COVID 19 in the CICU

Guest: Courtney E. Bennett, D.O.

Host: Malcolm R. Bell, M.D.

The data is strong: Patients with known cardiovascular disease or other risk factors for cardiovascular disease are at increased risk of COVID-19 infection. Patients with COVID-19 and underlying cardiovascular disease are sicker and require more ICU-level care than patients without cardiovascular risk factors. Those factors include hypertension, diabetes and obesity.

Joining us today to discuss COVID-19 and cardiovascular disease is Courtney E. Bennett, D.O., a cardiologist and the director of the cardiac intensive care unit at Mayo Clinic in Rochester, Minnesota.

Specific topics discussed:

Heightened risk of COVID-19 infection in patients with preexisting cardiovascular disease and impact on prognosis

Manifestations that identify patients as having myocardial insult or injury

Magnitude of troponin rises in these patients who may have septic shock or severe respiratory distress

The role of electrocardiogram (ECG) for patients with ST depression

Treatment for patients with ST elevation

Anticoagulation treatment for patients with acute coronary syndrome (ACS)

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

No CME credit offered for this episode.

Podcast episode transcript found here.

Ceramides as a New Biomarker for Cardiovascular Risk Prediction

Guest: Vlad C. Vasile, M.D., Ph.D. (@VladCVasile)

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

Ceramides are lipids that are ubiquitously expressed. They are present in all cell membranes. Some ceramides have been associated with risk of atherosclerotic disease in patients with known coronary artery disease. Researchers at Mayo Clinic and others have demonstrated that ceramides can also predict negative events in patients without known coronary artery disease.

Joining us today to discuss ceramides is Vlad C. Vasile, M.D., Ph.D., a preventive cardiologist and co-director of Cardiovascular Laboratory Medicine at Mayo Clinic in Rochester, Minnesota.

Specific topics discussed:

Ceramides and the ceramide score blood test

Primary and secondary risk assessment for atherosclerotic events

Using ceramide score in patients at intermediate risk

Score modification via diet, exercise and lipid-lowering agents

Testing for lipoprotein (a)

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

No CME credit offered for this episode.

Podcast episode transcript found here.

LVAD – Who Needs It?

Guest: Andrew (Drew) N. Rosenbaum, M.D. (@werDrD)

Host: Malcolm R. Bell, M.D.

About 6.5 million people over the age of 20 years in the U.S. have heart failure. That number is estimated to grow to about 8 million by 2030. Of those patients, about 300,000 would potentially benefit from left ventricular assist device (LVAD) therapy. Among patients with advanced heart failure, 66% to 75% would have comorbidities that would preclude benefit from LVAD therapy, so approximately 75,000 to 100,000 patients in the U.S. would be potentially eligible for LVAD therapy.

Joining us today to discuss LVADs is Andrew (Drew) N. Rosenbaum, M.D., a cardiologist at Mayo Clinic in Rochester, Minnesota.

Specific topics discussed:

Types of left ventricular assist devices: durable, destination therapy, bridge to transplantation

Who benefits from LVAD and why

LVAD durability

Age limitations for LVAD therapy

Inappropriate candidates for LVAD

End-stage renal disease, LVAD and dialysis

When to consider referral for LVAD therapy

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

No CME credit offered for this episode.

Podcast episode transcript found here.

Lipoprotein A - A Cardiovascular Risk Factor Commonly Ignored

Guest: Vlad C. Vasile, M.D., Ph.D. (@VladCVasile)

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

Lipoprotein (a) is a circulating protein that associates with a cholesterol complex. It comprises two particles — a low-density lipoprotein (LDL, or "bad") cholesterol particle and an LDL-like particle — and apolipoprotein A. Lipoprotein (a) is associated with increased atherosclerotic cardiovascular events independent of the traditional risk factors. It has also been associated with valvular heart disease. Currently, there are no specific drugs that both reduce lipoprotein (a) levels and influence treatment outcomes.

Joining us today to discuss lipoprotein (a) is Vlad C. Vasile, M.D., Ph.D., a preventive cardiologist and co-director of Cardiovascular Laboratory Medicine at Mayo Clinic in Rochester, Minnesota.

Specific topics discussed:

Lipoprotein (a) and its impact

Plaque formation and pro-inflammatory and pro-clotting molecules

Drugs and available treatment options

Lifestyle impact

Genetic basis and importance of familial awareness

Screening for lipoprotein (a)

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

No CME credit offered for this episode.

Podcast episode transcript found here.

TTR Cardiac Amyloid - How Common and How to Diagnose

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

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

There are two main types of cardiac amyloidosis. One is a medical emergency involving light chain amyloid. The source of the amyloid is the bone marrow, which secretes excessive amounts of monoclonal protein that infiltrate the myocardium and cause an acute necrotic infiltrative and restrictive cardiomyopathy. In the second type, transthyretin (TTR) amyloidosis, the source of the protein is the liver. The course of TTR amyloidosis occurs over years.

Joining us today to discuss cardiac amyloidosis 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:

Cardiac amyloidosis

Signs and symptoms indicative of cardiac amyloidosis

Patients who receive atrial fibrillation ablation and patients who receive transcatheter aortic valve replacement (TAVR)

Tools for diagnosis, including pyrophosphate (PYP) and MRI scans

Therapeutic options for patients with TTR amyloidosis, including tafamidis

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

No CME credit offered for this episode.

Podcast episode transcript found here.

COVID and Exercise:  Pearls from the Experts

Guest: Thomas G. Allison, Ph.D., M.P.H. (@DrTAllison)

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

Aerosol-generating procedures are medical procedures in which a patient has some significant and strong ventilation, such as coughing, that causes aerosols of a size that might release virus into the environment. Mayo Clinic has implemented procedures to protect both patients and staff from COVID-19 aerosols during stress testing.

Joining us today to discuss COVID-19 and its impact on exercise is Thomas G. Allison, Ph.D., M.P.H., director of the Pulmonary Exercise Laboratory and the Sports Cardiology Clinic at Mayo Clinic in Rochester, Minnesota.

Specific topics discussed:

Aerosols and aerosol-generating procedures

Aerosol generation during exercise

Masking and recirculators

Reduction in exercise capacity due to masking

Paper masks versus O2 consumption masks

Patient and staff protection

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

No CME credit offered for this episode.

Podcast episode transcript found here.

Bileaflet MVP Syndrome

Guest: Michael J. Ackerman, M.D., Ph.D. (@MJAckermanMDPhD)

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

Mayo Clinic researchers looked at a 10-year experience of 1,200 patients who came to the Windland Smith Rice Genetic Heart Rhythm Clinic. The researchers found that 24 of those patients were survivors of out-of-hospital cardiac arrest. Ten of those 24 survivors — 42% — had bileaflet prolapse. That finding helped the research team identify the features of arrhythmogenic bileaflet mitral valve prolapse syndrome.

Joining us today to discuss arrhythmogenic bileaflet mitral valve prolapse syndrome is Michael J. Ackerman, M.D., Ph.D., a pediatric cardiologist and principal investigator at the Windland Smith Rice Sudden Death Genomics Laboratory at Mayo Clinic in Rochester, Minnesota.

Specific topics discussed:

Mitral valve prolapse versus arrhythmogenic bileaflet mitral valve prolapse syndrome

Signs and symptoms of arrhythmogenic bileaflet mitral valve prolapse syndrome

Characteristic findings of complex ectopy

Work-up and next steps

A role for MRI

Mitral annular disjunction

Treatment options

A role for ablation

A genetic condition or not?

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

No CME credit offered for this episode.

Podcast episode transcript found here.

Reducing Cardiovascular Risk in Minorities

Guest: LaPrincess C. Brewer, M.D., M.P.H., (@DrLaPrincess)

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

Health disparities are differences in the incidence, prevalence, mortality, burden of disease and other adverse health conditions among specific population groups.

Health care disparities are differences in health care coverage, access to care and quality of care between those groups. Health care disparities limit people's ability to achieve health equity — the equally fair and just opportunity to be as healthy as possible.

Joining us today to discuss research in health care disparities is LaPrincess C. Brewer, M.D., M.P.H., a preventive cardiologist at Mayo Clinic in Rochester, Minnesota.

Specific topics discussed:

Health disparities versus health care disparities

Health equity explained

COVID-19 pandemic and the social determinants of health

Socioeconomic, racial and ethnic issues

FAITH! cardiovascular health and wellness program

FAITH! data and outcomes

Next steps for providers

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

No CME credit offered for this episode.

Podcast episode transcript found here.

COVID-19 in Cardio-Oncology

Guest: Joerg Herrmann, M.D. (@mayocvonc)

Host: Malcolm R. Bell, M.D.

Coronavirus disease 2019 (COVID-19), heart disease and cancerous tumors were the top three causes of death in the U.S. in 2020. Providers recognized early in the COVID-19 pandemic that patients with underlying cardiovascular disease or cardiovascular risk factors were at the highest risk of developing a severe course and even dying of COVID-19. Patients with cancer also had a higher risk of severe and fatal outcomes.

Joining us today to discuss COVID-19, heart disease and oncology treatment of tumors is Joerg Herrmann, M.D., director of the Cardio-Oncology Clinic at Mayo Clinic in Rochester, Minnesota.

Specific topics discussed:

Relationship between heart disease, cancerous tumors and COVID-19

Research in the connection between cardiac disease and an underlying tumor or the result of treatment of a tumor

Changes to patient care during the pandemic

Remote monitoring of patients and innovative artificial intelligence applications

Cardio-oncology lessons learned

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

No CME credit offered for this episode.

Podcast episode transcript found here.

The Role of High-Intensity Interval Training and Strength Training in Cardiovascular Health

Guest: Amanda R. Bonikowske, Ph.D.

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

The primary advantage of high-intensity interval training (HIIT) — periods of higher intensity exercise followed by periods of lower intensity exercise in repetition — for cardiorespiratory fitness is peak VO2. HIIT is a more potent stimulus for increasing peak VO2 in a much shorter period of time compared with moderate-intensity continuous training.

Joining us today to discuss HIIT is Amanda R. Bonikowske, Ph.D., program director for the Cardiac Rehabilitation Program at Mayo Clinic in Rochester, Minnesota.

Specific topics discussed:

HIIT explained

Variability, guidelines and rest-to-work ratios

Benefits over moderate-intensity training

The One-Minute Workout

Physiology of HIIT

Impact on HDL and LDL cholesterol, triglycerides and blood pressure

Safety

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

No CME credit offered for this episode.

Podcast episode transcript found here.