Let's LIME!: Recent Episodes
CardioNerds
LIME stands for Leadership & Innovation in Medicine & Education. LIME also means to hang around with friends. We bring leaders to talk about innovations in medicine, education, and beyond. So join us, and Let’s LIME with the visionaries of today!
In this episode, Dr. Gurleen Kaur (medicine resident at Brigham and Women’s Hospital and Director of CardioNerds Internship) and CardioNerds Academy interns Dr. Akiva Rosenzveig (medicine intern at Cleveland Clinic), Dr. Chelsea Tweneboah (medicine intern at Stonybrook University), student doctor Shivani Reddy (medical student at Western Michigan University), student doctor Diane Masket (medical student at Rowan School of Osteopathic Medicine), and student doctor Tina Reddy (medical student at Tulane University School of Medicine) discuss with Dr. Michelle Kittleson (Director of Education in Heart Failure and Transplantation, Director of HF Research, and Professor of Medicine at Cedars Sinai) about Mastering the Art of Patient Care. Dr. Kittleson shares pearls of wisdom from her book on topics including career transitions, mentorship, dealing with uncertainty, learning from mistakes, delivering difficult news, and being a woman and parent in medicine.
This episode was planned by Dr. Gurleen Kaur and episode audio was edited by student doctor Tina Reddy.
Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values.
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The following question refers to Section 3.2 of the 2021 ESC CV Prevention Guidelines. The question is asked by CardioNerds Academy Intern, student Dr. Hirsh Elhence, answered first by Ohio State University Cardiology Fellow Dr. Alli Bigeh, and then by expert faculty Dr. Eugene Yang.
Dr. Yang is professor of medicine of the University of Washington where he is medical director of the Eastside Specialty Center and the co-Director of the Cardiovascular Wellness and Prevention Program. Dr. Yang is former Governor of the ACC Washington Chapter and current chair of the ACC Prevention of CVD Section.
The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines represents a collaboration with the ACC Prevention of CVD Section, the National Lipid Association, and Preventive Cardiovascular Nurses Association.
Question #19
| True or False: A 70-year-old male has an estimated 10-year ASCVD risk (using SCORE2-OP) of 7.5% which confers a very high CVD risk and necessitates treatment with a statin. | | TRUE | | FALSE |
Answer #19
| Explanation | FALSE – CVD risk thresholds for risk factor treatment are higher in apparently healthy people 70 years and older in order to prevent overtreatment in the elderly. A 10-year CVD risk ≥15% is considered “very high risk” for individuals ≥70 years of age (compared to a ≥7.5% cut-off for “very high risk” in younger patients <50 years old). For these patients, treatment of ASCVD risk factors, including lipid-lowering medications, is recommended (class IIb). Lifetime benefit of treatment in terms of time gained free of CVD is lower in older people. The SCORE2-OP algorithm estimates 5-year and 10-year fatal and non-fatal CVD events adjusted for competing risks of non-CVD mortality. Treatment and risk stratification should (as with all patients) be individualized. For patient >70 years of age, a 10-year CVD risk of 7.5 to <15% is considered “high risk”, and treatment of risk factors should be considered taking CVD risk modifiers, frailty, lifetime treatment benefit, comorbidities, polypharmacy, and patient preference into account. For patient >70 years of age, a 10-year CVD risk of <7.5 is considered “low-to-moderate risk” and would generally not qualify for risk factor treatment unless one or several risk modifiers are present. Smoking cessation, lifestyle recommendations and a SBP <160 mmHg are recommended for all. | | Main Takeaway | * CVD risk assessment for patients 70-years and older is estimated using the SCORE2-OP algorithm. A predicted 10-year CVD risk score of ≥15% confers a very high CVD risk, however, this it is a class IIb indication to initiate/intensify lipid lowering therapies in these patients. Decision should be individualized and based on benefits vs risk assessment. | | Guideline Loc. | * 3.2.3.5 |
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It’s another session of CardioNerds Rounds! In these rounds, Dr. Natalie Stokes (Formerly FIT at University of Pittsburgh and now General Cardiology Faculty at University of Pittsburgh) and Dr. Karan Desai (formerly FIT at University of Maryland and now General Cardiology faculty at Johns Hopkins) join Dr. Rick Nishimura (Professor of Medicine at Mayo Clinic) to discuss the nuances of managing mitral regurgitation through real cases. Dr. Nishimura has been an author or Chair of the ACC/AHA valve guidelines going back 20 years and has been recognized internationally as one of the world’s best educators, so you don’t want to miss the #NishFactor on these #CardsRounds! Audio editing by CardioNerds academy intern, Pace Wetstein.
This episode is supported with unrestricted funding from Zoll LifeVest. A special thank you to Mitzy Applegate and Ivan Chevere for their production skills that help make CardioNerds Rounds such an amazing success. All CardioNerds content is planned, produced, and reviewed solely by CardioNerds. Case details are altered to protect patient health information. CardioNerds Rounds is co-chaired by Dr. Karan Desai and Dr. Natalie Stokes.
Speaker disclosures: None
Challenging Cases - Atrial Fibrillation with Dr. Hugh Calkins
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Show notes - Mitral Regurgitation with Dr. Rick Nishimura
Case #1 Synopsis:
A man in his 70s with a history of non-ischemic cardiomyopathy (last known LVEF 15-20%) and atrial fibrillation, presented with decompensated heart failure in the setting of moderate to severe mitral regurgitation. He was diuresed, transitioned to GDMT, and referred to cardiac rehabilitation. Over the next 6 months, he continued to have debilitating dyspnea (NHYA Class IIIa) and his outpatient physicians were limited on titrating GDMT further due to hypotension. A TEE was done which demonstrated EF 15%, severe MR by color and quantitation (EROA of 0.5 cm2; Regurgitant Volume of 65 mL), systolic flow reversal in the pulmonary vein and severe tricuspid regurgitation. We were asked how we would approach this case
Case #1Takeaways
In attempting to keep the evaluation of chronic mitral regurgitation relatively simple, we should ask ourselves three primary questions: (1) What is causing the MR; (2) How much MR is there; and (3) What is the hemodynamic consequence of the MR.To the first question of what is the etiology of the MR – a simple framework is to think of the etiology as an issue of the valve (primary) or an issue of the ventricle/atria (secondary). There is further classification that can be made based on the Carpentier Classification which speaks to the valve leaflet movement and position (normal leaflet motion, excessive leaflet motion [e.g., prolapse], or restricted in systole and/or diastole [e.g., rheumatic heart disease]).During rounds, Dr. Nishimura provided some historical context in that the original valve guidelines had recommendations for intervention on primary mitral regurgitation and not secondary – given that it is considered a disease of the ventricle. Trials like the COAPT trial have greatly shifted our practice in treating secondary mitral regurgitation. Though, we have to be familiar with which patients with secondary MR would truly derive benefit from mitral valve interventionIn regards to the COAPT trial, patients with moderate to severe (3+) or severe (4+) mitral regurgitation who remained symptomatic despite maximally tolerated guideline-directed medical therapy (GDMT) were included. Dr. Nishimura makes the point that about one-third of patients intended to be enrolled in the trial were not included because they improved so much on GDMT. And thus, when evaluating patients for consideration of mitral valve intervention in secondary MR – a...
Join Dr. Alin Gragossian for a discussion on leadership & innovation in medicine and education!
Let's LIME! is a fresh collaboration between the CardioNerds and NephJC. We sit down with today's visionaries in medicine to talk leadership, education, drive and more. LIME stands for Leadership & Innovation in Medicine & Education. LIME also means to hang around with friends. We bring leaders to talk about innovations in medicine, education, and beyond. So join us, and Let’s LIME with the visionaries of today!
Dr Alin Gragossian is a physician, heart Transplant recipient & advocate. Read more about Dr Alin Gragossian's journey here: www.achangeofhe.art/blog
Join Dr. Jennifer Gunter for a discussion on leadership & innovation in medicine and education!
Let's LIME! is a fresh collaboration between the CardioNerds and NephJC. We sit down with today's visionaries in medicine to talk leadership, education, drive and more. LIME stands for Leadership & Innovation in Medicine & Education. LIME also means to hang around with friends. We bring leaders to talk about innovations in medicine, education, and beyond. So join us, and Let’s LIME with the visionaries of today!
Dr. Jennifer Gunter is an OB/GYN and a pain medicine physician. who writes about sex, science, social media and more. Learn more at drjengunter.com.
Join Dr. Shreya Trivedi and Dr. Adam Rodman for a discussion on leadership & innovation in medicine and education!
Let’s LIME! is a fresh collaboration between the CardioNerds and NephJC. We sit down with today’s visionaries in medicine to talk leadership, education, drive and more. LIME stands for Leadership & Innovation in Medicine & Education. LIME also means to hang around with friends. We bring leaders to talk about innovations in medicine, education, and beyond. So join us, and Let’s LIME with the visionaries of today!
Dr. Adam Rodman is a Hospitalist at Beth Israel Deaconess Medical Center, Instructor at Harvard Medical School. He is the host of Bedside Rounds which is a medical podcast by @AdamRodmanMD) about fascinating stories in clinical medicine.
Dr. Shreya Trivedi is an Academic Hospitalist at Beth Israel Deaconess Medical Center and serves as Editor-in-Chief of Core IM Podcast.
Join Dr. Kimberly Manning for a terrific discussion about Leadership & Innovation in Medicine and education!
Let’s LIME! is a fresh collaboration between the CardioNerds and NephJC. We sit down with today’s visionaries in medicine to talk leadership, education, drive and more. LIME stands for Leadership & Innovation in Medicine & Education. LIME also means to hang around with friends. We bring leaders to talk about innovations in medicine, education, and beyond. So join us, and Let’s LIME with the visionaries of today!
Kimberly D. Manning is an American physician, Board Certified in Internal Medicine and Pediatrics, and serves as a Professor of Medicine as well as the Associate Chair of Diversity, Equity, and Inclusion for the Department of Medicine at Emory University School of Medicine in Atlanta, Georgia. Manning has been recognized at the national level for her mentorship and teaching as well as her blogging and public speaking. She is the winner of the ACGME Parker J. Palmer Courage To Teach Award, the Evangeline Papageorge Award, and her blog “Reflections of a Grady Doctor” was named as one of the top 4 medical blogs by “O” The Oprah Magazine.