In this episode I visit with Dr. John Gorcsan, an expert in echocardiography and strain imaging, to discuss the utility of ejection fraction. We discuss how EF came to be used in clinical practice, the importance of it in heart failure and the variation in measurement. We introduce strain imaging and what that adds to ejection fraction, particularly in the setting of severe mitral regurgitation.
References from our discussion:
GLS in Acute Heart Failure – Park et al. JACC 2018
Strain in primary, asymptomatic MR- Mentias et al. JACC 2016
In this episode I meet with Dr Murali Chakinala, an expert in pulmonary hypertension at Washington University in St Louis. We review the groupings of pulmonary hypertension, diagnosis and management considerations.
In this episode I visit with Dr Richard Bach, the director of the Hypertrophic Cardiomyopathy Center at Washington University. We talk about everything from diagnosis, risk of exercise, medical management, indications for myectomy and alcohol ablations.
The first patient treated with tPA in an acute myocardial infarction was at Barnes-Jewish Hospital. In this episode, I talked with one of the key players in making that happen, Dr Phil Ludbrook. It’s a great bit of medical history that I hope you enjoy!
Link to original case series of 7 patients published in the New England of Journal of Medicine in 1984.
Second part with Dr Karen Joynt Maddox discussing alternative payment models. In part one, we discussed the history of how quality measures began to be collected to being used in current reimbursement. In part two, we discuss some of the limitations of these models and the unanticipated consequences on some populations.
The way we pay for medical care is changing. In this first episode of a two-part series, Dr Karen Joynt Maddox explains the history of the transition towards a quality based system. See her article in the New England Journal of Medicine here.
I visited with Dr Linda Peterson about cardiac rehab. We review who qualifies for referral, what cardiac rehab is, the benefits and the challenges for patient participation. In the podcast, I reference a few articles regarding the mortality benefit. Links are found below:
JACC 2016 Meta-analysis
Mayo study of post-CABG patients
Mayo study of post-PCI patients
In collaboration with Dr Clifford Robinson (RadOnc), Dr Phillip Cuculich helped pioneer a completely noninvasive method to identify the origin of ventricular tachycardia and treat with radiation. Dr Cuculich and I talked about the trial, how it came about, and we learn from the results.
See the manuscript published in the New England Journal of Medicine here.
I met with Dr Kathryn Lindley to talk about peripartum cardiomyopathy. Dr Lindley’s research and clinical focus is in this area, and really helped me understand this disease better. We review the risk factors, clinical manifestations, diagnostics and treatment considerations.
I discuss an interesting case I recently encountered on the wards with a brief review of the general principles of presentation and treatment.
In this episode I talk with Dr Alan Zajarias about TAVR (transcatheter aortic valve replacement). We talk about how candidates are evaluated and current research.
Dr David L Brown and Dr Richard Bach discuss the recent ORBITA trial. Dr Brown co-authored the accompanying editorial in the Lancet and Dr Bach is an interventional cardiologist.
I met with the director of the Health Systems Innovation Laboratory at Washington University School of Medicine, Dr Thomas Maddox, MD, and we talked about PCSK9 inhibitors. Where did the idea for these drugs come from, how effective are they, and why are they not used more in current practice?
In this episode I visit with Dr Mike Rich and discuss stress testing. We review the various modalities, whom to send for stress testing and the prognostic utility of stress testing.