47th Annual Cardiology Teaching Day Wednesday, October 18, 2017 | 7:30AM-4:00PM ​The Grandview, 176 Rinaldi Blvd., Poughkeepsie, NY 12601

 

 

 

TREASURE HUNT- LOOKING FOR HIDDEN SOURCES

Gap 

Incomplete work up  stroke patients  leads to an increased risk of recurrent stroke.

Need

Aggressive evaluation including TEE, prolonged cardiac monitoring and hematologic workup

Can lead to improved clinical outcomes.

Objective      

In patients presenting with stroke, diagnostic  evaluation generally includes anatomic imaging of the brain, and a review of blood pressure control and imaging of cerebral and carotid arteries.  Additional diagnosis entities to consider include paroxysmal  atrial fibrillation with concomitant left atrial appendage thrombus,patent foramen ovale and paradoxic embolism, mitral stenosis, endocarditis and aortic atherosclerotic disease. Management strategies can be divided into two broad areas that includes antiplatelet and anticoagulation therapies as well mechanical approaches using disc occluders for patent foramen ovale and Watchman devices for occlusion of the left atrial appendage.Current guidelines for the use of these devices as well as outcome data will be presented.  Controversies in the use of anticoagulant drugs will be discussed with an emphasis on the concept of bridging therapies during anticoagulant interruption. 

1. Evaluate patients presenting with stroke.
2. Identify the appropriate diagnosis entity of patient presenting with stroke.
3. Select appropriate management strategy for patients presenting with stroke.

 

THE FORGOTTEN RIGHT HEART

Gap

Common diseases of the right heart remain an area fraught with difficulties in  diagnosis and management.. Failure to discover pulmonary hypertension and pulmonary emboli  leads to a reduction in  quality of life and poor clinical outcomes. Evolving use of catheter directed thrombolysis may lead to improved clinical outcomes in patients with submassive and massive pulmonary emboli. Diagnostic and therapeutic treatments of this class remains under utilized.

Need

Foremost is the need to include pulmonary hypertension and acute and chronic pulmonary emboli in the differential diagnosis of patients presenting with shortness of breath. Non invasive and invasive diagnostic techniques need to be more commonly utilized to document pulmonary hypertension. Catheter based thrombolytic therapy is now available in our community and adds a potential life saving approach.

Objectives

Right heart catheterization remains an important tool for evaluation of symptomatic patients suspected of having pulmonary hypertension. Evaluation for chronic thromboembolic pulmonary hypertension, left heart failure, mitral valve disease and primary pulmonary hypertension now leads to improved clinical outcomes. Use of endothelial  receptor antagonists, prostanoids and phosphodiesterase 5 inhibitors represent  effective tools in management of severe pulmonary  hypertension. On the acute side of right heart disease, acute pulmonary emboli are estimated to cause 250 000 cases of sudden death each year.  Directed thrombolytic therapy offers an opportunity to reduce complications from systemic therapy as well as reducing long term right heart failure.

 

1. Evaluate patients presenting with right heart disease.
2. Identify the appropriate diagnosis entity of patient presenting with Right Heart Disease.
3. Select appropriate management strategy for patients presenting with right heart disease.

 

OLD VALVES- NEW TREATMENTS

Gap

Many patients with severe aortic and mitral valve disease were previously thought  not to be candidates for repair. Technological  advances now allow for non-surgical repair with reasonable morbidity  and mortality.  Treatment of these lesions remains underutilized.

Need

Symptomatic patients with severe aortic stenosis previously considered to be surgically inoperable may now be offered trans aortic valve replacement (TAVR) as an excellent option to improve quality of life and survival. In a similar argument, symptomatic patients with severe degenerative mitral regurgitation who were previously thought to be high risk surgical candidates may now be offered mitral clip procedures.

Objectives

Key to management of mitral regurgitation involves precise evaluation of the severity and etiology of mitral valve disease. Transesophogeal echo and 3D imaging are comprehensive studies which are important in determining optimal candidates for both surgical and catheter based mitral valve repair. Information gained is also important in guiding adequate repairs. Management of mitral regurgitation centers on issues of medical optimization of coexisting conditions as well as timing of surgical repair. Selection of appropriate candidates for open surgical repair and replacement focuses on the realization that early treatment of mitral regurgitation prevents irreversible systolic dysfunction and heart failure. Advantages of mitral valve repair include freedom from tissue prosthesis degeneration and the lack of requirement for anticoagulation with mechanical devices. Mitral clip procedures offer an opportunity for palliation of severe mitral insufficiency without the need for median sternotomy and cardiopulmonary bypass. Severe aortic stenosis is increasingly recognized in our aging population. TAVR offers shorter hospital stays with comparable outcomes in selected patients and is now being performed on an increasing basis.       

1. Evaluate patients presenting with valve disease.
2. Select appropriate management strategy for patients presenting with valve disease.