Cardionerds: A Cardiology Podcast

This is the first episode in an important series on cardiovascular prevention. It's no secret that cardiovascular disease is the #1 killer worldwide; the total impact on humanity is just staggering. A focus on preventing CVD is an impetus for every cardionerd. In this episode Dan, Amit, Carine, and Heather discuss an illustrative case discussion and review the Cardionerds 2+4 paradigm of cardiovascular prevention: 2 fundamental principles of management + 4 steps in risk stratification. The Cardionerds CV prevention series will include in-depth deep dives on so many topics related to prevention starting with this case discussion. Stay tuned for upcoming episodes on the ABCs of prevention, obesity, hypertension, diabetes mellitus and anti-diabetes agents, personalized risk and genetic risk assessments, hyperlipidemia, women's cardiovascular prevention, coronary calcium scoring and so much more! Take me to the Cardionerds Cardiovascular Prevention PageTake me to episode topics page We are truly honored to be producing the Cardionerds CVD Prevention Series in collaboration with the American Society for Preventive Cardiology! The ASPC is an incredible resource for learning, networking, and promoting the ideals of cardiovascular prevention! This series is kicked off by a message from Dr. Amit Khera, President of the American Society for Preventive Cardiology and President of the SouthWest Affiliate of the American Heart Association. TWO principles of management Emphasize healthy lifestyle for everyone regardless of riskEscalate Preventive Measures with ↑ Risk  FOUR steps of risk stratification Qualitative risk approximation - identify major risk factors and start counseling and education. Quantitative risk estimation - use a validated model to quantify a patient’s future risk of CVD. Identify Risk Enhancing Factors - personalize risk if patient is in the gray zones after step 2Measure coronary artery calcium score - selectively if risk remains uncertain Cardiovascular Prevention Amit Goyal, MDDaniel Ambinder, MDCarine Hamo, MDHeather Kagan, MD

Dr. Rab Razzak, palliative care expert, discusses the importance of palliative care in heart failure management. Topics include patient-centered care, effective communication strategies, and the impact of mentorship in healthcare. Special guest Dr. Arsalan Derakhshan joins the discussion on this insightful podcast episode.

Dr. Robert Mentz, director of the Heart Failure section in the Duke Division of Cardiology, discusses diuretics, anti-hyperglycemic therapies including SGLT2/GLP1 agents, angiotensin receptor-neprilysin inhibitors (ARNi), iron as therapies for Heart Failure with Preserved Ejection Fraction (HFpEF). Additionally, study design and ongoing research in HFpEF is discussed. At the end of the episode Dr. Mentz provides an additional update that highlights how the COVID-19 pandemic has influenced clinical trials around the world. Special thanks to guest interviewers, Duke cardiology fellows, Dr. Kelly Arps and Dr. Rahul Loungani! On the CardioNerds Heart Failure topic page you’ll podcast episodes, references, guest experts and contributors, and so much more. Take me to the Heart Failure Topic PageTake me to episode topics pageAcute Decompensated Heart Failure Primer – Youtube Dr. Robert Mentz completed internal medicine training at Brigham and Women’s Hospital and cardiology fellowship followed by advanced heart failure and transplant cardiology training at Duke University Hospital and the Duke Clinical Research Institute. He is the new director of the Heart Failure section in the Duke Division of Cardiology. His areas of clinical and research focus include treating comorbid diseases in heart failure patients, use of biomarkers and surrogate and non-fatal outcomes in heart failure trials, and novel therapeutic approaches to heart failure. Dr. Mentz is heavily involved in many clinical trials and serves as the associate editor at Circulation: Heart Failure. In addition to his clinical and research endeavors, Dr. Mentz is heavily invested in the cardiology fellowship where he serves as associated program director and renown mentor for which he has won many fellow-nominated awards. Finally, as former director of the Duke University Cooperative Cardiovascular Society, he expanded the network of current and former Duke trainees to be a leading enroller in clinical trials. We are really excited about him joining the show to discuss Diuretics ARNi SGLT2/GLP1 therapies for HFpEF. Dr. Rahul Loungani completed medical school at the medical university of SC and then traveled to Baltimore for internal medicine training in the Osler Residency Program at the Johns Hopkins Hospital.  Here he fell in love with the management and hemodynamics of critically ill patients. He is currently a third-year cardiology fellow at Duke University Medical Center where he will also be pursuing fellowship in advanced heart failure and transplant cardiology next year. His current interests are in Cardiac amyloid, in particular it's arrhythmic manifestations, early diagnosis, and novel therapeutics. He also loves teaching the housestaff and was awarded the Cassell-Saperstein award at Duke,  recognizing the fellow who most demonstrates a commitment to teaching and passion for clinical education. Outside of the hospital loves being a new dad to baby Arya. Dr. Kelly Arps completed medical school at Emory University school of medicine and internal medicine training in the Osler Residency Program at the Johns Hopkins Hospital. She is currently is pursuing her cardiology fellowship at Duke University Medical Center.  CardioNerds Heart Failure Series

We discuss Heart Failure with Preserved Ejection Fraction (HFpEF) with Dr. Kavita Sharma, director of the Heart Failure with Preserved Ejection Fraction Program and interim director of Advanced Heart Failure Transplant section at The Johns Hopkins Hospital. CardioNerds hosts Carine Hamo and Daniel Ambinder are joined by Dr. Beth Feldman (resident at The Johns Hopkins Hospital). Topics discussed include a definitions, diagnosis, phenotypic presentations, inpatient management of acute decompensated heart failure, role of dopamine, advanced therapies of HFpEF, and the Paraglide trial.References mentioned in this episode can be found here On the CardioNerds Heart Failure topic page you’ll podcast episodes, references, guest experts and contributors, and so much more. Take me to the Heart Failure Topic PageTake me to episode topics pageAcute Decompensated Heart Failure Primer – Youtube Dr. Kavita Sharma graduated from the University of Virginia School of Medicine and completed her residency and served as the assistant chief of service, cardiology fellowship and advanced heart failure fellowship at the Johns Hopkins Hospital. She is the Director of the Johns Hopkins Heart Failure with Preserved Ejection Fraction Program and is currently the interim director of Advanced Heart Failure Transplant section at Hopkins. She has a specialized interest in heart failure with preserved ejection fraction (HFpEF), and directs one of the largest programs in the country dedicated to caring for patients with this condition. She is the principal investigator of numerous clinical and translational trials in HFpEF and leads a team of nurses, research coordinators, and fellows-in-training in this multifaceted program. She is an invited speaker at national meetings in topic areas covering advanced heart failure and HFpEF. Dr. Beth Feldman graduated from Temple University School of Medicine and is currently on the Longcope Firm on the Osler Medical Service at Johns Hopkins University Hospital. Before pursuing a career in medicine, she worked in health care consulting focusing in health systems. She is passionate about health policy and health systems research. She is hoping to pursue a career in cardiology, with a particular interest in critical care. Kavita Sharma, MDBeth Feldman, MDCardioNerds Heart Failure Series

Interventional cardiology and structural interventions in heart failure are discussed by Dr. Jeffrey Moses, Director of Interventional Therapeutics at Columbia University Medical Center Director of Advanced Cardiac Interventions at St Francis Hospital and Heart Center in Roslyn, NY. CardioNerds hosts Amit Goyal and Daniel Ambinder are joined by Dr. Jackie Latina (Cardiology fellow at The Johns Hopkins Hospital). Topics discussed include percutaneous intervention and complex and high-risk coronary intervention (CHIP), treatment of functional mitral and tricuspid regurgitation, aortic stenosis, and the utility of interatrial shunt devices for the treatment congestive heart failure. On the CardioNerds Heart Failure topic page you’ll podcast episodes, references, guest experts and contributors, and so much more. Take me to the Heart Failure Topic PageTake me to episode topics pageAcute Decompensated Heart Failure Primer – Youtube Dr. Jeffrey W. Moses completed medical school at the University of Pennsylvania School of Medicine and his internship, residency and fellowship in Cardiology at the Presbyterian University of Pennsylvania Medical Center. He currently serves as Director of Interventional Cardiovascular Therapeutics at Columbia University Medical Center and as Director of Advanced Cardiac Interventions at St Francis Hospital and Heart Center in Roslyn, NY. Dr. Moses is an Associate Director of the Transcatheter Cardiovascular Therapeutics (TCT) conference. He has served as lead investigator for numerous national and international clinical studies and he has made important contributions in the areas of clinical research and educational activities in interventional vascular therapy. He is also a pioneer in developing approaches involving minimally invasive surgery, angioplasty, gene therapy, novel imaging technologies and various support devices that allow for wider application of interventional cardiovascular procedures. Dr. Jacqueline Latina was born and raised in the suburbs of Boston, MA, but fortunately escaped without a Boston accent. She is a graduate of Princeton University with an A.B. in chemistry. She earned her M.D. at Tufts University School of Medicine. Her internship and internal medicine residency were completed at Mount Sinai Hospital in New York City, where she stayed on for an American Heart Association postdoctoral research fellowship. She completed an M.S. in clinical research methods at the Columbia Mailman School of Public Health during that time. She is currently a cardiology fellow at Johns Hopkins Hospital, and plans to start interventional cardiology fellowship in June 2020.  She chuckles if you ask “Are you Latina?” Jeffrey W. Moses, MDJacqueline Latina, MDCardioNerds Heart Failure Series

The Cleveland Clinic Director of Cardiac MRI, Dr. Deborah Kwon, discusses the principles and clinical applications of cardiac MRI, taking us from the protons to the bedside with a series of illustrative cases. CardioNerds hosts Amit Goyal, Daniel Ambinder, and Carine Hamo are joined by Dr. Nicole Pristera (Cleveland Clinic cardiology fellow). Flutter moment by student doctor Arooma Shahid. On the CardioNerds Myocarditis page you will find podcast episodes, infographic, youtube videos, references, tweetorials and guest experts & contributors, flutter stars and so much more. CardioNerds Myocarditis PageCardioNerds Multimodality CV Imaging PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Links in this episode: Mental Filter: Matters of the Heart: Part 1Mental Filter: Matters of the Heart: Part 2Cardiac Imaging Agorà Dr. Debbie Kwon attended medical school at the University of Michigan and internal medicine residency at the University of Pennsylvania. She completed her general cardiology and cardiovascular imaging fellowships at the Cleveland Clinic. She is the Director of Cardiac MRI At the Cleveland Clinic and serves as the Core Lab MRI director for the Pulmonary Vascular Disease Phenomics (PVDOMICS) multicenter National institution of Health (NIH) Study. Dr. Nicole Pristera is a cardiology fellow at the Cleveland Clinic.  She earned her medical degree at Case Western Reserve University and completed her internal medicine residency training at Duke University. Her clinical interests include interventional cardiology and cardiac critical care. Outside of the hospital, she enjoys traveling, hiking, and learning foreign languages. Dr. Arooma Tahir completed her medical degree from Lahore Medical and Dental college in Lahore Pakistan. She went to medical school to pursue her passion and currently she is studying for USMLEs in Fresno, CA. She enjoys hiking, trying out different cuisines, and podcast by cardionerds.  Interview Questions How would you give a basic intro to cardiac MRI principles to a first year cardiology fellow? What should we know about the common sequences for cardiac MRI?We all learn about the risks of NSF.  How much of these risks are a reality and when should we truly avoid gadolinium exposure?What are some challenges to MRI?What types of information about the heart can we obtain with a CMR? The role for Cardiac MRI in particular cases discussed with Dr. Kwon CAD: A 45 year old G1P1 woman with prior preeclampsia and anterior STEMI s/p LAD PCI 3 years ago is being seen for chest pain. TTE shows LVEF 45% with mid-apical anterior hypokinesis and apical aneurysm. How does CMR help delineate ischemic heart disease (perfusion, viability, chambers)  Pericarditis: her stress MRI shows an anteroapical perfusion defect and apical aneurysm with mural thrombus, with corresponding LGE. On further review, her chest pain is sharp, pleuritic, and worsens with recumbency. EKG on follow-up shows diffuse ST elevations and PR depressions except for in aVR which shows ST depression and PR elevation. ESR and CRP are moderately elevated.  ARVC: A 35 year old female athlete who is admitted after VF arrest that occurred during a tennis match. Thankfully she received immediate bystander CPR with early defibrillation and prompt ROSC. She has had prior syncope during training and an uncle died suddenly at age 40. Resting EKG shows an incomplete right bundle, right precordial TWIs, and epsilon waves in V1-V3.  On tele she’s had multiple runs of NSVT of LBBB morphology. Echocardiogram shows RV dilation. A heart failure consult is considering EMBx but requests a CMR beforehand. Role in select other cardiomyopathies: HCM, Amyloid, hemochromatosis etc (if time) Valvular Heart Disease: A 28 year old man with no PMH who presents...

What does it feel like to have fulminant myocarditis? How does it feel to see a loved one on ECMO? What impact do healthcare heroes have on their patients' and their families'? Tune into this remarkable firsthand patient perspective as Chas and Julie Miller recount their experience with fulminant myocarditis. In Episode 31 we discussed the science & medicine of myocarditis. Now in Episode 32 we realize the emotions and human experience on the other side through the lens of a patient and his loving wife. Special messages from CCU nursing, Megan VanName, Alyssa Noonan, and Kelly Norsworthy, as well as Dr. Dan Choi, cardiac surgeon at Johns Hopkins Hospital. On the CardioNerds Myocarditis page you will find podcast episodes, infographic, youtube videos, references, tweetorials and guest experts & contributors, flutter stars and so much more. Take me to the Myocarditis Series PageTake me to the episode topics pagesCheck out Amit Goyal’s Myocarditis Tweetorial 5 points of maximal impulse in approaching myocarditis (review from episode 31) Build the clinical suspicion for myocarditis: You need a high index of suspicion given the variable presentation, and definitely need to keep a differential so you don’t miss things like acute coronary syndromes.Decide if EMBx is necessary: Most often obtained in fulminant presentations to look for pathologic findings of giant cell myocarditis or eosinophilic myocarditis, because these findings will change management.Manage the acute cardiac injury, which can range from supportive care to treatment of shock, arrhythmias, and even tamponade.Manage the chronic cardiac sequelae: Recovering from the acute phase of myocarditis doesn’t necessarily mean smooth sailing — some develop chronic heart failure, warranting GDMT — or guideline directed management and therapy, as defined byDr. Randall Starling in Ep 13.Treat the myocarditis: Immunosuppression is often started empirically in fulminant disease, but continuation depends on what you find on pathology.

The CardioNerds discuss a case of fulminant myocarditis, teaching a comprehensive approach to myocarditis with just 5 foundational principles. Review the myocarditis infographic on the myocarditis topic page. The episode ends with a special message from the true heroes of this episode, Chas and Julie Miller.  This marks our first episode after 100,000 downloads of the show - and this is a benchmark that we are celebrating together with all of you. Since launch, we have had 82 voices on the show and youtube channel. Our website which collates all the podcast episodes, youtube videos, tweetorials, and more has been accessed in 120 countries. We just cannot thank you enough!  On the CardioNerds Myocarditis page you will find podcast episodes, infographic, youtube videos, references, tweetorials and guest experts & contributors, flutter stars and so much more. Take me to the Myocarditis Series PageTake me to the episode topics pagesCheck out Amit Goyal's Myocarditis Tweetorial 5 points of maximal impulse in approaching myocarditis Build the clinical suspicion for myocarditis: You need a high index of suspicion given the variable presentation, and definitely need to keep a differential so you don’t miss things like acute coronary syndromes.Decide if EMBx is necessary: Most often obtained in fulminant presentations to look for pathologic findings of giant cell myocarditis or eosinophilic myocarditis, because these findings will change management.Manage the acute cardiac injury, which can range from supportive care to treatment of shock, arrhythmias, and even tamponade.Manage the chronic cardiac sequelae: Recovering from the acute phase of myocarditis doesn’t necessarily mean smooth sailing -- some develop chronic heart failure, warranting GDMT -- or guideline directed management and therapy, as defined by Dr. Randall Starling in Ep 13.Treat the myocarditis: Immunosuppression is often started empirically in fulminant disease, but continuation depends on what you find on pathology.

Cardiovascular experts, Drs. JoAnn Lindenfeld, Javid Moslehi and Richa Gupta from Vanderbilt University Medical Center and Dr. Enrico Ammirati from Milan, Italy join Amit and Dan for a two part discussion about all things to consider for myocarditis in general (part 1) and COVID-19 myocarditis and heart transplantation in the COVID-19 era (part 2). Flutter Moment by Barrie Stanton (RN). On the CardioNerds Myocarditis page you will find podcast episodes, infographic, youtube videos, references, tweetorials and guest experts & contributors, flutter stars and so much more. Take me to the Myocarditis Series Page  Take me to the COVID-19 Series Page Take me to the Episode Topics Page Dr. JoAnn Lindenfeld, is a Professor of Medicine and the Director of Heart Failure and Heart Transplantation Section at Vanderbilt Heart and Vascular Institute.  She is the past president of the Heart Failure Society of America and serves on editorial boards of numerous journals including JACC, JACC Heart Failure and JHLT.  She is also a member of the AHA/ACC/HFSA heart failure guideline writing committee and was previously chair of the HFSA practice guidelines for the 2006 and 2010 guidelines. In addition to this she’s been an investigator in multiple large-scale clinical trials including the COAPT trial and has served on numerous steering committees, end point committees and data and safety monitoring committees. She is the author of a more than 300 original papers, reviews, and book chapters in the field of heart failure and heart transplantation. Dr. Javid Moslehi is an associate professor of medicine at Vanderbilt University Medical Center where he is the director of the cardio-oncology program.  He is a clinical cardiologist and basic/translational biologist interested in cardiovascular complications associated with novel molecular targeted cancer therapies and the implications of these on our knowledge of basic cardiovascular biology. At Vanderbilt he runs an independent basic and translational research laboratory and program with a focus on signal transduction in the myocardium and vasculature as well as establishing pre-clinical models of cardiotoxicity involving novel targeted oncologic therapies. Dr. Enrico Ammirati is an assistant professor of cardiology and advanced heart failure and transplant cardiologist in Milan, Italy at the Niguarda Hospital with a special research interest and expertise in acute myocarditis and acute heart failure.  He is a fellow of the European Society of Cardiology and has won numerous awards, he has also published incredibly important work on the distinction between fulminant and nonfulminant myocarditis and the prognostic implication of histologic subtypes.  His research interests also include the role of adaptive immunity in heart transplantation and atherosclerosis and he is the author of well over 100+ peer reviewed publications.

Cardiovascular experts, Drs. JoAnn Lindenfeld, Javid Moslehi and Richa Gupta from Vanderbilt University Medical Center and Dr. Enrico Ammirati from Milan, Italy join Amit and Dan for a two part discussion about all things to consider for myocarditis in general (part 1) and COVID-19 myocarditis and heart transplantation in the COVID-19 era (part 2). Flutter Moment/Song by Drs. Matt (Internal Medicine) and Beth Faiman (Oncology). On the CardioNerds Myocarditis page you will find podcast episodes, infographic, youtube videos, references, tweetorials and guest experts & contributors, flutter stars and so much more. Take me to the Myocarditis Series Page Take me to the COVID-19 Series PageTake me to the Episode Topics Page Interview Questions What is myocarditis?How do we classify it?How do we diagnose myocarditis?Why don’t we biopsy everyone?When do we think biopsy may change management?Do we really understand the mechanism of myocardial injury in what we call myocarditis?How do we figure mechanisms out and why is this important? Guests and Experts Dr. JoAnn Lindenfeld, is a Professor of Medicine and the Director of Heart Failure and Heart Transplantation Section at Vanderbilt Heart and Vascular Institute.  She is the past president of the Heart Failure Society of America and serves on editorial boards of numerous journals including JACC, JACC Heart Failure and JHLT.  She is also a member of the AHA/ACC/HFSA heart failure guideline writing committee and was previously chair of the HFSA practice guidelines for the 2006 and 2010 guidelines. In addition to this she’s been an investigator in multiple large-scale clinical trials including the COAPT trial and has served on numerous steering committees, end point committees and data and safety monitoring committees. She is the author of a more than 300 original papers, reviews, and book chapters in the field of heart failure and heart transplantation. Dr. Javid Moslehi is an associate professor of medicine at Vanderbilt University Medical Center where he is the director of the cardio-oncology program.  He is a clinical cardiologist and basic/translational biologist interested in cardiovascular complications associated with novel molecular targeted cancer therapies and the implications of these on our knowledge of basic cardiovascular biology. At Vanderbilt he runs an independent basic and translational research laboratory and program with a focus on signal transduction in the myocardium and vasculature as well as establishing pre-clinical models of cardiotoxicity involving novel targeted oncologic therapies. Dr. Enrico Ammirati is an assistant professor of cardiology and advanced heart failure and transplant cardiologist in Milan, Italy at the Niguarda Hospital with a special research interest and expertise in acute myocarditis and acute heart failure.  He is a fellow of the European Society of Cardiology and has won numerous awards, he has also published incredibly important work on the distinction between fulminant and nonfulminant myocarditis and the prognostic implication of histologic subtypes.  His research interests also include the role of adaptive immunity in heart transplantation and atherosclerosis and he is the author of well over 100+ peer reviewed publications. JoAnn Lindenfeld, MDEnrico Ammirati, MDJavid Moslehi, MDMyocarditis Infographic