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

I visit with Robert Christenson PhD about the troponin assays and how they can be falsely positive from anti-body mediated interference. I present a case and we discuss the mechanisms which create the false positives (or negatives) with the assays, how manufacturers are trying to mitigate them and the emerging challenge of biotin supplements.

References (hyperlinks on apcardiology.com):

Arshed et al. Elevated Troponin I in the Absence of Coronary Artery Disease: A Case Report With Review of Literature. J Clin Med Res 2015

Krahn et al. High Percentage of False Positive Cardiac Troponin I Results in Patients with Rheumatoid Factor. Clinical Biochemistry. 1999

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

Links:

Unveiling transthyretin cardiac amyloidosis and its predictors among elderly patients with severe aortic stenosis undergoing transcatheter aortic valve replacement.

Expert Consensus Recommendations for Multimodality Imaging in Cardiac Amyloidosis

Identification of Transthyretin Cardiac Amyloidosis Using Serum Retinol-Binding Protein 4 and a Clinical Prediction Model