STEMI/NSTEMI and OMI/NOMI Paradigms

Guest: Stephen W. Smith, M.D.

Host: Anthony H. Kashou, M.D.

Early detection of acute myocardial infarction (MI) can impact patients' immediate care and long-term outcomes. Most trained physicians can detect common ST-elevation MI (STEMI) patterns on ECG. However, a subset of patients does not present with common STEMI patterns. There are ECG patterns that can be identified to improve patient outcomes but are not yet widely known or accepted in current guidelines.

Joining us today to discuss the STEMI versus non-STEMI (NSTEMI) and occlusion MI (OMI) versus nonocclusion MI (NOMI) paradigms is Stephen W. Smith, M.D., Emergency Medicine, Hennepin Healthcare, in Minneapolis.

Specific topics discussed:

The problem with the STEMI versus NSTEMI dichotomy

Subgroup within the NSTEMI cohort that may benefit from emergent reperfusion therapy

ECG findings to watch for — beyond, standard STEMI findings — that indicate an occluded artery

Access to Dr. Smith's evaluation formula

Patterns to watch for in diagnosis of OMI

Benign mimickers

Key takeaways for the novice interpreter

Other clinical factors to watch for that may indicate OMI

Recommendations for emergency medicine providers

Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV and @MayoCVservices.

Facebook: MayoCVservices

LinkedIn: Mayo Clinic Cardiovascular Services

NEW Cardiovascular Education App:The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today!

No CME credit offered for this episode.

Podcast episode transcript found here.

Imaging in HCM

Guest: Jeffrey B. Geske, M.D. (@jeffreygeske)

Host: Kyle W. Klarich, M.D. (@KyleWKlarich)

ACA/AHA guidelines related to hypertrophic cardiomyopathy were modified in 2020. Although recommendations for the diagnosis of adult patients reflect minimal change, guidelines for the diagnosis of pediatric patients include new cutoffs. From an imaging perspective, the decision-making algorithm for sudden cardiac death risk stratification incorporates variables not present in prior guidelines.

Joining us today to discuss imaging in hypertrophic cardiomyopathy is Jeffrey B. Geske, M.D., Cardiology, at Mayo Clinic in Rochester, Minnesota.

Specific topics discussed:

Benefits of echocardiography and cardiac MRI in hypertrophic cardiomyopathy

Scar burden and guidelines for quantification

Imaging guidelines for apical variant hypertrophic cardiomyopathy

Recommendations for frequency of cardiac MRI related to delayed gadolinium enhancement

Role of serial imaging in the clinical management of patients

Best methods to assess dynamic outflow tract obstruction in hypertrophic cardiomyopathy

Use of squat-to-stand and valsalva maneuvers

Changes pertaining to imaging for hypertrophic cardiomyopathy in the 2020 ACA/AHA guidelines

Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV.

NEW Cardiovascular Education App:The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today!

No CME credit offered for this episode.

Podcast episode transcript found here.

New HCM Guidelines

Guest: Steve R. Ommen, M.D. (@SteveOmmen)

Host: Kyle W. Klarich, M.D. (@KyleWKlarich)

The distinguished chair of the writing committee for the AHA/ACC 2020 hypertrophic cardiomyopathy guidelines discusses key points in the evolution of guidelines since 2011.

Joining us today to discuss current hypertrophic cardiomyopathy guidelines is Steve R. Ommen, M.D., a cardiologist and the director of the Hypertrophic Cardiomyopathy Clinic at Mayo Clinic in Rochester, Minnesota.

Specific topics discussed:

Major changes to the guidelines

Importance of allowing patients to participate in informed decisions related to their care

Advocating for the role of comprehensive hypertrophic cardiomyopathy centers

Clarification of screening of children and adolescents

Risk stratification for sudden cardiac death

Emerging implications for use of septal reduction therapies

Healthy lifestyles and exercise risks and benefits

Guidelines accessibility on American College of Cardiology and American Heart Association apps

Concept of shared decision making and incorporation of the risk calculator into conversation with the patient

Revisions to risk factors for sudden cardiac death

Discrepancies with 2014-2015 European Society of Cardiology guidelines

Partnership and teamwork between comprehensive hypertrophic cardiomyopathy centers and non-center-based cardiologists

Guidelines for screening of adolescents

Recommendations for active healthy lifestyles and competitive athletes

Cautions regarding patients with hypertrophic cardiomyopathy who develop atrial fibrillation

Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV.

NEW Cardiovascular Education App:The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today!

No CME credit offered for this episode.

Podcast episode transcript found here.

Evolution of Computerized ECG Interpretation

Guest: Peter Macfarlane, Ph.D., D.Sc.

Host: Anthony H. Kashou, M.D.

In the 1960s, investigative works for the methods to analyze electrocardiograms (ECGs) with automated techniques were conducted at the University of Glasgow. The evolution of the University of Glasgow's ECG interpretation software — now used worldwide — has shaped the ECG criteria used in clinical practice today.

Joining us today to discuss ECG analysis is Peter Macfarlane, Ph.D., D.Sc., the lead developer of the program. He is a University of Glasgow emeritus professor and honorary senior research fellow who in 2014 was awarded a Commander of the British Empire for his services to health care.

Specific topics discussed:

History of ECG analysis at the University of Glasgow

Other researchers involved in early ECG interpretation and development

Key features required and criteria needed to recognize sinus rhythm

What the process of commercial development looked like

Clinical trials and studies that validated the work

Impact of age, sex, race and ethnicity on the ECG

The future of the Glasgow technique in electrocardiography

Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV and @MayoCVservices.

Facebook: MayoCVservices

LinkedIn: Mayo Clinic Cardiovascular Services

NEW Cardiovascular Education App:The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today!

No CME credit offered for this episode.

Podcast episode transcript found here.

PYP Imaging in Conjunction with Cardiac Amyloid Clinic

Guest: Omar F. Abou Ezzeddine, M.D., C.M., M.S. (@abouezzeddine)

Host: Paul A. Friedman, M.D. (@drpaulfriedman)

There has been a revolution in the diagnosis of amyloid heart disease: Nuclear imaging has made endomyocardial biopsy the exception, rather than the rule.

Joining us today to discuss the role of nuclear imaging in the diagnosis of amyloid heart disease is Omar F. Abou Ezzeddine, M.D., C.M., M.S., a consultant in Cardiovascular Medicine and director of the Cardiac Sarcoid Clinic at Mayo Clinic in Rochester, Minnesota.

Specific topics discussed:

Types of amyloid that infiltrate the heart muscle and cause myocardial toxicity

Pyrophosphate (PYP) detection of those amyloids

PYP imaging limitations and drawbacks, including risk of false-positives and false-negatives

Limitations of single-photon emission computerized tomography (SPECT) imaging

Pros and cons of hybrid SPECT-CT vs. SPECT-alone imaging

Role of PYP imaging in assessment of therapeutic response

Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV.

NEW Cardiovascular Education App:The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today!

No CME credit offered for this episode.

Podcast episode transcript found here.

PET Imaging for Cardiac Sarcoidosis in Conjunction with Cardiac Sarcoid Clinic

Guest: Omar F. Abou Ezzeddine, M.D., C.M., M.S. (@abouezzeddine)

Host: Paul A. Friedman, M.D. (@drpaulfriedman)

Positron emission tomography (PET) imaging can help diagnose and manage heart disease in a way that eliminates the need for heart tissue samples and replaces more complex, less effective imaging approaches.

Joining us today to discuss PET imaging for cardiac sarcoidosis is Omar F. Abou Ezzeddine, M.D., C.M., M.S., a consultant in Cardiovascular Medicine and director of the Cardiac Sarcoidosis Clinic at Mayo Clinic in Rochester, Minnesota.

Specific topics discussed:

Introduction to sarcoidosis

Rationale behind the use of PET imaging to assess for cardiac sarcoidosis

When to suspect cardiac sarcoidosis

Necessity of whole-body imaging for diagnosis

Comparison of magnetic resonance imaging and PET imaging and a role for hybrid imaging

Artificial intelligence applications for PET imaging

Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV.

NEW Cardiovascular Education App:The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today!

No CME credit offered for this episode.

Podcast episode transcript found here.

Computerized ECG Interpretation Software

Guest: Ian Rowlandson

Hosts: Anthony H. Kashou, M.D. and Peter A. Noseworthy, M.D. (@noseworthypeter)

Since the first human electrocardiogram (ECG) was recorded in 1887, the clinical use, means to interpret and ability to record cardiac biosignals have continued to evolve. Computerized electrocardiography software has helped with ECG interpretation, improved clinical workflow, and advanced the understanding of electrophysiology.

Joining us today to discuss computerized electrocardiography is Ian Rowlandson, a biomedical engineer and chief scientist of diagnostic cardiology at GE Healthcare, which supplies Mayo Clinic's ECG technology.

Specific topics discussed:

Development of computerized electrocardiography software

Evolution of the automated ECG interpretation process

Interpretation and benefits of serial ECG comparison

Common challenges in the development of ECG algorithms

Common diagnoses that are difficult for ECG algorithms to capture

Changes, including artificial intelligence, expanding the focus of ECG interpretation

Future of computerized electrocardiography

Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV and @MayoCVservices.

Facebook: MayoCVservices

LinkedIn: Mayo Clinic Cardiovascular Services

NEW Cardiovascular Education App:The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today!

No CME credit offered for this episode.

Podcast episode transcript found here.

HFpEF Diagnosis and Treatment in the Cath Lab

Guest: Barry A. Borlaug, M.D.

Host: Malcolm R. Bell, M.D.

Heart failure with preserved ejection fraction (HFpEF), formerly referred to as diastolic heart failure, is defined hemodynamically as an inability of the heart to pump blood adequately at normal filling pressures. But while some people have high filling pressures while at rest, others have high filling pressures during exercise. Diagnosis of HFpEF in the Cardiac Catheterization Laboratory involves both at-rest and exercise studies.

Joining us today to discuss the diagnosis of HFpEF and patient selection for Cardiac Catheterization Laboratory testing is Barry A. Borlaug, M.D., a cardiologist at Mayo Clinic in Rochester, Minnesota.

Specific topics discussed:

HFpEF defined

Diagnosis and patient selection for catheterization laboratory testing

H2FpEF scoring system

Catheterization laboratory at-rest and exercise studies, tests and measurements

Key parameters for HFpEF diagnosis

General study length

Treatment recommendations

Cardiac rehabilitation considerations

Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV.

NEW Cardiovascular Education App:The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today!

No CME credit offered for this episode.

Podcast episode transcript found here.

Inclisiran – How Does it Really Work?

Guest: R. Scott Wright, M.D.

Host: Stephen Kopecky, M.D. (@DrSteveKopecky)

In 2021, the U.S. Food and Drug Administration (FDA) approved the use of inclisiran to lower low-density lipoprotein (LDL) cholesterol in people with atherosclerotic cardiovascular disease.

Joining us today to discuss inclisiran is R. Scott Wright, M.D., a cardiologist at Mayo Clinic in Rochester, Minnesota. Dr. Wright was intimately involved in planning recent studies of inclisiran and reporting the results.

Specific topics discussed:

How inclisiran works

FDA-identified indications for use

Administration and dosing

Cost of the drug

LDL cholesterol reduction results

Initial and long-term side effects

Long-term benefits and studies

Inclisiran and lipoprotein (a)

Off-target effects and drug-drug interaction monitoring

The ideal patient and patients who are not appropriate to receive inclisiran

Research outcomes for patients who are statin intolerant

Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV.

NEW Cardiovascular Education App:The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today!

No CME credit offered for this episode.

Podcast episode transcript found here.

The Journal of Electrocardiology And A Future Glimpse

Guest: Adrian Baranchuk, M.D. (@adribaran)

Hosts: Anthony H. Kashou, M.D. and Peter A. Noseworthy, M.D. (@noseworthypeter)

The Journal of Electrocardiology has documented the evolution of the field since 1968. The peer-reviewed medical journal remains a go-to resource for physicians around the world.

Joining us today to discuss why and how the electrocardiogram (ECG) has withstood the test of time and where he envisions the field heading is Adrian Baranchuk, M.D., Journal of Echocardiology editor-in-chief. Guest host Peter A. Noseworthy, M.D., Cardiovascular Medicine, at Mayo Clinic in Rochester, Minnesota, also joins the conversation.

Specific topics discussed:

Baranchuk's experience and involvement with electrocardiology and how it led to his position as editor-in-chief

Challenges faced to ensure the journal remains a leader in the field

Fascination with the ECG and features responsible for its enduring role in medicine

Baranchuk's current research and vision for the future of ECG

Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV and @MayoCVservices.

Facebook: MayoCVservices

LinkedIn: Mayo Clinic Cardiovascular Services

NEW Cardiovascular Education App:The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today!

No CME credit offered for this episode.

Podcast episode transcript found here.