The CardioNerds and Dr. Shashank Sinha on Treating a Middle-Aged HF Patient

By CardioNerds - Last Updated: November 16, 2023

The following question refers to Section 8.5 of the 2022 ACC/AHA/HFSA Guideline for the Management of Heart Failure.

Ms. V. Tea is a 55-year-old woman with a history of cardiac sarcoidosis, heart failure with mildly reduced ejection fraction (EF 40%), and ventricular tachycardia with CRT-D who presents with recurrent VT. She has undergone several attempts at catheter ablation of VT in the past and has been trialed on amiodarone, which was discontinued due to hepatotoxicity. She continues to have episodic VT requiring antitachycardia pacing and ICD shocks despite medical therapy with mexiletine, metoprolol, and sotalol. Her most recent PET scan showed no active areas of inflammation. Currently, her vital signs are stable, and her labs are unremarkable. What is the best next step for this patient?
A Evaluation for heart transplant
B Evaluation for LVAD
C Dobutamine
D Prednisone
E None of the above

Shivani Reddy, a medical student at Western Michigan University and CardioNerds Intern, asked the question. It was answered first by Dr. Michael Francke, a cardiology fellow at the University of Southern California and CardioNerds FIT Trialist, and then by expert faculty Dr. Shashank Sinha. Dr. Sinha is an assistant professor of medical education at the University of Virginia School of Medicine and an advanced heart failure, MCS, and transplant cardiologist at Inova Fairfax Medical Campus.

*The answer is provided at 3:28 of the episode.

The Decipher the Guidelines: 2022 ACC/AHA/HFSA Guideline for The Management of Heart Failure series was developed by the CardioNerds and created in collaboration with the American Heart Association and the Heart Failure Society of America. It was created by 30 trainees—spanning the education spectrum from college through advanced fellowship—under the leadership of CardioNerds cofounders Drs. Amit Goyal and Dan Ambinder, with mentorship from Drs. Anu Lala, Robert Mentz, and Nancy Sweitzer. We thank Drs. Judy Bezanson and Elliott Antman for their tremendous guidance.

This podcast originally appeared on CardioNerds.


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