Cardiology-Dr.AsifUllah

10/12/2025

Advances in Neurocardiology: Timing of Anticoagulation in Patients With Ischemic Stroke and Atrial Fibrillation 💔

The American Heart Association celebrates its 100th anniversary 🎉, highlighting advances in neurocardiology, a subspecialty merging heart and brain 💡. This update focuses on atrial fibrillation (AF) and timing of anticoagulation initiation after ischemic stroke, a cornerstone of secondary prevention 💊.

The timing of anticoagulation post-stroke is debated ⚖️ due to concerns over hemorrhagic transformation risk 🩸 and embolization risk in untreated AF 💔. Traditionally, anticoagulation was delayed to minimize bleeding risk, following 1-3-6-12-day protocols based on stroke severity 📆.

Recent evidence suggests earlier anticoagulation initiation in selected patients may reduce recurrent thromboembolism risk without increasing bleeding complications ✅. Direct oral anticoagulants (DOACs) initiated early after stroke appear safe and may reduce recurrent stroke risk 💊.

This review synthesizes recent literature on optimal anticoagulation timing in AF patients after ischemic stroke 📚. Relevant studies were identified through PubMed searches using keywords like "atrial fibrillation," "ischemic stroke," and "anticoagulation" 🔍. Priority was given to randomized controlled trials and high-quality observational studies 📊.

09/12/2025

GLP-1RA Discontinuation: Key Findings 💡
Nearly 60% of older adults with diabetes in the US and 31% in Japan discontinued GLP-1RAs within 12 months of starting injectable semaglutide. Discontinuation rates were higher among individuals with cardiovascular disease or chronic kidney disease.

Factors Contributing to Discontinuation 🤔
Medication intolerance
Out-of-pocket costs 💸
Drug stockouts 📦
Lower copayments in Japan may contribute to lower discontinuation rates compared to the US 🇯🇵🇺🇸

Implications and Recommendations 📝
Minimizing cost sharing can improve affordability and adherence 💰. Concerted global efforts are needed to support persistence with semaglutide, especially among high-risk populations 🌎. Further research is needed to understand reasons for discontinuation and optimize treatment regimens 🔬

Study Limitations ⚠️
Lack of information on out-of-pocket costs and healthcare professional characteristics 📊. Uncertain generalizability to patients without diabetes, younger populations, or individuals initiating oral semaglutide 🤝

Funding and Support 💸
Institutional funds from the Richard A. and Susan F. Smith Center for Outcomes Research 🏛️. Grants from various organizations, including the National Heart, Lung, and Blood Institute and the American Heart Association [1-6]

In a binational study of older adults with diabetes, nearly 60% in the US and 31% in Japan discontinued GLP-1RAs within 12 months of starting injectable semaglutide, with higher discontinuation among those with cardiovascular disease or chronic kidney disease. https://ja.ma/44V6Pdk

09/12/2025

Albuminuria: A Systemic Red Flag 🚨
Albuminuria is a critical indicator of kidney damage and a sentinel marker for cardio-renal-metabolic risk 🌡️. Early detection and management are crucial to prevent disease progression and reduce morbidity 💊.

Screening and Initial Assessment 🔍
The Urine Albumin-to-Creatinine Ratio (UACR) is the gold standard test for screening 📝. A level of ≥23 mg/mmol indicates microalbuminuria, triggering further evaluation and management 🚨.

Phenotype-Driven Initial Therapy 💉
Treatment is tailored to the patient's primary clinical profile:
- Obesity 🏋️‍♀️: GLP1-RA as first-line therapy, followed by ACEI/ARB
- Hypertension (HTN) 💉: ACEI/ARB as first-line therapy, followed by MRA
- Type 2 Diabetes (T2D) 🍭: SGLT2i as first-line therapy, followed by ACEI/ARB
- Heart Failure/ASCVD ❤️: SGLT2i as first-line therapy, followed by ACEI/ARB
- CKD (eGFR

29/11/2025

Resistant hypertension in chronic kidney disease (CKD) is a significant concern. The current approach involves a stage-wise treatment plan.

- *Initial Treatment*: ACE inhibitors (ACEI) or angiotensin receptor blockers (ARB) combined with calcium channel blockers (CCB) form the base treatment.
- *Next Steps*: Diuretics and mineralocorticoid receptor antagonists (MRA) are added, followed by SGLT2 inhibitors, finerenone, and GLP-1 receptor agonists.
- *Advanced Options*: Renal denervation may be considered for select patients.

*Nephroprotective Measures*:

- SGLT2 inhibitors (eGFR > 20 ml/min/1.73 m²) for CKD stages 1-3
- Non-steroidal MRAs (finerenone) for CKD stages 4-5ND (eGFR 25 ml/min/1.73 m²)
- GLP-1 RA (semaglutide) for additional benefits

*Treatment Considerations*:

- Beta blockers for cardiac comorbidities
- Spironolactone or other MRAs as alternative options
- Renal denervation for specific patients¹

28/11/2025

💬 Editorial: A study in JAMA demonstrates that most new-onset atrial fibrillation (AF) episodes after cardiac surgery are brief and resolve within 30 days.

These findings support the concept that postoperative AF is reversible and suggest long-term anticoagulation should be the exception rather than the norm for these patients, pending further evidence.

https://ja.ma/4py6aqn

28/11/2025

💊 SGLT2 inhibitors in 90-year-olds with heart failure?

Observational study of 496 older people with high comorbidity burden

SGLT2i therapy associated with:

⬇️ 33% lower mortality
⬇️ 36% lower HF rehospitalisation
⬇️ 40% lower composite risk

📈 Good tolerability, with low discontinuation (2.7%) despite more urinary/genital infections.

📌 Even in frail, high-risk geriatric patients, SGLT2i can be effective and safe

Age and comorbidity shouldn’t be barriers to treatment.

https://www.ahajournals.org/doi/10.1161/CIRCHEARTFAILURE.125.012794

28/11/2025

🔴Lipoprotein(a) Reduction with Lipid-Lowering Drugs – What Works in 2025? 😍📝⤵️

♦️🧾 Atherosclerosis, June 2025 | Meta-analysis of 147 RCTs, 145,314 patients

🔍 Key Clinical Insights

✅ Lipoprotein(a) [Lp(a)] is a causal and independent ASCVD risk factor
✅ It is not effectively reduced by statins or most conventional LLTs
✅ This large meta-analysis evaluated which therapies truly lower Lp(a)

💉 Effective Lp(a)-Lowering Agents

🔹 PCSK9 monoclonal antibodies
→ Reduced Lp(a) by ~29% (absolute drop ~6.4 mg/dL)
→ Greater drop in patients with higher baseline Lp(a)

🔹 Inclisiran
→ Reduced Lp(a) by ~22% (absolute drop ~4.8 mg/dL)

🔹 CETP inhibitors
→ Lp(a) reduction ~46% (absolute drop ~6.8 mg/dL)

🔹 Niacin
→ Lp(a) lowered ~37% (absolute drop ~7.1 mg/dL)
→ Historical use; limited by tolerability and flushing

🚫 Therapies with No Significant Effect on Lp(a)

✖️ Statins
✖️ Ezetimibe
✖️ Bempedoic Acid
✖️ Omega-3 fatty acids
✖️ Fibrates

These drugs do not significantly influence Lp(a), despite their LDL-C lowering effects.

📌 Clinical Pearl

🩺 In patients with controlled LDL-C but residual CV risk and high Lp(a), consider:
→ PCSK9 inhibitors
→ Inclisiran
→ (In the future) CETP inhibitors if approved

🧪 Subgroup Insight

The higher the baseline Lp(a) level, the more absolute benefit seen from these agents.
This supports personalized lipid therapy, especially in familial or genetically high Lp(a).

🧠 Final Word

➡️ Statins alone are not enough for patients with high Lp(a)
➡️ Consider targeted therapies to reduce residual ASCVD risk
➡️ More trials are needed to prove whether Lp(a) lowering truly reduces CV events

https://www.atherosclerosis-journal.com/article/S0021-9150(25)01318-8/abstract?dgcid=raven_jbs_aip_email

Lipoprotein (a) [Lp(a)] is an independent and causal risk factor for atherosclerotic cardiovascular disease. In this study we aimed at assessing the effect of currently available lipid-lowering therapies (LLTs) on Lp(a) plasma levels.

23/11/2025

🛑🛑Top 50 Takeaways (2025 Cholesterol Guidelines)

🟤 1. LDL ≥190 mg/dL in anyone ≥20 yrs → start high-intensity statin.
⚫️ 2. LDL ≥160 mg/dL + strong family history → treat even

15/11/2025

Understanding the Hyperacute T-Wave (HATW) Score

The HATW score is a tool used to identify a specific heart condition called hyperacute T-waves, which can indicate a heart attack (acute coronary syndrome, ACS).

How it Works:

1. Magnitude Score (0-1): Measures T-wave size compared to QRS complex.
2. Symmetry Score (0-1): Measures T-wave shape.
3. Total Score: Combines magnitude and symmetry scores.

Interpretation:
- A score ≥0.70 in 2 contiguous leads may indicate hyperacute T-waves.
- This could suggest a heart attack, especially if other symptoms are present.

Example:
- A patient with chest pain and an ECG showing HATW score of 0.98 (magnitude: 1.0, symmetry: 1.0) may be having a heart attack.

Important:
- The HATW score is not a definitive diagnosis tool.
- It's used in conjunction with other clinical information and ECG findings.
- Consult a cardiologist or emergency medicine specialist for proper interpretation and treatment.

02/11/2025

- A sheath placed in the femoral vein before intervention may be useful for:
- Rapid flow of fluid
- Insertion of a temporary pacemaker (if necessary, but not routine)
- Conscious patients can perform "cough cardiopulmonary resuscitation" to overcome:
- Short period of profound hypotension
- Bradyarrhythmia
- If high clinical suspicion for significant bradyarrhythmia:
- Place a temporary wire in the right atrium
- Ready to advance into the right ventricle for pacing if necessary
- In case of a real emergency:
- Use the 0.014-inch wire in the coronary artery as a pacing wire

01/11/2025

In cases of severe heart failure, cardiac transplantation is often considered a viable treatment option. However, due to the scarcity of donor organs and the complexities involved in transplantation, alternative solutions are frequently explored. One such alternative is the Left Ventricular Assist Device (LVAD), a mechanical pump designed to support the heart's function by augmenting the left ventricle's pumping capacity. The LVAD is typically implanted in patients with end-stage heart failure, serving as a bridge to transplantation or, in some instances, as destination therapy for those ineligible for transplantation. By mechanically assisting the failing heart, LVADs can significantly improve cardiac output, reduce symptoms, and enhance the patient's quality of life while awaiting a potential transplant or as a long-term solution
.

23/10/2025

Here are the top things to know about the 2025 AHA Guidelines for CPR and ECC:

1. Universal Chain of Survival: Developed for both pediatric and adult in-hospital and out-of-hospital cardiac arrest, while a Neonatal Chain of Care guides prenatal to postnatal care.

2. Foreign Body Airway Obstruction (FBAO) Treatment: Rescuers should administer alternating cycles of 5 back blows and 5 abdominal thrusts for adults and children, starting with back blows.

3. Infant Chest Compressions: Perform using the heel of one hand or the two-thumb technique, eliminating the two-finger technique.

4. Naloxone Use: Enhanced public availability and use for suspected opioid-related emergencies.

5. Temperature Control: Maintain for at least 36 hours in adults who remain unresponsive after cardiac arrest.

6. Ethics Chapter: New chapter addressing foundational ethics principles and contemporary challenges.

7. Defibrillation Techniques: Double sequential external defibrillation (DSED) and vector change (VC) defibrillation are not recommended due to lack of evidence.

8. IV Access: Initial attempts at intravenous (IV) access are recommended over intraosseous (IO) access for adult patients in cardiac arrest.

9. Pediatric Cardiac Arrest: New recommendations for predicting neurologic outcome after pediatric cardiac arrest.

10. Cognitive Aids: Recommended for healthcare professionals during resuscitation events, but not for lay rescuers.

Additionally, significant changes in compression technique for infants include:

- Recommended techniques: Two-thumb-encircling hands technique or heel of one hand technique (if unable to encircle the chest)
- Discontinued technique: Two-finger technique along the sternum
- Updated recommendations: Single or two-rescuer CPR: Use either two thumbs or the heel of one hand, whichever achieves the best depth.