drafted by Saahil Jumkhawala. 1. The Spectrum of Post-PE Disease The term “post-PE syndrome” should be used with caution, as it refers to a spectrum of disease rather than a single entity. This spectrum includes symptoms (sequelae) that exist in a patient’s life following an incidental PE event that they did not have before. On one extreme is Chronic Thromboembolic Pulmonary Hypertension (CTEPH): The definition is clear, but it is the most deadly type, though thankfully rare (2% to 4%). It involves a residual clot and pulmonary hypertension identifiable at rest. In the middle is Chronic Thromboembolic Disease (CTED): Patients may have residual defects seen on a VQ or CT scan, but they do not have pulmonary hypertension. On the other side is a milder disease, which can include fatigue, dyspnea, or a patient’s perceived impairment, where the definitions of CTEPH and CTED are not met, but the patient remains symptomatic. 2. Structured Follow-up and Screening for Post-PE Symptoms Structured follow-up is key for all PE survivors, though the structure may vary based on available resources (PCP, Cardiology, Pulmonary, or multidisciplinary clinic). Recommended Timeline for Follow-up: Data from studies like ELOPE and FOCUS suggest checkpoints at 3, 6, 12, and up to 16 to 24 months. This timeline is designed to identify patients who may develop CTEPH. 88% of patients who develop CTEPH will be identified within about a year. A structured follow-up can reduce the delay in CTEPH diagnosis from 10–12 months to 4–6 months. Personal Practice Note: A quick 2–3 week/30-day check-in is recommended for severely ill patients (e.g., those who had TPA, profound shock, or ECMO support) to ensure medication compliance, manage symptoms, and identify red flags. Screening Tools (Objective Assessment): The first step is an inventory of patient symptoms, leaning toward objective rather than subjective assessment. Recommended Simple Tools: Modified Medical Research Council (MMR-C) for dyspnea evaluation. Post-VTE Functional Status (PVFS) scale. The Pulmonary Embolism Quality of Life (QL) questionnaire is comprehensive but long, making it tedious and better suited for research. Future Utility: Technology (AI/electronic tools) may assist in administering these questionnaires before the clinic visit, presenting the information as a “dashboard” for the provider. 3. Management of Persistent Symptoms and Further Testing Initial Non-Invasive Tests (Often done at 3 months): Echocardiogram VQ Scan Full PFTs Six-minute walk CPET Further Evaluation for Persistent Symptoms (e.g., at 6 months): If non-invasive tests (Chest X-ray, ECG, CPET) are normal but symptoms persist, more invasive testing should be considered as the patient has not returned to baseline. Repeat VQ scan or echocardiogram if symptoms have changed. Right Heart Catheterization (RHC) at rest or with exercise. Invasive CPET. PA gram (Pulmonary Angiogram) to assess vasculature. 4. Recurrence Risk and Anticoagulation Duration The decision to continue or discontinue anticoagulation depends on the patient’s risk factors, the situation of the PE (provoked or unprovoked), presence of active cancer, and patient preference. Recurrence Risk Scores: Simple scores are preferred for practicality. DASH Score. HERDO2 Score (particularly for women). The Vienna Score can be considered if the question is whether to restart anticoagulation after a disruption. Role of D-dimer in Abbreviation: While D-dimer can be used to guide the decision to restart anticoagulation after a planned pause (if D-dimer is high, resume), patient symptoms are preferable to guide management decisions like early abbreviation. 5. Prevention of Post-PE Syndrome Currently, there is no clear tool known to prevent the post-PE syndrome/spectrum of disease. Best Current Advice for Prevention/Recovery: Anticoagulation compliance. Pulmonary rehabilitation, which aids in faster recovery. General precautions, such as smoking cessation and body weight management. Future Research: Ongoing trials are investigating whether acute management strategies (e.g., using thrombolytics in intermediate-risk PE) can prevent long-term sequelae. (The PYTHO trial did not show a reduced rate of CTEPH in intermediate-risk PE patients who received thrombolytics). References: Khan, F., Tritschler, T., Kahn, S. R., & Rodger, M. A. “Venous Thromboembolism.” The Lancet, vol. 398, no. 10294, 2021, pp. 64-77. doi:10.1016/S0140-6736(20)32658-1. Kearon, C., & Kahn, S. R. “Long-Term Treatment of Venous Thromboembolism.” Blood, vol. 135, no. 5, 2020, pp. 317-325. doi:10.1182/blood.2019002364. Kahn, S. R., & de Wit, K. “Pulmonary Embolism.” The New England Journal of Medicine, vol. 387, no. 1, 2022, pp. 45-57. doi:10.1056/NEJMcp2116489. Di Nisio, M., van Es, N., & Büller, H. R. “Deep Vein Thrombosis and Pulmonary Embolism.” The Lancet, vol. 388, no. 10063, 2016, pp. 3060-3073. doi:10.1016/S0140-6736(16)30514-1. Chopard, R., Albertsen, I. E., & Piazza, G. “Diagnosis and Treatment of Lower Extremity Venous Thromboembolism: A Review.” JAMA, vol. 324, no. 17, 2020, pp. 1765-1776. doi:10.1001/jama.2020.17272.

More than 60% of maternal deaths occur during the postpartum period, and hypertensive disorders of pregnancy are a major, preventable driver of that statistic. For too long, the transition from labor and delivery to home has been a vulnerable blind spot—leading to high rates of avoidablereadmissions. But the landscape has shifting. In this episode, we are diving deep into why OB providers must optimize blood pressure control before and after postpartum discharge. We'll be breaking down the landmark 2025 MOPP study, which shook up our traditional targets by examining tight versus standard blood pressure control, alongside the recently released May 2026 ACC Expert ConsensusDecision Pathway.What is the actual "goal BP" for a safe postpartum discharge? When should we initiate outpatient tight control, and how do we prevent these patients from bouncing back to the ED? Grab your coffee and pull up a chair. Let's look at the evidence.20% DISCOUNT: https://strongcoffeecompany.com/discount/CHAPANOSPINOBG1.          Gibson K, Hameed A. Society for Maternal-Fetal Medicine Special Statement: Checklist forpostpartum discharge of women with hypertensive disorders. AJOG, 2020. 2.          Farahi N, Oluyadi F, Dotson AB. Hypertensive Disorders of Pregnancy. American Family Physician. 2024. 4.          Lindley KJ, Bello NA, Berlacher KL, et al. Optimization of Postpartum Care for Patients With and at Risk for Premature and Long-Term Cardiovascular Disease: 2026 ACC Expert Consensus. Journal of the American College of Cardiology. May 2026. 5.          ACOG Task Force on Hypertension in Pregnancy, 20136.          Rosenfeld EB, Sagaram D, Lee R, et al. Management of Postpartum Preeclampsia and Hypertensive Disorders (MOPP): Postpartum Tight vs Standard Blood PressureControl. JACC. Advances. 2025.

Listener feedback, more long-term data on the TAVR/SAVR question, population prevalence of valvular heart disease in the US, and a CMS proposal to expand TAVR coverage are the topics John Mandrola, MD, discusses in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I Listener Feedback ICD Trends and Outcomes: 15-Year Analysis https://doi.org/10.1093/europace/euag110 MADIT-RIT https://www.nejm.org/doi/full/10.1056/NEJMoa1211107 II More Long Term Data on TAVR vs SAVR PARTNER 2 Trial https://www.jacc.org/doi/10.1016/j.jacc.2026.03.169 10-Year Outcomes of SAPIEN 3 TAVR or SAVR in Intermediate-Risk Patients https://doi.org/10.1016/j.jacc.2026.03.170 TAVR at a Decade: Editorial https://doi.org/10.1016/j.jacc.2026.04.042 EVOLUT Trial https://www.jacc.org/doi/10.1016/j.jacc.2026.02.5063 Updated 5-year Outcomes of TAVR vs SAVR in AS https://heart.bmj.com/content/early/2026/02/11/heartjnl-2025-327092 NOTION Trial https://doi.org/10.1093/eurheartj/ehae043 PARTNER 3 Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2509766 NOTION 2 Trial https://academic.oup.com/eurheartj/article/45/37/3804/7673297 TAVR vs SAVR Editorial : https://academic.oup.com/eurheartj/advance-article-abstract/doi/10.1093/eurheartj/ehag407/8708044 III The PREVUE-VALVE Study PREVUE-VALVE Study https://www.jacc.org/doi/10.1016/j.jacc.2026.02.5137 IV CMS has Proposed New Coverage for TAVR CMS Proposal Document https://www.cms.gov/medicare-coverage-database/view/ncacal-decision-memo.aspx?proposed=Y&ncaId=321 You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

This week we review a recent report of a novel form of CPVT (catecholaminergic polymorphic ventricular tachycardia) with associated neurodevelopmental delays. What is the genetic basis for these patients? What is different about the arrhyhthmias seen and how they are triggered in this variant? Should all patients with CPVT be screened for neurodevelopmental delays? Should those with neurodevelopmental delays and RYR2 variants be screened for CPVT? Associate Professor of Peditrics at Baylor College of Medicine/Texas Children's Hospital, Dr. Christina Miyake, shares her deep insights this week. doi: 10.1161/CIRCEP.124.013437

Primary stroke prevention is a critical opportunity for neurologists, with most stroke risk driven by modifiable factors such as hypertension and lifestyle behaviors. This episode highlights practical tools and strategies, including Life's Essential 8 and contemporary risk calculators, while also exploring evolving approaches to shared decision making and secondary prevention. In this episode, Katie Grouse, MD, FAAN, speaks with Mitchell S. Elkind, MD, MS, FAAN, author of the article "Stroke Prevention" in the Continuum® June 2026 Cerebrovascular Disease issue. Dr. Grouse is a Continuum® Audio interviewer and a clinical assistant professor at the University of California, San Francisco in San Francisco, California. Dr. Elkind is the Chief Science Officer for Brain Health and Stroke at the American Heart Association in Dallas, Texas, and a professor of neurology and epidemiology at Columbia University in New York, New York. Additional Resources Read the article: Stroke Prevention Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Guest: @MitchElkind Full episode transcript available here Dr Grouse: Neurologists have generally been more involved in secondary stroke prevention, but primary stroke prevention is increasingly recognized as an important topic of discussion for neurologists. Today, I have the opportunity to interview Dr. Mitchell Elkind, who wrote the article on stroke prevention in the newest Continuum issue on cerebrovascular disease.  Dr Jones: This is Dr. Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast.  Dr Grouse: This is Dr. Katie Grouse. Today, I'm interviewing Dr. Mitchell Elkind about his article on stroke prevention. This article appears in the June 2026 Continuum issue on cerebrovascular disease. Welcome to the podcast, and please introduce yourself to the audience.  Dr Elkind: Thank you so much, Katie. So, my name is Mitch Elkind, and I'm the Chief Science Officer for Brain Health and Stroke at the American Heart Association and a stroke neurologist by background.  Dr Grouse: Well, I just want to start by saying that I really enjoyed reading this article. I think this is just a really wonderful article I recommend strongly. Such a high yield, an important topic for a lot of us who see patients who are interested in learning about their stroke risks or need help with, uh, stroke prevention after having a stroke. So, I wanted to start. What's changed in the last couple of years? You know, what are some big highlights that you really want to stress that are different from maybe the last time we reviewed this topic?  Dr Elkind: Sure. Well, there's been a lot of development in the field of secondary stroke prevention, for one thing. But even beyond that, I think we increasingly appreciate how important it is to control what we call the social drivers of health on the earlier side, primordial or primary prevention. And that has been a big advance, I'd say. And I would also say, I think it's really important for neurologists to understand some of those questions about primordial and primary prevention. You know, we tend to get involved with patients after they've had a stroke or maybe a TIA, some kind of event. But sometimes we find people who are following for, you know, non-stroke related conditions who have risk factors also. And we can really play an important role in identifying those risk factors and helping to prevent a first stroke or vascular event as well. So, I think it's real important for us to be doctors even before we're neurologists. So, you know, Katie, about ninety percent of stroke risk is modifiable, so we can do a great job as neurologists in preventing stroke. And one of the most important things that we can do is to identify and treat high blood pressure. And recently, actually, the American Heart Association, American College of Cardiology guidelines on the management of hypertension have said that treatment of high blood pressure not only prevents stroke, but it can also help to prevent cognitive decline and dementia. And this is the first time that we've had a class of recommendation one and level of evidence A, the highest level of recommendation we give for the use of blood pressure treatment to prevent dementia. And that's largely based on the results of some large trials that have come out recently showing that you can prevent dementia with blood pressure control. So that's a really exciting link, I think, between cardiovascular risk factor control and subsequent brain health. It just illustrates the role that neurologists can play in, so many conditions outside of stroke as well.  Dr Grouse: That's a really great point, and I want to get a little more into the idea of primordial stroke prevention. Can you tell us a little bit more about what that might be?  Dr Elkind: So primordial prevention refers to addressing how we can prevent risk factors from occurring in the first place, and how can we improve the environments in which people live. You know, we know that only about twenty percent of health outcomes is dependent on what happens between the patient and their doctor in the office. About eighty percent of it is due to what happens in the environments in which we live, work, pray, and play. And so that's what we mean when we refer to the social drivers of health. What is the neighborhood like where somebody lives? Do they have access to healthy food? Do they have places where they can go to exercise? Is there air pollution in the area that may affect their health? You know, one really interesting fact that's become apparent in the last few years is that air pollution is a major risk factor for stroke. Something like a sixth of all strokes can be attributed to the quality of air. And so, what are the things we can do at the broader public policy, community level to reduce the risk of risk factors like high blood pressure and diabetes even before somebody has an event that brings them to the attention of the doctor? So that's what we're thinking about with regard to primordial prevention. It's the earliest stage in prevention.  Dr Grouse: And that's really fascinating. You know, I think an area that we haven't, as neurologists, really put a lot of our time thinking about, but clearly a very important thing. I really appreciated reading your article about how you incorporated the fact that, you know, a lot of these risk factors overlap very, very closely with all the risk factors for various types of cardiovascular events. And I would imagine that the work you've done as the Chief Clinical Science Officer for the American Heart Association has informed a lot of the way you've thought about-Trying to bring all these risks together and think a little bit more holistically about the whole thing. Could you tell us a little bit more about that and the work that you've done on the American Heart Association's Life's Essential 8 score?  Dr Elkind: Sure. I can't take credit for it. It's really work that was done by others at the Heart Association, particularly a cardiologist and epidemiologist named Don Lloyd-Jones. But many other volunteers participated. Life's Essential 8 is our approach to primary stroke prevention and cardiovascular prevention more broadly. We say Life's Essential 8 because it includes four health behaviors and four health factors that people can observe to reduce their risk of cardiovascular disease. The four factors are kind of things like know your numbers, your blood pressure, your blood sugar, your body mass index, right, which is a combination of weight and height, and your cholesterol level. So, know those numbers and keep them within the recommended ranges, and talk to your doctor if they're not. And then four lifestyle behaviors. So, one of them is to eat a healthy diet, and typically that means the Mediterranean diet. It means getting regular exercise, and we recommend 150 minutes a week of moderate to vigorous physical activity. Of course, it means abstinence from smoking or other tobacco products. And the last one, the eighth one, which I was so excited about when we added this, is sleep, recommending at least seven hours of sleep a night. So, I was really excited about this because we used to talk about Life's Simple 7, and then the last iteration of our recommendations included this recommendation for adequate sleep because of the mounting evidence of the importance of sleep to cardiovascular health. But sleep is really a brain function, right? And so, it was really the first, in a way, specific brain function that was added to our recommendations. So that's Life's Essential 8. People can read about it online at heart.org and recommend it to your patients as a simple way for people to understand the best approach to reducing their risk of cardiovascular disease, including stroke.  Dr Grouse: I checked it out myself after reading the article. It's very accessible to patients. It's a great education tool. And they can, you know, see their own score and use that in their own way to, to think about what their risks are and how they can help mitigate and then rescore themselves down the line. There's also, though, on the kind of more the clinician side, the PREVENT calculator as well. Could you tell us a little bit more about how we could use that in approaching this patient population?  Dr Elkind: Yeah. So, I think of Life's Essential 8 as being a patient-focused tool that people can use. PREVENT is really more for clinicians. Anybody can look it up online and enter your data into it. There's a risk calculator online. But the basic idea behind PREVENT and other similar risk calculators is that it's a way to estimate somebody's risk of having a cardiovascular event like stroke or a heart attack or even heart failure by entering information about your health. And we used to think, we used to use something called the ASCVD, atherosclerotic cardiovascular disease risk calculator, or the Framingham score. Framingham Heart Score, for example, was another one. PREVENT is the latest version, and it has several advantages over those earlier types of risk predictors. For one thing, it predicts risk at younger ages as well. It goes down to age 30. It predicts risk over a longer duration of time, so over 30, 10 or 30 years. It eliminates the use of race as an item to put into the calculator and substitutes for that socioeconomic status, so it's not a race base, but a measure of social disadvantage. And it also includes kidney elements, kidney measures. It includes renal function, for example, that weren't included in prior measures, and it can also be used to predict heart failure, which was not part of the original calculators. Another major advantage of the PREVENT study is that it was based on real-world data from about three million patients, many, many more than the 50,000 or so that the earlier risk calculators were based on. So, it has a much more robust data set and therefore allows a bit more precision in the ability to predict future risk of events. And typically, primary care doctors would enter their patient's data, calculate a risk, and then based on the results of the risk calculator, they can make recommendations about what type of medications a person should take or what other strategies they could use to reduce their risk. And so that's the role that PREVENT plays, is really being focused more for the clinician than the patient.  Dr Grouse: Really great tool for us to be aware of. You earlier alluded to the fact that neurologists are in the situation where we sometimes are helping patients with this primary prevention. But you also make a case for why it's in the patient's best interest for us to be involved in, in these conversations when we can, when we have the opportunity. Can you tell us more about that?  Dr Elkind: Shared decision-making is really important because we know that people aren't going to lead the healthiest possible lives if they're not invested in their care. And so, a doctor telling somebody what to do if the patient doesn't want to do it is gonna have limited benefit.So we emphasize the importance of shared decision-making as much as possible. And I think that where this comes up a lot is actually in the situation of, for example, atrial fibrillation, where patients will often be put on a blood thinner. And many people are fearful of blood thinners. They worry about the risk of bleeding. Maybe they know a relative who's had a bleeding complication from a blood thinner, and so they may be disinclined to try it. And so, it's really important to have these discussions about the risks and the benefits of medication and engage the patient in thinking about this. And there are even tools and visual aids that people can look to to help explain some of these complicated concepts to patients. So, these are the kinds of things that reflect implementation science as a way to improve adherence. We know what works in a clinical trial setting often, but the challenge is translating that into the real world and getting our patients to use the medications that we believe scientifically have been shown to be of benefit. I've actually been surprised sometimes at conversations I've had with people, in some cases, healthcare professionals who resist going on blood thinners because of their fear of the complications. And I feel like the evidence is there. Why don't they believe me? And that's why it's really important to have the conversation. Even our peers and colleagues can sometimes question the evidence, and it's important for us to be aware of that.  Dr Grouse: Absolutely. I think that sounds very reasonable to me, and hopefully these tools will help us with making some of these decisions with our patients. Now, turning our attention a little bit to secondary prevention. So, you know, someone's already had a stroke or a TIA, sort of thinking about what we can do to optimize their risk factors for further strokes. You know, I think there has been some changes that have happened, I think, in the last few years that might be affecting some of the decisions we're making and some of the advice we're giving our patients. I wanted to talk a little bit about GLP-1 receptor agonist medications. Is the data there to support use of this either in secondary prevention or even in primary prevention in the case of stroke?  Dr Elkind: There is evidence that supports the use of GLP-1s for stroke prevention. We need more data, though. We need trials that focus only on patients with stroke, for example, there have been studies in patients with cardiovascular disease broadly that include stroke patients. But if you look at the subcategory just of stroke patients alone, the data in that subgroup alone don't always show a benefit. And so, we need more data that's focused on stroke patients alone. So, I think the data are continuing to emerge, but we need more still.  Dr Grouse: Is there any development in the thought about whether we should be putting patients on antiplatelet therapies for incidental, incidentally identified strokes? For instance, if you got an MRI for migraine or for other reasons and you found one, no history of any stroke-like symptoms. Should we be putting these patients on aspirin or any other types of therapies?  Dr Elkind: That's a really great question. And again, it's an area where there's some controversy and really, there's really no definitive data that would support using antiplatelet therapy in people with incidentally discovered infarcts or what we call, you know, whispering strokes or silent strokes. Many stroke neurologists will use antiplatelet agents. This is one of those areas where it's so important to identify the risk factors. As we were saying before, patients who have other neurological disorders like migraine or epilepsy may turn out to have cardiovascular risk factors like diabetes and high blood pressure. That's why it's so important for neurologists to be able to treat those patients or refer them to specialists who can. Patients who have incidentally discovered lesions similarly are a group where we should be looking for risk factors. So, I don't think of it only in terms of do we put them on an antiplatelet or not, but really more holistically, can we identify their other risk factors and address those? Should the patient's information be entered into a risk calculator like PREVENT, for example, so that we can come up with a more global or holistic measure of their cardiovascular risk and address that as appropriate? Because if they are at risk for stroke, they're also at risk for cardiac events, including heart attack, heart failure, sudden cardiac arrest, and so forth. So, I think of it as a, as a great kind of teachable moment or an opportunity to catch somebody and bring them into the healthcare system more broadly and address those other potential risk factors.  Dr Grouse: Speaking of, of risk factors that we often like to think about and work up when possible, in cases where it seems certainly possible the patient had an embolic stroke, but perhaps we've done a few weeks or four weeks of cardiac monitoring, have not found any evidence of atrial fibrillation. What's new and what's the current recommendations for doing further monitoring when there's high suspicion for cardioembolic stroke?  Dr Elkind: This is a really active area of investigation, and guidelines suggest that we should do some cardiac monitoring for atrial fibrillation after an unexplained stroke, but it's not clear how much we should do. Studies generally show that the longer you follow somebody on a cardiac monitor after stroke, the more likely you are to detect atrial fibrillation. It could be as high as thirty percent after a few years. And that's great. And if you detect atrial fibrillation, people usually end up being recommended for a blood thinner. But how extensively we should monitor remains unknown. And I think a lot of the investigation recently has been around the question of, are there other ways to get that information rather than waiting six months or a year for the person to develop atrial fibrillation?It's a little bit funny logically to think a person has a stroke today, a year later you discover atrial fibrillation on the monitor, and you say, "Oh, now I know what caused your stroke a year ago." Right? The temporality, the causality perhaps is off in that case. And so, wouldn't it be better if we could tell what somebody's risk of having another cardioembolic stroke is, or the likelihood that they have atrial fibrillation is at the time that you first see them for the stroke, you know, in the hospital, for example. And so, there's some really new technologies that have evolved like AI or artificial intelligence interpretation of EKGs that can give a really good indication of which people are gonna go on to develop atrial fibrillation. And so, I think we need some more trials in that area to demonstrate that we can detect the risk of AFib and treat that even before it appears on one of those delayed monitors. That's an area that I think is very exciting right now. There's also a further question with regard to how to treat these patients, which is that sometimes atrial fibrillation is a consequence of the stroke itself. So, we can think about what people call known AF, meaning atrial fibrillation that's known about before the stroke even occurs, versus AF that's detected after a stroke, or AF-DAS, people will say. Those may have very different implications for the risk of recurrence and what the person's cardiovascular status is. So, I think what we've learned over the last few years is that atrial fibrillation, it used to be like the slam dunk for a stroke neurologist. It was the easy thing. You know, you had a stroke, you have AFib, you should be on a blood thinner. Now we know that there's lots of different kinds of AFib. There's AFib before stroke, there's AFib after stroke, there's burden of atrial fibrillation. So, some people may have 30 seconds of AFib, some people may have several hours, some people may be in it continuously. It comes and goes, and that can make it challenging to manage. So, we have a lot more work to do to understand this problem better.  Dr Grouse: That also gets me into some other interesting areas that I think there's still some question, you know, how aggressive should you be? How often is it a case of is this correlated or is this causative? For instance, when a patent foramen ovale is, is discovered in patients with cryptogenic stroke. Are there any tools or new developments to help us understand whether these PFOs should be closed in these cases?  Dr Elkind: PFO and stroke is a great story that's been going on for decades. And again, we've made tremendous progress in the last several years. So, it's true that about 20% or so of people have a PFO, and because of that, it can be really hard to say with any certainty whether an individual patient sitting in front of you, that the PFO was the cause of their stroke. Rarely we can have a really high degree of certainty. You know, if somebody has, uh, a DVT, for example, and shortly after that maybe they have pulmonary embolism and then a stroke, and we can say, "Oh, clearly this was a paradoxical embolism," went to the lungs and then some crossed over and went to the brain. That happens really infrequently. Most of the time you're faced with a patient who has a PFO and a stroke, and they may have some other risk factors. There are some tools that we can use to help figure out the likelihood that a PFO is related to a stroke. One of those is called the ROPE score or the risk of paradoxical embolism score that was developed by David Thaler and, uh, David Kent from Tufts and a group of other investigators as well. That score allows one to say what the likelihood is that the PFO was causative of the stroke, and it's based on a person's risk factors such that the younger you are, the more likely it is the PFO caused the stroke. And the absence of risk factors make it more likely that the PFO caused the stroke. So, the higher your ROPE score indicating the fewer other reasons you have a stroke, the more likely the PFO is to be causative. So that can be helpful in identifying patients who may have had a stroke due to their PFO. There are other features that are identified in something called the PASCAL score, which is a way of assessing the degree of shunting and whether or not there's an atrial septal aneurysm that can be used as additional factors that lead to the likelihood that a PFO was causative rather than just incidental. So, by putting this kind of information together, we can kind of do precision neurology or precision prevention by identifying which patients with a PFO are really the ones we need to worry about and do procedures like closure.  Dr Grouse: I look forward to hearing more and learning more as more advances are made in these areas. Dr Elkind: Thank you.   Dr Grouse: And thank you so much for joining us today to talk about your article.   Dr Elkind: Oh, I appreciate it. Thank you for giving me the opportunity. I really enjoyed it.  Dr Grouse: Again, today I've been interviewing Dr. Mitchell Elkind about his article on stroke prevention. This article appears in the June 2026 Continuum issue on cerebrovascular disease. Be sure to check out Continuum Audio episodes from this and other issues, and thank you to our listeners for joining today.  Dr Monteith: This is Dr. Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

In this MedAxiom HeartTalk, host Melanie Lawson, MS, sits down with Jasen Gundersen, MD, CEO and Christie Yoder, COO at CardioOne. Together, they explore practical strategies for immediate growth in cardiology practices, emphasizing small, achievable changes over long-term planning. 

In this special 500th episode of Heart Doc VIP, Dr. Joel Kahn reflects on the personal and professional journey that shaped his 36-year career in cardiology and preventive medicine. From his childhood in Detroit and medical training at the University of Michigan to founding the Kahn Center for Cardiac Longevity, Dr. Kahn shares the mentors, experiences, and lessons that influenced his approach to patient care. He also reviews new research on heart disease mortality in the United States, vitamin K2 and coronary artery calcium progression, plant-based diets for chronic kidney disease, factors influencing carotid intima-media thickness (CIMT), and emerging advances in calcium scoring technology.  Thank you to Igennus for sponsoring this milestone episode. Visit Igennus.com/DrKahn and use code DRKAHN for savings on their vegan-certified supplements.

CME credits: 0.75 Valid until: 16-06-2027 Claim your CME credit at https://reachmd.com/programs/cme/unblocking-clinical-inertia-the-cmi-era-in-ohcm-care/56382/ Did you miss our symposium at ESC HF 2026? It's not too late! This CME-accredited broadcast replay focuses on improving the diagnosis and management of obstructive hypertrophic cardiomyopathy (oHCM). Learn how to distinguish oHCM from heart failure and how cardiac myosin inhibitors can optimize patient outcomes. Join us and gain valuable tips on applying these insights in practice.For more information please visit the Heart Failure Congress 2026 website.=

Send us Fan MailDr. Jodi Nishida is a returning guest on our show! Be sure to check out her first appearance on episode 721 of Boundless Body Radio!Dr. Jodi Nishida is a Doctor of Pharmacy and accredited Metabolic Healthcare Practitioner who has been in healthcare for over 30 years. After experiencing the ketogenic lifestyle's effect on her own autoimmune condition, she decided to build a keto-based medical practice called The Keto Prescription so others could benefit from it too.Over the last several years, she has helped thousands of patients realize the benefits of clean, medically guided keto. With an accreditation in ketogenic nutrition; certifications in cardiovascular disease management, pharmacogenomics, and medication management; and first-hand experience working in gastrointestinal clinics and women's health clinics, Jodi works closely with each patient to tailor keto to their medications, medical conditions, lifestyle, and socioeconomic situation.Health is not a one-size-fits-all approach, and we all have unique challenges. Because all of us are addicted to sugar and processed food to some extent, fueled largely by our food industry, she has also partnered with two highly qualified psychologists locally, to help her patients address the root of their eating behaviors.She is also the owner of her latest venture, Rise Cafe, located in Honolulu, HI! The coffee shop is an offshoot of her medical practice where she can proudly bring low carb, no sugar items to the people of Hawaii. Rise Cafe is their combined effort to improve the health of those who visit!Find Dr. Jodi Nishida at-https://weloverise.com/IG- @theketoprescriptionhttps://www.theketoprescription.com/Check out the HILAROUS reviews on Yelp!Find Boundless Body at-myboundlessbody.comBook a session with us here! 

This episode explores how translational research bridges the gap between scientific discovery and real-world patient care, and highlights the nurse's pivotal role in clinical trials. Tune in to guests Brittany Butts, PhD, RN, and Erin Ferranti, PhD, MPH, RN, FAHA, FPCNA, FAAN, to learn how you can champion research, from participation to publication, and drive meaningful change in healthcare.Link to the Cardiovascular Nursing Certificate here: https://pcna.net/career-development/cardiovascular-nursing-certificate/See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

This episode equips nurses with practical tools to assess and manage patients with cardiometabolic risks like obesity, hypertension, and diabetes. Guests Yvonne Commodore-Mensah, PhD, MHS, RN, and Cindy Lamendola, MSN, NP, dive into the power of lifestyle changes to reduce these risks, while also breaking down the latest clinical guidelines and pharmacotherapies to keep your practice current and effective. Link to the Cardiovascular Nursing Certificate: https://pcna.net/career-development/cardiovascular-nursing-certificate/See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Listener feedback, transcatheter tricuspid valve replacement, a new metabolic disease called CKM, the ARISE-FLUIDS Trial, the BIHCA trial, and temporal trends in ICD therapies are the topics John Mandrola, MD, discusses in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I Listener Feedback LOSE-AF Trial https://jamanetwork.com/journals/jama/fullarticle/2849335 ARREST-AF Trial https://jamanetwork.com/journals/jamacardiology/fullarticle/2840225 POP-AF Trial https://doi.org/10.1093/eurheartj/ehaf689 PRAGUE-25 Trial https://www.jacc.org/doi/10.1016/j.jacc.2025.04.042 II Transcatheter Tricuspid Valve Replacement TRISCEND Cost Study https://doi.org/10.1016/j.shj.2026.101049 TRISCEND II Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2401918 III More Disease Creation – the CKM Syndrome ACC/AHA Release First-Ever Guideline for CKM Syndrome https://www.medscape.com/viewarticle/acc-aha-release-first-ever-guideline-ckm-syndrome-2026a1000jbs CKM Guideline in Circulation https://www.ahajournals.org/doi/10.1161/CIR.0000000000001447 IV Two Trials That Teach Important EBM Lessons ARISE-FLUIDS Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2516225 Dr Josh Farkas Post on X https://x.com/PulmCrit/status/2065064796270022845?s=20   V  Bicarbonate for Inpatient Cardiac Arrest –The BIHCA trial BIHCA Trial https://jamanetwork.com/journals/jama/fullarticle/2850405 VI The Decline of VT in Heart Failure Trends and Outcomes in ICD Recipients: 15-Year Analysis https://doi.org/10.1093/europace/euag110 Declining Risk of Sudden Death in HF https://www.nejm.org/doi/full/10.1056/NEJMoa1609758 You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

The March 2026 ACC/AHA Guideline on the Management of Dyslipidemia made a major pivot regarding Lipoprotein(a) by establishing a formal recommendation for universal screening in adults. This 2026 guideline, published in the Journal of the American College of Cardiology, issued a Class 1 recommendation stating that every adult should have their Lp(a) measured at least once in their lifetime. Because Lp(a) levels are genetically determined and remain highly stable throughout a person's life, a single lifetime check is sufficient for the vast majority of the population to establish their baseline risk. Well, that's great for Family medicine or internal medicine, but how does that affect us in women's health? Well, it's complicated: lipoprotein(a) has been associated with an increased risk of VTE and has also been associated, in some studies, with FGR, preeclampsia, and preterm birth! So, can these patients receive oral contraceptives? What about Perioperative and postop care? Do these patients require anticoagulation? What about pregnancy- is LDA recommended here? And lastly, what about TXA use in patients with HMB? This podcast topic comes from one of our podcast family members who is an OBGYN military personnel caring for our wonderful troops overseas. Listen in for details!16% OFF TONA ACTIVE WEAR PROMO: https://tonaactive.com/discount/CHAPANOSPINOBG1. Ezzat, D., Lopez, D. M., Claggett, B. L., Li, L., Mohammadnia, N., Schuermans, A., Hemeryck, J., Chang, A., Murillo, S., O'Donoghue, M. L., Bikdeli, B., Yu, Z., Natarajan, P., Patel, A. P., Pabon, M. A., & Honigberg, M. C. (2026). Lipoprotein(a) and incident venous thromboembolism in pre- and postmenopausal women, and in men. European Heart Journal, ehag252. https://doi.org/10.1093/eurheartj/ehag2522.ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Dyslipidemia Writing Committee. (2026). 2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Dyslipidemia. Circulation, 153, e1155–e1300. https://doi.org/10.1161/CIR.00000000000014233. CDC MEC 4. Prevention of Venous Thromboembolism in Gynecologic Surgery: ACOG Practice Bulletin, Number 232. Obstetrics and Gynecology. 2021. Committee on Practice Bulletins—Gynecology5. Sofi F, Marcucci R, Abbate R, Gensini GF, Prisco D.Lipoprotein(a) as a Risk Factor for Venous Thromboembolism: A Systematic Review and Meta-Analysis of the Literature.Seminars in Thrombosis and Hemostasis. 2017. Dentali F, Gessi V, Marcucci R, et al. Lipoprotein (A) and Venous Thromboembolism in Adults: The American Journal of Medicine. 2007.

This week we go back 2.5 years and delve into the world of cardiovascular surgery when we review a review of STS data on the pulmonary artery band (PAB). The STS assigns a STAT category of 4 to this operation, denoting higher risk for mortality. Is this warranted? Are all PAB candidates equal? What features are associated with higher or lower mortality rates in patients undergoing banding? Should the data in this work drive innovation to avoid the PAB in some settings? These are amongst the questions posed to the senior author of this week's work, cardiovascular surgeon Dr. Tara Karamlou who is Professor of Surgery at the Cleveland Clinic in Cleveland, Ohio. DOI: 10.1016/j.athoracsur.2023.09.020

It beats. It throws blood. It breaks – but not if Dr. Herman Taylor can help it. Cardiology is a vast field but Dr. Taylor joined for a 101 on how the heart works, and how to take care of it. Get pumped for valves, tubes, electrical shocks, heavy metal hearts, what to do in an emergency, and what your heart wants you to eat. Also: the worst heart-themed art out there.  Browse Dr. Taylor's publications on ResearchGate A donation went to the Center for Black Agency and Resilience Full-length (*not* G-rated) Cardiology episode + tons of science links More kid-friendly Smologies episodes! Become a patron of Ologies for as little as a buck a month OlogiesMerch.com has hats, shirts, hoodies, totes! Follow Ologies on Instagram and Bluesky Follow Alie Ward on Instagram and TikTok Sound editing by Mercedes Maitland of Maitland Audio Productions and Jake Chaffee Made possible by work from Noel Dilworth, Susan Hale, Kelly R. Dwyer, Aveline Malek and Erin Talbert Smologies theme song by Harold Malcolm Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Posloucháte Jedno procento Miloše Čermáka. Já jsem Miloš Čermák a moje jedno procento jsou dva centimetry na výšku a asi kilogram živé váhy. Jedno procento je taky podcast, kam si zvu zajímavé a zábavné hosty. Nebo prostě lidi, které mám rád či z různých důvodů obdivuju.Josef Veselka za poslední tři roky nikomu nezachránil život. Což je něco, co je v jeho životě zcela nezvyklé: předtím zachraňoval životy na denní bázi. Ne proto, že je superman nebo má mimořádné schopnosti. Ale protože je kardiolog. Zachraňování životů je něco, co kardiologové dělají běžně. Je to jejich práce. Josef Veselka tuhle práci miloval, a teď ji už tři roky nedělá, a nikoli proto, že si to tak vybral.Disclaimer: Josef Veselka je můj kamarád a známe se dlouho, a myslím i dobře. Nejsem nezaujatý novinář ani komentátor. Tohle je ostatně už pátý podcast za sedm let, který jsme spolu natočili. Ne proto, že bych mu chtěl dělat reklamu nebo propagaci, ani jedno nepotřebuje a nestojí o to. Ale protože se nám spolu dobře povídá.A taky proto, že Josef Veselka má vždycky co říct. Pořád je totiž vědec, a to ne ledajaký: před měsícem mu vyšla studie v The American Journal of Cardiology, a on je jejím prvním autorem. Týká se léku, který může změnit léčbu hypertrofické kardiomyopatie, tedy nemoci, v níž Veselka patří ke světové špičce.Zároveň je spisovatel. Právě vydal thriller Prezidentské konzilium, první díl tetralogie Správci systému. Je o tom, co se stane, když se kolem nemocného prezidenta sejdou chytré hlavy a každá sleduje jiné cíle, než se zdá. Veselka ví, o čem píše: v jednom prezidentském konzíliu, tom Havlově, sám seděl.  Ale pozor, prezident v románu není Havlem inspirovaný. Skoro by se dalo říct, že je charakterově na úplně druhém konci spektra. A vzorem pro Veselkovu postavu nebyl žádný z prezidentů, které Česko mělo. Je to postava komplexní, šokující... a víc neřeknu, protože už bych prozrazoval děj. Veselkova rada budoucím prezidentům mimochodem zní: nechtějte konzilium, chtějte jednoho fachmana.Mluvili jsme o tom, proč Josef Veselka ydržel v německé nemocnici jen čtyři měsíce, přestože tvrdil, že chce pracovat až do smrti. Proč? Třeba proto, že mu tam stokrát řekli, že je překvalifikovaný. Německé zdravotnictví popisuje jako excelovou tabulku, kde má každý své místo — a on byl to číslo v tabulce, které bliká červeně. Povídali jsme si i o tom, co cítil, když policie zatkla ředitele Motola, s nímž si patnáct let tykal, ale který smybolizoval nespravedlnost toho, že po několika dekádách v oboru odešel ze sálu, kde sám sebe vnímal jako nejvíc užitečného. Co tedy cítil? Byly to tři různé emoce a mezi nimi jen dny. Jaké emoce to byly? Poslouchejte.A konečně, mluvili jsme i o tom, proč se v Česku dá koupit lecos, ale špičková zdravotní péče ne, a proč je proto zdravotnictví tak cenná kořist pro politiky. Cennější než například České dráhy.Samozřejmě došlo na umělou inteligenci. Veselka napsal o své nemoci tři knihy a stovku odborných článků, a přesto říká, že v testu z vlastního oboru by ho ChatGPT porazil. Svému chatu říká Maxi a konzultuje s ním i vlastní zdraví. Pokud chcete v AI najít partnera, který vám bude pomáhat, a nikoli bojovat s vašimi lékaři, i to se v dnešní epizodě dozvíte.Připomínám: v pátek 19. června mám v Divadle v Řeznické první reprízu svého standupového speciálu. Hodně mi na tomhle materiálu záleží, nejen proto, že se ke standupu vracím zhruba p roční pauze, a je to osm let od mého posledního sólového speciálu. Ten se jmenoval Manželka mi slíbila černošku, a i o tom bude v Řeznické řeč.Těším se na vás, a lístky si můžete koupit na webu divadla. Odkaz najdete na mém webu Jedno procento. Ještě jednou díky. A teď už …… přeju příjemný a pohodový poslech.

Replacing animal protein with plants preserves kidney function, improves cardiovascular health, and lowers mortality across populations. #KidneyHealth #ProteinSwitch #Longevity

Health economics is not just about reimbursement. It is about proving how a technology reduces the total cost of care. In this episode, Betty Tsai, President of Cardiology Services International, explains why medtech companies must think beyond existing CPT or MS-DRG codes when shaping their commercialization strategies. Speaking with Saul at the MedTech Innovator event, she highlights how health economics reveals the true cost of a patient journey, from initial admission through readmissions and long-term care. Betty explores how value-based care and CMS performance metrics are reshaping hospital revenue and influencing adoption decisions. She also discusses alternative reimbursement pathways, such as the New Technology Add-on Payment, and emphasizes that companies demonstrating both clinical and economic value are more attractive to providers and investors. Tune in and learn why proving economic value may be one of the most important steps in driving medtech adoption. Resources: Connect with and follow Betty Tsai on LinkedIn.

Most people use moderation as a reason to keep doing what they are doing. Dr. Columbus Batiste says that is exactly the mindset that can have lasting health implications. In this episode of NHA Today, Dr. Stephan Esser sits down with Dr. Columbus Batiste, board-certified interventional cardiologist, author, and co-founder of Healthy Heart Nation. Known as the Healthy Heart Doc, Dr. Batiste has spent his career doing what most cardiologists do not: asking patients not just what they eat, but what they eat for their health - and then building a plan around what they actually want. His personal story is the backbone of this conversation. His father was health-conscious, ran a health food store, and juiced long before it was fashionable - but also loved sodasand sweets in moderation. He died from the effects of diabetes. Reading Caldwell Esselstyn's chapter titled Moderation Kills changed the course of Dr. Batiste's career. In this conversation you will learn:• Why moderation is a justification we only apply to things we know we should not be doing• The three most heart-protective food groups and why they work at the cellular level• How to talk to patients (or yourself) about food in a way that actually creates change• The SELFISH acronym: seven pillars of heart health from spirituality to humor• Why 80% of health outcomes happen outside the doctor's office• The role of stress, presence, and relationships in cardiovascular disease• Dr. Batiste's take on AI in medicine and what an elderly patient said that stopped him cold• What he is bringing to the NHA Annual Conference this June ---ABOUT DR. COLUMBUS BATISTE---Columbus Batiste, MD is a board-certified interventional cardiologist, co-founder of Healthy Heart Nation, and author of Selfish: A Cardiologist's Guide to Curing a Stressed and Broken Heart. He is the Regional Chief of Cardiology for Southern California Permanente Medical Group and a celebrity media contributor featured in documentaries, articles, and podcasts worldwide. He will be speaking at the NHA Annual Conference, June 25 to 28, 2026. ---LINKS AND RESOURCES---Full episode and show notes: Subscribe: https://www.healthscience.org/podcast/NHA Annual Conference (June 25 to 28, 2026): https://checkout.healthscience.org/2026-nha-conferenceDr. Batiste's website: https://drbatiste.comFollow Dr. Batiste on Instagram: https://www.instagram.com/healthyheartdoc/Dr. Batiste on LinkedIn: https://www.linkedin.com/in/drbatiste/Book - Selfish: A Cardiologist's Guide: [add purchase link]Follow Dr. Esser on Instagram: https://www.instagram.com/esserhealth/

A round-up of the main headlines in Sweden on June 9th 2026. You can hear more reports on our homepage www.radiosweden.se, or in the app Sveriges Radio. Presenter/producer: Sujay Dutt.

High blood pressure is often unnoticed until serious issues arise. In this episode, we explore what causes it and how simple daily habits—like diet, exercise, sleep, stress management, and hydration—can help lower it naturally and protect your heart.  Learn more about Sudip Saha, MD 

Dr. Ami Bhatt is the Chief Innovation Officer for the American College of Cardiology and Chair of FDA's Digital Health Advisory Committee.We discuss the intersection of medicine and technology, highlighting the impact of digital health on chronic disease management, patient education, and access to care. The conversation delves into telemedicine, remote monitoring, patient empowerment, integrative care, and the future of predictive and preventative healthcare.This episode was sponsored by Ardelyx.

We welcome Dr. Christopher Dibble, a cardiologist with St. Peter's Cardiology Associates. Ray Graf hosts.

New guidelines for managing cholesterol levels have recently been released by the American College of Cardiology. Cardiologist Roger Blumenthal at Johns Hopkins chaired the committee that wrote the guidelines, and says that in reviewing the data it became clear that … Certain groups of people seem to be missing out when it comes to optimizing cardiovascular disease prevention, Elizabeth Tracey reports Read More »

Cholesterol management, per new guidelines from the American College of Cardiology, is just one aspect of measures you can take to lower your risk for cardiovascular disease, the number one cause of death. Roger Blumenthal, a cardiologist at Johns Hopkins … What's involved in lowering your risk for cardiovascular disease? Elizabeth Tracey reports Read More »

How Young Lupus Patients Can Cope With Physical And Mental Health Issues Lupus is a chronic condition where a person's immune system attacks their healthy tissue. But while the physical toll is obvious, the extreme mental health issues that can arise are too often ignored. Our experts this week explain the connection between lupus and mental health, and discuss a program that's finally addressing these issues in young patients. Guests:  Natoshia Cunningham, Red Cedar Distinguished professor & associate professor in the Department of Family Medicine, Michigan State University, founder, TEACH Program Isabella Colindres, consumer advocate, TEACH Program Host and Producer: Kristen Farrah   Genetic Testing Is The Key To Optimizing Your Health Health optimization has become a huge focus in recent years, but many people are skipping the foundational step – genetic testing. Knowing the core of who you are helps direct you to the best medicine, diet, and exercise for you. Our expert explains the benefits of genetic testing and how to make sure you're getting quality results. Guest: Dr. Puya Yazdi, Chief Science & Medical Officer, SelfDecode Host: Greg Johnson Producer: Kristen Farrah Facebook: ingoodhealthpodX: @ ingoodhealthpodIG: @ingoodhealthpodYouTube: @ingoodhealthpodSpotify Apple Podcast In Good Health PodcastSubscribed to the newsletterFull ArchiveContact UsBecome an Affiliate Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Genetic Testing Is The Key To Optimizing Your Health Health optimization has become a huge focus in recent years, but many people are skipping the foundational step – genetic testing. Knowing the core of who you are helps direct you to the best medicine, diet, and exercise for you. Our expert explains the benefits of genetic testing and how to make sure you're getting quality results. Guest: Dr. Puya Yazdi, Chief Science & Medical Officer, SelfDecode Host: Greg Johnson. Producer: Kristen Farrah Facebook: ingoodhealthpodX: @ ingoodhealthpodIG: @ingoodhealthpodYouTube: @ingoodhealthpodSpotify Apple Podcast In Good Health PodcastSubscribed to the newsletterFull ArchiveContact UsBecome an Affiliate Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Chemical cardioversion in the ED, HF monitoring, weight loss in AF, and surgical LAA excision are the topics John Mandrola, MD, discusses in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I Chemical Cardioversion of AF in the ED: The FLECA-ED Trial FLECA-ED Rationale paper https://pmc.ncbi.nlm.nih.gov/articles/PMC10299428/ FLECA-ED ESC Slides https://esc365.escardio.org/presentation/321209 Review on Flecainide Use Despite CAST https://doi.org/10.1016/j.hrthm.2025.08.034 RACE 7 ACWAS Trial https://www.nejm.org/doi/full/10.1056/NEJMoa1900353 II Heart Failure Monitoring – The ALLEVIATE-HF Trial ALLEVIATE-HF Trial https://doi.org/10.1016/j.jacc.2026.03.075 CHAMPION Trial https://doi.org/10.1016/S0140-6736(11)60101-3 GUIDE HF Trial https://doi.org/10.1016/S0140-6736(21)01754-2 ALLEVIATE-HF Editorial: Alerts Are Not Treatment https://doi.org/10.1016/j.jacc.2026.04.014 Steve Stiles Medscape report on CHAMPION https://www.medscape.com/viewarticle/755189 III A Negative Weight Loss Study in AF LOSE-AF Trial https://jamanetwork.com/journals/jama/fullarticle/2849335 IV Surgical LAA Excision OPINION Trial https://doi.org/10.1093/eurheartj/ehaf674 LAAOS 3 trial https://www.nejm.org/doi/full/10.1056/NEJMoa2101897 You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

This week we speak with 2 pioneers in the field of pediatric cardiac critical care, Dr. Anthony Rossi and Dr. Gil Wernovsky. Both were present at the very start of the field of cardiac critical care for children. What was it like in an era before transesophageal echocardiography or even postoperative echo? Why was the advent of the bidirectional cavo-pulmonary anastomosis such a game changer in the care of children with heart disease? What do Drs. Rossi and Wernovsky think were the most important improvements to care for children with heart disease in their 35+ year careers? What about care today troubles these intensive care gurus? This is a rare opportunity to speak with two who have seen and done it all in cardiac critical care for children.For those interested to hear Dr. Rossi speak about goal directed therapy, take a listen to episode 21 and episode 200 of this podcast!

The following question refers to Section 7.1 of the 2025 ACS Guidelines. The question is asked by Thomas Jefferson medical student and CardioNerds Academy Intern Dr. Grace Qiu, answered first by University of Michigan fellow and CardioNerds FIT Ambassador Dr. Kayla Secrest, and then by expert faculty Dr. Sunil Rao. Dr. Rao is an interventional cardiologist, Professor of Medicine at NYU Grossman School of Medicine, Deputy Director of the Leon H. Charney Division of Cardiology, and the Director of Interventional Cardiology for the NYU Langone Health System. He is the Editor-in-Chief for Circulation Cardiovascular Interventions and was the Chair of the Writing Committee for the 2025 ACS Guidelines. This episode is part of our comprehensive Decipher the Guidelines Series covering the 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes. Question #1 A 68-year-old man with a history of hypertension, hyperlipidemia, stage III chronic kidney disease, and prior tobacco use presents to a local emergency department with reports of chest pain while raking leaves at home. Upon arrival, he is hemodynamically stable with a heart rate of 86 beats per minute and a blood pressure of 133/85 mmHg. His EKG reveals ST elevations in the septal and anterior leads (V1-V4). He is given 324mg of aspirin and is promptly evaluated by the interventional cardiology team, who elects to take him emergently to the catheterization lab. Upon arrival to the catheterization lab, the nurse asks the interventional fellow which access sites they should prep for this case? How should the interventional fellow respond? A Right radial artery only B Radial + bilateral femoral C Bilateral femoral only Answer #1 Explanation  The correct answer is B. Radial and bilateral femoral Radial artery access is the preferred vascular access site for coronary angiography and PCI in patients with ACS. Transradial access has been shown to reduce mortality, bleeding, and vascular complications compared with transfemoral access (Class I, LOE A). Radial access also allows earlier ambulation and is associated with greater patient comfort. Although the right radial artery is the most widely studied upper-extremity access site, alternative sites such as the ulnar and distal radial arteries have demonstrated similar outcomes. However, the radial artery may be required as a bypass conduit for CABG. In institutions where the radial artery is routinely used for surgical grafting, this potential future use should be considered when selecting vascular access. In addition, transfemoral access—preferably performed with ultrasound guidance—should be considered in patients in whom temporary mechanical circulatory support (MCS) is anticipated or in those for whom radial access is not feasible due to anatomical or technical constraints. Prepping bilateral groins in addition to the radial artery provides a backup strategy for urgent MCS placement or for transition to femoral access should radial access fail. For these reasons, prepping both the radial artery and bilateral groins is the most appropriate response. Radial-only preparation is incorrect because, although radial access is preferred, patients with STEMI may still require emergent MCS or alternative access if the radial artery is unsuitable. Preparing only the wrist without backup femoral access may delay care should hemodynamic instability occur. Femoral-only preparation is incorrect because transradial access provides superior outcomes in ACS, including significant reductions in all-cause mortality, major bleeding, and vascular complications. RCTs and meta-analyses, including MATRIX (which showed lower MACE and net adverse clinical events with radial access) and SAFARI-STEMI (which showed no difference in mortality but was underpowered)—support radial as first-line access when feasible. Main Takeaway For patients with ACS undergoing PCI, radial access is strongly preferred to reduce mortality, bleeding, and vascular complications. Guideline Loc. Section 7.1  

Send us Fan MailDr. Ankur Vyas, cardiologist with St. Luke's Heart Care Clinic, joins Dr. Arnold to discuss simple, natural steps you can take to protect your heart and reduce your risk of heart disease.To learn more, visit unitypoint.org/cr-heart. If you have a topic you'd like Dr. Arnold to discuss with a guest on the podcast, shoot us an email at stlukescr@unitypoint.org.

Description:  How do GLP-1 receptor agonists or GIP agonists work and what is the impact for my psoriatic disease? Hear dermatologist Dr. Ronald Prussick and cardio-immunologist Dr. Brittany Weber answer such questions and more.           Join host Archie Franklin as he takes a deep dive into the use of GLP-1 receptor agonists and GIP agonists and the convergence of systemic inflammation related to psoriatic disease with renowned dermatologist and Vice Chair of the NPF Medical Board, Dr. Ronald Prussick from Washington Dermatology Center in Rockville and Frederick, MD, and, cardio-immunologist Dr. Brittany Weber, Director of the Cardio-Rheumatology/ Cardio-Dermatology Program at the University of Texas Southwestern. Learn more about the use of incretin hormones, the impact of weight management on psoriatic disease, metabolic and cardiovascular risk, as well as results from the TOGETHER-Pso and TOGETHER-PsA clinical trials.  This episode addresses the actions of incretin hormones (GLP-1 receptor agonist and GIP agonist) and how such use may be beneficial in the management of inflammation related to psoriasis and psoriatic arthritis.  Thank you to Lilly for their support of this program activity.  Timestamps: (0:00)  Intro to Psoriasis Uncovered & guest welcome dermatologist Dr. Ronald Prussick and cardio-immunologist Dr. Brittany Weber.  (1:35)  What are incretin hormones and how GLP-1 or GIP receptor agonists (RA) inhibit appetite to initiate weight loss. (3:29)  Why GLP-1 RAs are of interest in the management of psoriasis and psoriatic arthritis. (5:23)  The metabolic, cardiovascular, and psoriatic disease convergence. (7:19)  Will reduction of inflammation impact cardiovascular risk? (10:59) Treatment challenges associated with having psoriatic disease and being overweight or obese. (13:45)  Key points around the use of GLP-1 receptor agonists when managing psoriasis and psoriatic arthritis. (17:06)  Results of the TOGETHER-PsO and TOGETHER-PsA phase 3 clinical trials combining use of an IL-17 inhibitor and a GIP and GLP-1                receptor agonist therapy. (19:07)  Having the conversation of adding a GLP-1 RA medication to a treatment regimen. (22:40)  The paradigm shift of GLP-1 receptor agonists and the impact they can have on shared inflammatory pathways. Key Takeaways: ·       Glucagon-like peptide-1 (GLP-1) receptor agonists and glucose-dependent insulinotropic polypeptide (GIP) agonists are two incretin hormones that assist in managing excess body weight -- which as a result can be helpful in managing inflammation in the body.   ·       Psoriasis isn't just a skin and joint disease. It's a complex network of systemic inflammation with shared inflammatory pathways that worsens with increased weight impacting the severity of the disease, and accelerates the risk of metabolic dysfunction, and cardiovascular disease.   ·       The best outcomes occur as a result of multidisciplinary collaboration to address the impact of excess weight and systemic inflammation. If you are struggling to lose weight with diet and exercise, speak with your medical team about your options including the use of GLP-1 or GIP agonists.   Guest Bios: Renowned dermatologist Ronald Prussick, M.D., Medical Director of the Washington Dermatology Center in Rockville and Fredrick, Maryland, specializes in the treatment of psoriasis along with other diseases of the skin, hair, and nails. Dr. Prussick is also a Clinical Associate Professor in Dermatology at George Washington University in Washington, D.C.. Dr. Prussick has a research interest in the impact of diet on psoriatic disease and metabolic health, first becoming interested after being involved in Dr. Joel Gelfand and Dr. Nehal Mehta's work in vascular inflammation trials using FDG-PET/CT scans to view systemic and cardiovascular inflammation associated with psoriatic disease. Dr. Prussick has since participated in the development of the 2018 Dietary Recommendations for Adults with Psoriasis or Psoriatic Arthritis and more recently the position statement "GLP-1 Receptor Agonists in Psoriasis: A Primer from the National Psoriasis Foundation Medical Board". Dr. Prussick is Vice Chair of the NPF Medical Board which provides clinical direction, treatment guidance, and education oversight to the organization and its Executive leaders.  Brittany Weber, M.D., Ph.D. is a cardio-immunologist who is the Director of the Cardio-Rheumatology/ Cardio-Dermatology Program at the University of Texas Southwestern. She is also a member of the Division of Cardiology, a clinical investigator, and imaging specialist. Dr. Weber's research integrates advanced imaging, molecular biology, clinical trials, and population health to understand how systemic inflammation and immune deregulation drives cardiovascular dysfunction. Prior to joining UT Southwestern in 2025, Dr. Weber served on the faculty at Harvard Medical School and was the Director of the Cardio-Rheumatology Clinic at Brigham and Women's Hospital, a nationally recognized clinic addressing inflammation-related heart disease through collaborative, patient centered care. Dr. Weber is also an author on the position statement "GLP-1 Receptor Agonists in Psoriasis: A Primer from the National Psoriasis Foundation Medical Board". Resources: "The Metabolic Collison and How You Can Take Control with Psoriatic Disease" podcast episode with dermatologist Dr. Ronald Prussick and registered dietitian Danielle Cahalan   "NPF Medical Board Issues GLP-1 Primer for Dermatologists" Press Release "Finding My Path to Managing Psoriatic Disease and Excess Weight" podcast episode featuring dermatologist Dr. Erin Boh, patient advocate Brian Lehrschal, and moderator Jennifer Bomberger. 

Want to know what the top earners in pharmaceutical sales actually take home? The numbers you see on job boards dramatically undercount the truth because they leave out quarterly bonuses, RSUs, car allowances, and life-changing equity buyout premiums. Every Monday night, we coach you live to land the job. In this episode of Medical Sales U, Dave Sterrett breaks down the Top 7 Highest-Paying Pharmaceutical Sales Jobs in the country right now. From the incredible work-life balance of dermatology biologics to the multi-millionaire equity upside of oncology biotech startups, we are counting down the real numbers and giving you the honest truth about what it takes to clear the bar and land these elite specialty roles.TIMESTAMPS00:00 - Intro: What Job Boards Get Wrong About Pharma Compensation02:15 - The Total Compensation Formula (Base + Bonuses + RSUs)04:30 - #7: Dermatology Biologics Sales Specialist ($140K - $230K)07:10 - #6: Cardiology & GLP-1 Metabolic Sales Specialist ($155K - $250K)10:05 - #5: Neuroscience & CNS Sales Specialist ($175K - $250K)13:20 - #4: Rare Disease Key Account Specialist ($180K - $300K)16:45 - #3: Biotech Specialty Sales (Gene & Cell Therapy) ($200K - $320K)19:30 - #2: Oncology Sales Specialist - Large Pharma ($200K - $315K)22:15 - #1: Oncology Biotech Startup Sales Specialist ($240K - $350K+ No Ceiling!)24:40 - How to Build Your Record & Earn Clinical CredibilityIf you found this breakdown valuable, please SUBSCRIBE, drop a comment saying “Break in”, and share this with someone mapping out their trajectory in the medical sales industry!Ready to break into medical sales and secure your first $95k+ base offer?Join Medical Sales U: medicalsalesu.com/#MedicalSales #PharmaSales #PharmaceuticalSales #MedicalSalesU #OncologySales #BiotechJobs #HighPayingCareers #SalesCompensation

Bob Harringson and former FDA commissioner Rob Califf discuss medical misinformation, its impact on public and individual health, and how to fight against it. This podcast is intended for healthcare professionals only. To read a transcript or to comment, visit https://www.medscape.com/author/bob-harrington  Is a Long-Simmering Crisis Boiling Over? U.S. Primary Care Today https://doi.org/10.1056/NEJMms2510425 The Global Wellness Economy Hits a Record $6.8 Trillion and Is Forecast to Reach $9.8 Trillion by 2029 https://globalwellnessinstitute.org/press-room/press-releases/the-global-wellness-economy-hits-a-record-6-8-trillion-and-is-forecast-to-reach-9-8-trillion-by-2029/  Life's Essential 8: Updating and Enhancing the American Heart Association's Construct of Cardiovascular Health: A Presidential Advisory From the American Heart Association https://doi.org/10.1161/CIR.0000000000001078  Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(04)17018-9/abstract  Here's What We Know https://weillcornell.org/heres-what-we-know  Fifth Circuit sides with ivermectin-prescribing doctors in their quarrel with the FDA https://www.courthousenews.com/fifth-circuit-sides-with-ivermectin-prescribing-doctors-in-their-quarrel-with-the-fda/  SNAP Tracker: People Are Losing Food Assistance as the Republican Megabill Is Implemented https://www.cbpp.org/research/food-assistance/snap-tracker-people-are-losing-food-assistance-as-the-republican-megabill  Chronic Conditions and Food Insecurity in US Children https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2839376  As Unregulated Peptides Flood the Market, Clinicians Encouraged to Counsel Patients https://www.medscape.com/viewarticle/unregulated-peptides-flood-market-clinicians-encouraged-2026a1000e63 Coethia https://coethia.com/  You may also like: Hear John Mandrola, MD's summary and perspective on the top cardiology news each week, on This Week in Cardiology https://www.medscape.com/twic  Questions or feedback, please contact news@medscape.net

Management of blood cholesterol is a major factor in the prevention of cardiovascular disease, as reflected in new guidelines released by the American College of Cardiology, and it should start early in life and be monitored throughout the lifespan. Johns … Monitoring cholesterol and other factors should be done regularly to prevent cardiovascular disease, Elizabeth Tracey reports Read More »

A quarter of US adults have elevated levels of LDL, the type of cholesterol in the blood most often associated with atherosclerosis and cardiovascular disease. Now the American College of Cardiology has issued new guidelines for managing cholesterol, last updated … New guidelines from the American College of Cardiology for cholesterol guidelines are here, Elizabeth Tracey reports Read More »

If you've been told you have high LDL cholesterol in your blood, the first place to begin to try to improve it is with diet and exercise. That's according to new guidelines from the American College of Cardiology, and such … The first strategy to improve blood cholesterol levels in lifestyle management, Elizabeth Tracey reports Read More »

When it comes to ideal LDL cholesterol levels in the blood, ideal is a bit of a moving target. Johns Hopkins cardiologist Roger Blumenthal, chair of an American College of Cardiology committee that has just updated cholesterol guidelines, says it … What LDL cholesterol level should you be aiming for? Elizabeth Tracey reports Read More »

Listener discretion is advised! References: Buttner & Arlanger. (May 3, 2022). ST depression does not localise. Available: https://litfl.com/st-depression-does-not-localise/ Cannon, J. W., Khan, M. A., Raja, A. S., et al. (2017). Damage control resuscitation in patients with severe traumatic hemorrhage. Journal of Trauma and Acute Care Surgery, 82, 605-617. Kabra, R., Acharya, S., Kamat, S., & Kumar, S. (2022). ST-Segment Elevation in Lead aVR With Global ST-Segment Depression: Never Neglect Left Main Coronary Artery (LMCA) Occlusion. Cureus. Lee, G.-K., Hsieh, Y.-P., Hsu, S.-W., Lan, S.-J., & Soni, K. (2019). Value of ST‐segment change in lead aVR in diagnosing left main disease in Non‐ST‐elevation acute coronary syndrome—A meta‐analysis. Annals of Noninvasive Electrocardiology, 24. Morrison, C. A., Carrick, M. M., Norman, M. A., et al. (2011). Hypotensive Resuscitation Strategy Reduces Transfusion Requirements and Severe Postoperative Coagulopathy in Trauma Patients With Hemorrhagic Shock: Preliminary Results of a Randomized Controlled Trial. Journal of Trauma: Injury, Infection & Critical Care, 70, 652-663. Rossaint, R., Afshari, A., Bouillon, B., et al. (2023). The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition. Critical Care, 27. Tamura, A. (2014). Significance of lead aVR in acute coronary syndrome. World Journal of Cardiology, 6(7), 630. Uthamalingam, S., Zheng, H., Leavitt, M., Pomerantsev, E., Ahmado, I., Gurm, G. S., & Gewirtz, H. (2011). Exercise-Induced ST-Segment Elevation in ECG Lead aVR Is a Useful Indicator of Significant Left Main or Ostial LAD Coronary Artery Stenosis. JACC: Cardiovascular Imaging, 4, 176–186. Weymouth, W., Long, B., Koyfman, A., & Winckler, C. (2019). Whole Blood in Trauma: A Review for Emergency Clinicians. The Journal of Emergency Medicine, 56, 491-498. Wang, A., Singh, V., Duan, Y., Su, X., Su, H., Zhang, M., & Cao, Y. (2020). Prognostic implications of ST‐segment elevation in lead aVR in patients with acute coronary syndrome: A meta‐analysis. Annals of Noninvasive Electrocardiology, 26.

A life-long treatment for high LDL, a VESALIUS subanalysis, tirzepatide beats semaglutide again, arrhythmia burden in cardiac amyloidosis, and a lipid guideline rebuttal are the topics John Mandrola, MD, discusses in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I Permanent Lipid Lowering therapy Verve 102 Therapy for FH https://www.nejm.org/doi/full/10.1056/NEJMoa2601283 II Vesalius Substudy on PCSK9i Use in Patients With Previous PCI VESALIUS Subgroup Analysis https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.126.080616 VESALIUS Study - NEJM https://www.nejm.org/doi/full/10.1056/NEJMoa2514428 III Tirzepatide looking to be best again SURPASS-EARLY Trial https://www.acpjournals.org/doi/10.7326/ANNALS-25-05602 SURMOUNT-5 Trial https://www.nejm.org/doi/abs/10.1056/NEJMoa2416394 IV Arrhythmias in Cardiac Amyloidosis Loop Recorders Reveal Arrhythmias in Cardiac Amyloidosis https://www.medscape.com/viewarticle/loop-recorders-reveal-arrhythmias-cardiac-amyloidosis-2026a1000gq9 EXCALIBUR Study https://www.jacc.org/doi/10.1016/j.jacc.2026.04.030 V Lipid Guidelines ·       In Defense of the 2026 Dyslipidemia Guideline https://www.medscape.com/viewarticle/defense-2026-dyslipidemia-guideline-2026a1000hd0 Lipid Guidelines: Four Major Concerns https://www.medscape.com/viewarticle/lipid-guidelines-four-major-concerns-2026a1000fim You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

This week we review a recent report from the team at Amrita Institute in Cocchin, India about their use of extended reality and virtual reality as well as heart model printing to aid in planning for complex intracardiac baffles for the treatment of complex congenital heart defects. What was the process used to provide actionable advice in the operating room during surgery? How has the team in southern India created a workflow that can accurately predict this complex anatomy and the patches needed to successfully septate complex hearts? We speak with the director of the 3D imaging group at Amrita, Professor Mahesh Kappanayil about this remarkable achievement of imaging in collaboration with surgery. DOI: 10.1016/j.jtcvs.2026.03.616

CardioNerds Dr. Joseph Kassab, Dr. Mariana Garcia-Arango, and Dr. Christopher Mason explore the technological revolution of Coronary CT Angiography (CCTA) with expert faculty Dr. Michael Gallagher. The discussion details how CCTA has evolved into a frontline diagnostic and preventive tool, moving beyond simple anatomy to incorporate physiology via CT-FFR and biology through AI-driven plaque quantification. The episode reviews landmark evidence like the SCOT-HEART and PROMISE trials, the nuances of CAD-RADS 2.0 reporting, and the emerging role of AI in monitoring treatment response and personalizing cardiovascular care. Critically, they also discuss some of the assumptions and limitations of these techniques. Stay tuned for a matching review article to be submitted to US Cardiology Review, the official Journal of CardioNerds. This episode was supported by an independent medical education grant from HeartFlow. All CardioNerds education is planned, produced, and reviewed solely by CardioNerds.  Enjoy this Circulation Paths to Discovery article to learn more about the CardioNerds mission and journey. US Cardiology Review is now the official journal of CardioNerds! Submit your manuscripts here. CardioNerds Multimodality Cardiovascular Imaging PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll Pearls Shift in Paradigm: CCTA is no longer just an anatomic test; with some key limitations, it can provide anatomy, physiology (CT-FFR), and plaque biology (AI-CPA) in a single non-invasive scan. The “Power of Zero” vs. Plaque: While a normal CCTA has a >95% negative predictive value, future MIs often arise from non-obstructive plaque that traditional stress tests might miss. CAD-RADS 2.0 Utility: The addition of plaque burden modifiers (P1–P4) is a “game changer,” allowing clinicians to identify high-risk patients who need aggressive lipid-lowering despite having only mild stenosis. CT-FFR as a Virtual Stress Test: CT-FFR uses computational fluid dynamics to simulate blood flow, potentially reducing unnecessary invasive catheterizations by approximately 61% without sacrificing safety. Seeing the Invisible: AI-based quantitative plaque analysis (QCPA) can identify “subvisual” plaque and low-attenuation (lipid-rich) components that are the primary drivers of acute coronary syndromes. Show Notes How has the role of CCTA changed compared to traditional functional testing? Historically, stress testing answered “is there ischemia today?”, which often reflects late-stage disease. CCTA identifies disease across the entire spectrum, asking “is there atherosclerosis and how much plaque is present?”. Landmark evidence: SCOT-HEART showed a 41% relative risk reduction in MI at 5 years attributed to intensified preventive therapies, and PROMISE showed CCTA was better at selecting patients who truly needed invasive angiography. Diagnostic CCTA imaging depends on the protocol, contrast timing, heart rate, heart rhythm, breathholding, scanner quality, and several patient factors (obesity, prior stents, heavy calcification, complex bypass anatomy, and motion artifact all may limit imaging). “CCTA is exceptional for the right patient, with the right scanner, and the right team.” What are the key modifiers introduced in CAD-RADS 2.0, and why do they matter? CAD-RADS 2.0 moved beyond stenosis severity to include plaque burden (P0 to P4), high-risk plaque (HRP) features, and the presence of ischemia based on CT-FFR. It serves as a clinical decision support tool: a patient with mild (25-49%) stenosis but “extensive” (P4) plaque burden is considered high risk and warrants aggressive risk factor modification. How is CT-FFR calculated, and when is it most useful in clinical practice? CT-FFR uses resting CCTA data and computational fluid dynamics to create a 3D model of coronary flow during simulated maximal hyperemia. It is often used for intermediate lesions (40–90% stenosis) to predict if they are  ischemia-producing, guiding the decision whether to proceed with invasive angiography.  The assumptions necessary for this computational modeling may not apply well to patients with microvascular dysfunction, significant myocardial scar or prior infarction, or ventricular hypertrophy. Still, data indicate that CT-FFR performs similarly to PET in predicting hemodynamically significant lesions.  CT-FFR performs well at the extremes (either clearly normal or clearly abnormal). Accuracy dips, however, in the intermediate range (~0.75-0.80), where decision-making is most critical. In this grey zone, additional factors can help guide the approach, including the amount of myocardium supplied, translesional gradient, and plaque features.   CT-FFR has not been validated in distal segments, stented segments, heavily calcified coronary arteries, or in patients with severe aortic stenosis. Caution with CT-FFR should be utilized in very calcified coronary segments.  What is AI-based quantitative plaque analysis (QCPA), and what metrics are ready for clinical use? This is potentially a paradigm shift, moving away from stenosis-centric thinking to a more disease burden and plaque biology focus. QCPA uses deep learning algorithms to automatically segment the vessel wall and quantify plaque volume in mm³. Ready for “prime time” metrics include: Total Plaque Volume (TPV), non-calcified plaque volume, and Low-Attenuation Plaque (LAP) burden. Can serial CCTA be used to monitor the effectiveness of medical therapies like statins? While not yet a routine guideline-driven practice, trials like PARADIGM and EVAPORATE show that therapies can stabilize plaque; notably, CCTA is better for monitoring than CAC scores, which can be misleading as statins often increase plaque calcification as part of the stabilization process. There are no randomized trials that serial CCTAs improve outcomes. Cost and radiation exposure will be notable limitations. Serial scan timing, scan acquisition and interpretation standardization would be key. Dr. Gallagher notes that we are moving toward a world in which plaque burden may become a “treatment biomarker,” similar to tumor burden in oncology.  References 1. Coronary Computed Tomography Angiography From Clinical Uses to Emerging Technologies: JACC State-of-the-Art Review. Abdelrahman KM, Chen MY, Dey AK, et al. Journal of the American College of Cardiology. 2020;76(10):1226-1243. doi:10.1016/j.jacc.2020.06.076. 2. Non-Invasive Imaging in Coronary Syndromes: Recommendations of the European Association of Cardiovascular Imaging and the American Society of Echocardiography, in Collaboration With the American Society of Nuclear Cardiology, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance. Edvardsen T, Asch FM, Davidson B, et al. Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography. 2022;35(4):329-354. doi:10.1016/j.echo.2021.12.012. 3. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Gulati M, Levy PD, Mukherjee D, et al. Journal of the American College of Cardiology. 2021;78(22):e187-e285. doi:10.1016/j.jacc.2021.07.053. 4. Contemporary, Non-Invasive Imaging Diagnosis of Chronic Coronary Artery Disease. van der Bijl P, Gulati M, Saraste A, et al. Lancet (London, England). 2025;406(10519):2577-2587. doi:10.1016/S0140-6736(25)01586-7. 5. State of the Art: Evaluation and Medical Management of Nonobstructive Coronary Artery Disease in Patients With Chest Pain: A Scientific Statement From the American Heart Association. Slipczuk L, Blankstein R, Bucciarelli-Ducci C, et al. Circulation. 2025;152(23):e443-e466. doi:10.1161/CIR.0000000000001394. 6. Diagnostic Performance of Fractional Flow Reserve Derived From Coronary CT Angiography: The ACCURATE-CT Study. Li C, Hu Y, Jiang J, et al. JACC. Cardiovascular Interventions. 2024;17(17):1980-1992. doi:10.1016/j.jcin.2024.06.027. 7. Clinical Outcomes Based on Coronary Computed Tomography-Derived Fractional Flow Reserve and Plaque Characterization. Sato Y, Motoyama S, Miyajima K, et al. JACC. Cardiovascular Imaging. 2024;17(3):284-297. doi:10.1016/j.jcmg.2023.07.013. 8. Clinical Use of Coronary Computed Tomography Angiography-Derived Fractional Flow Reserve: Expert Consensus by an International Working Group. Tang CX, Leipsic JA, Nørgaard BL, et al. European Radiology. 2026;:10.1007/s00330-025-12313-6. doi:10.1007/s00330-025-12313-6. 9. Diagnostic accuracy of computed tomography–derived fractional flow reserve: a systematic review. Cook CM, Petraco R, Shun-Shin MJ, et al. JAMA Cardiol. 2017;2(7):803-810. Doi:10.1001/jamacardio.2017.1314 10. Diagnostic performance of noninvasive fractional flow reserve derived from coronary computed tomography angiography in suspected coronary artery disease: the NXT trial (Analysis of Coronary Blood Flow Using CT Angiography: Next Steps). Nørgaard BL, Leipsic J, Gaur S, et al. J Am Coll Cardiol. 2014;63(12):1145-1155. Doi:10.1016/j.jacc.2013.11.043 11. Comparison of coronary computed tomography angiography, fractional flow reserve, and perfusion imaging for ischemia diagnosis. Driessen RS, Danad I, Stuijfzand WJ, et al. J Am Coll Cardiol. 2019;73(2):161-173. Doi:10.1016/j.jacc.2018.10.056. 12. 1-year outcomes of FFRCT-guided care in patients with suspected coronary disease: the PLATFORM study. Douglas PS, De Bruyne B, Pontone G, et al. J Am Coll Cardiol. 2016;68(5):435-445. Doi:10.1016/j.jacc.2016.05.057. 13. Comparison of an initial risk-based testing strategy vs usual testing in stable symptomatic patients with suspected coronary artery disease: the PRECISE randomized clinical trial. Douglas PS, Nanna MG, Kelsey MD, et al; PRECISE Investigators. JAMA Cardiol. 2023;8(10):904-914. Doi:10.1001/jamacardio.2023.2595. 14. Diagnostic and clinical value of FFRCT in stable chest pain patients with extensive coronary calcification: the FACC study. Mickley H, Veien KT, Gerke O, et al. JACC Cardiovasc Imaging. 2022;15(6):1046-1058. doi:10.1016/j.jcmg.2021.12.010. 15. Low-Attenuation Noncalcified Plaque on Coronary Computed Tomography Angiography Predicts Myocardial Infarction: Results From the Multicenter SCOT-HEART Trial (Scottish Computed Tomography of the HEART). Williams MC, Kwiecinski J, Doris M, et al. Circulation. 2020;141(18):1452-1462. doi:10.1161/CIRCULATIONAHA.119.044720. 16. AI-Guided Quantitative Plaque Staging Predicts Long-Term Cardiovascular Outcomes in Patients at Risk for Atherosclerotic CVD. Nurmohamed NS, Bom MJ, Jukema RA, et al. JACC. Cardiovascular Imaging. 2024;17(3):269-280. doi:10.1016/j.jcmg.2023.05.020. 17. Interaction of AI-Enabled Quantitative Coronary Plaque Volumes on Coronary CT Angiography, FFRCT, and Clinical Outcomes: A Retrospective Analysis of the ADVANCE Registry. Dundas J, Leipsic J, Fairbairn T, et al. Circulation. Cardiovascular Imaging. 2024;17(3):e016143. doi:10.1161/CIRCIMAGING.123.016143. 18. Prognostic Value of AI-Based Quantitative Coronary CTA vs Human Reader-Based Visual Assessment: Results From the CONFIRM2 Registry. van Rosendael A, Nakanishi R, Bax JJ, et al. JACC. Cardiovascular Imaging. 2026;19(3):345-359. doi:10.1016/j.jcmg.2025.09.021.13. Pericoronary Adipose Tissue as a Marker of Cardiovascular Risk: JACC Review Topic of the Week. Tan N, Dey D, Marwick TH, Nerlekar N. Journal of the American College of Cardiology. 2023;81(9):913-923. doi:10.1016/j.jacc.2022.12.021. 19. Effect of Icosapent Ethyl on Progression of Coronary Atherosclerosis in Patients With Elevated Triglycerides on Statin Therapy: Final Results of the EVAPORATE Trial. Budoff MJ, Bhatt DL, Kinninger A, et al. European Heart Journal. 2020;41(40):3925-3932. doi:10.1093/eurheartj/ehaa652. 20. Coronary CT Angiography Evaluation With Artificial Intelligence for Individualized Medical Treatment of Atherosclerosis: A Consensus Statement From the QCI Study Group. Schulze K, Stantien AM, Williams MC, et al. Nature Reviews. Cardiology. 2026;23(2):100-115. doi:10.1038/s41569-025-01191-6.

In this episode of The Visible Voices Podcast, Dr. Columbus Batiste — interventional cardiologist, lifestyle medicine physician, Regional Chief of Cardiology for Southern California Permanente Medical Group, founder of Healthy Heart Nation, and author of Selfish: A Cardiologist's Guide to Healing a Broken Heart — makes the case that prescriptions and procedures alone are not enough. Dr. Batiste draws on the preventable losses of his father and father-in-law to explore why moderation is not a health strategy, what inflammation and silent chronic disease are doing beneath the surface, and how food, breath, love, sleep, and laughter are evidence-based medicine. He shares the science behind hibiscus tea, dark leafy greens, garlic, blueberries, and beets as blood pressure and heart health tools, and offers practical guidance for patients at every income level. Find Columbus https://drbatiste.com/ ▶ Subscribe on YouTube @resaelewissmd — new Visible Voices episodes on Wednesdays.

Three more digoxin trials, yet another GLP-1 drug on the horizon, vagal nerve stimulation, trial inside baseball, and more on lipid guidelines are the topics John Mandrola, MD, discusses in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I More About Low-dose Digoxin in HF — The DECISION Trial(s) DECISION Trial https://www.nature.com/articles/s41591-026-04406-6 Digitalis Glycosides in HF — JAMA Meta-Analysis https://jamanetwork.com/journals/jama/fullarticle/2848972 DIGIT-HF Trial https://www.nejm.org/doi/10.1056/NEJMoa2415471 RADIANCE Trial (1993) https://www.nejm.org/doi/full/10.1056/NEJM199307013290101 DECISION Withdrawal Study https://doi.org/10.1093/eurheartj/ehag385 Digoxin Discontinuation vs Continuation in Chronic HF https://doi.org/10.1016/j.amjcard.2007.02.099 II Yet another GLP-1 Drug Announced this Week Lillly News Release on Retatrutide https://investor.lilly.com/news-releases/news-release-details/lillys-triple-agonist-retatrutide-delivered-powerful-weight-loss III A Big Story in HF Science – Vagal Nerve Stimulation in HFrEF ANTHEM HFrEF trial https://doi.org/10.1016/j.jacc.2026.03.040 Editorials An Unfinished ANTHEM https://doi.org/10.1016/j.jacc.2026.04.033 When Trials Stop Prematurely https://doi.org/10.1016/j.jacc.2026.03.039 IV Lipid Guideline News Lipid Guidelines: Four Major Concerns https://www.medscape.com/viewarticle/lipid-guidelines-four-major-concerns-2026a1000fim Editorial: Time to Move Beyond the Statin Nocebo Effect  https://www.jacc.org/doi/10.1016/j.jacc.2026.04.002 Correspondence: SAMSON N-of-1 Trial of Statin, Placebo, or No Treatment https://www.nejm.org/doi/full/10.1056/NEJMc2031173 You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

This week we review a landmark paper from the NEJM by the SCOUT-HCM study group assessing the impact of mavacamten on HCM in the adolescent patient. How does this agent work and what impact did it have on the LVOT gradients in obstructed HCM teens? Does this agent affect other biomarkers associated with more obstruction in this setting? Who is a good potential candidate for the use of this agent? Why must the EF be carefully monitored while using this agent? Dr. Joseph Rossano, Professor of Pediatrics at The University of Pennsylvania and the chief of pediatric cardiology at The Children's Hospital of Philadelphia joins the podcast to discuss this groundbreaking work.doi: 10.1056/NEJMoa2601103

In this episode, CardioNerds Dr. Colin Blumenthal, Dr. Kelly Arps, and Dr. Yong Hao Yeo are joined by electrophysiology expert Dr. Bradley Knight to discuss atrial fibrillation (AF) management in challenging clinical scenarios. We explore arrhythmias in patients with pre-excitation syndromes, particularly Wolff-Parkinson-White (WPW) syndrome, and strategies for rhythm control. We also discuss AF management in pregnancy, adult congenital heart disease, and patients with tachycardia-bradycardia (tach-brady) syndrome. This episode provides essential insights into nuanced decision-making for the care of patients with complex arrhythmia profiles. Audio editing by CardioNerds academy intern, Grace Qiu. Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. CardioNerds Atrial Fibrillation PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! PEARLS AF in WPW is a true emergency—AV nodal blocking agents can be deadly. In patients with WPW syndrome, AF can rapidly conduct through the accessory pathway, risking ventricular fibrillation and sudden death. Avoid AV nodal blockers like beta-blockers and calcium channel blockers. Catheter ablation is the first-line rhythm control strategy in WPW. Catheter ablation carries a Class I recommendation and offers >90% success. If antiarrhythmic drugs are needed, sodium channel blockers like flecainide or propafenone are preferred in patients without structural heart disease. In pregnancy, protecting the mother is protecting the fetus. An unstable mother means an unstable fetus. Rate control is the first step in AF with rapid ventricular responses and electrical cardioversion is safe when needed. Multidisciplinary care is essential. AF in congenital heart disease is often outside the pulmonary veins. Surgical scars and chamber remodeling in ACHD patients often lead to AF from non-pulmonary vein foci. Electrogram-based mapping and targeted ablation strategies are essential to increase success rate of durable rhythm control. Tachy-brady syndrome may require pacing to unlock therapy. AF may cause atrial myopathy and sinus node dysfunction. These patients often require permanent pacing to allow safe use of rate-controlling medications like beta-blockers and to prevent syncope or chronotropic incompetence. Notes: Notes drafted by Dr. Yong Hao Yeo Why is atrial tachycardia in patients with WPW syndrome dangerous? Patients with WPW commonly present with supraventricular tachycardia (SVT) due to atrioventricular reentrant circuits, either orthodromic or antidromic. This SVT can degenerate into AF. In the absence of AV nodal as the governor between the atrium and ventricles, the accessory pathway may conduct impulses rapidly and frequently. This can lead to dangerously high ventricular rates, predisposing patients to ventricular fibrillation and sudden cardiac arrest. What are some strategies for rhythm control in patients with WPW and atrial tachycardia? Catheter ablation is the first-line therapy (Class I recommendation), with a success rate of over 90%. Ablation reduces the risk of sudden cardiac arrest, though some patients may remain prone to AF. If ablation is not feasible/ contraindicated, sodium channel blockers such as flecainide and propafenone are good options in patients without ischemia or structural heart disease (Class IIa recommendation). Amiodarone should be avoided because it has a long half-life, can accumulate in the system, and may delay definitive treatment with catheter ablation. AV nodal blocking agents like beta blockers and calcium channel blockers should be avoided, as they are less effective at controlling ventricular rate in WPW and can increase conduction over the accessory pathway. These agents can also exacerbate the risk of rapid ventricular rates during AF and worsen left ventricular function. What are some special considerations in managing AF in pregnant patients? The primary goal in managing cardiovascular disease during pregnancy is to protect the mother, as fetal outcomes depend on maternal well-being. Therefore, while caution is necessary, we should avoid undertreating pregnant patients with AF. In cases of AF with rapid ventricular response (RVR), rate control is usually the first-line strategy, with beta blockers preferred over digoxin or non-dihydropyridine calcium channel blockers. It is then reasonable to initially observe for spontaneous conversion in stable patients. Antiarrhythmic drugs (AADs) are generally avoided during the first trimester, but clinical judgment on a case-by-case basis is essential. Evidence for the safety of AADs in pregnancy is limited, often derived from their use in other conditions such as fetal SVT. Flecainide and sotalol are reasonable options for rhythm control (Class IIa recommendation). Electrical cardioversion is considered safe in pregnancy and should be utilized when indicated (Do not forget!). There is no pregnancy-specific thromboembolic risk stratification tool. CHA₂DS₂-VASc scoring and the presence of risk factors like mitral stenosis can help guide anticoagulation decisions, though the magnitude of thromboembolic risk during pregnancy remains unclear. Rate control agents are typically continued during delivery due to the increased physiologic stress of labor and delivery. Multidisciplinary care is crucial and should involve obstetrics, maternal-fetal medicine, cardiology, and electrophysiology specialists. What are some key considerations for AF management in patients with adult congenital heart disease (ACHD)? Patients with repaired congenital heart disease are at increased risk for arrhythmias due to two main factors: surgical scars that create arrhythmogenic foci and mechanical remodeling of the atria or ventricles resulting from the underlying disease. In these patients with structural heart disease, sodium channel blockers may not be ideal antiarrhythmic options. When selecting an antiarrhythmic drug, clinicians must consider the nature of structural or surgical impairments, such as right bundle branch block or prolonged QT interval. It is also essential to assess renal and hepatic function (often impaired in patients with ACHD) to ensure appropriate metabolism and clearance of antiarrhythmic medications. Electrogram-based ablation strategies (those leveraging artificial intelligence are developing!) may help identify effective ablation targets, which are often outside the pulmonary veins in patients with ACHD. These individualized approaches can improve ablation success rates in this complex patient population. What makes tachycardia-bradycardia (tach-brady) syndrome a unique challenge in arrhythmia management? Patients who present with both AF and bradycardia, especially with syncope, require a thoughtful diagnostic approach to identify the underlying rhythm disturbance. Extended cardiac monitoring, including event monitors or implantable loop recorders, can help capture intermittent arrhythmias and correlate them with symptoms. AF may lead to atrial myopathy, and since the sinus node resides within the atrium, this can result in sinus node dysfunction—a hallmark of tachy-brady syndrome. Following spontaneous conversion from AF to sinus rhythm, sinus node dysfunction may persist, leading to prolonged pauses or chronotropic incompetence. Management becomes more complex when beta-blockers are needed for AF with RVR, as they can exacerbate bradycardia. Permanent pacemaker implantation is often the next step to consider. Permanent pacemaker implantation is often considered to facilitate safe rate control in these cases. In younger patients, aggressive AF burden reduction may prevent atrial remodeling and the development of true atrial myopathy, potentially avoiding pacemaker implantation. References Joglar JA, Chung MK, Armbruster AL, et al. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2023;149(1). doi:https://doi.org/10.1161/CIR.0000000000001193 ‌ Van IC, Rienstra M, Bunting KV, et al. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). European Heart Journal. 2024;45(36). doi:https://doi.org/10.1093/eurheartj/ehae176 ‌ Joglar JA, Kapa S, Saarel EV, et al. 2023 HRS expert consensus statement on the management of arrhythmias during pregnancy. Heart Rhythm. Published online May 1, 2023. doi:https://doi.org/10.1016/j.hrthm.2023.05.017 ‌ Stout KK, Daniels CJ, Aboulhosn JA, et al. 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: Executive Summary. Journal of the American College of Cardiology. 2019;73(12):1494-1563. doi:https://doi.org/10.1016/j.jacc.2018.08.1028 ‌