Interventional Cardiologist @lenoxhill / @ZuckerSoM🫀| Interests #CHIP #PERT #CardiacCriticalCare | Previously @nymedcollege @PennMedicine | tweets are my own |
New York, NY
Joined March 2017
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Excited to share our paper, now out in @JACCJournals! Important work led by @MAlvarezVillela:
🔥 Fever in AMI-CS is common and is associated with greater illness severity but seems to be noninfectious in most cases
#CardiogenicShock 🫀
doi.org/10.1016/j.jacadv.202…
Excellent review highlighting importance of understanding ethnic background as a part of CV risk
- Comp lipid workup + inflammatory assessment
- Imaging for early/soft plaque detection
- Early interventions w/ meds
South Asian Cardiovascular Risk: jacc.org/doi/10.1016/j.jacas…
See our latest publication from the #Northwell-Shock registry led by @MAlvarezVillela in @JACCJournals
In line with recent literature, we found a potential beneficial effect of MCS use in STEMI-CS but not in NSTEMI-CS.
#JACC: Advances jacc.org/doi/10.1016/j.jacad…
Very interesting from @GreggWStone
Makes sense intuitively - more ischemic time on an already stunned myocardium, elevating EDP, contrast delivery etc...
Non-shock doesn't necessarily mean patient is "stable".
Atul D. Bali, MD retweeted
Key updates to this guideline include:
➡️ The use of the American Heart Association PREVENT-ASCVD equations to guide primary-prevention and lipid-lowering therapy decisions.
➡️ Testing Lp(a) at least once in a lifetime and selective apolipoprotein B measurement to improve risk assessment and guide treatment
➡️ The return of LDL-C and non-high-density lipoprotein cholesterol treatment goals (with lower targets for higher-risk groups)
➡️ Expanded use of coronary artery calcium scoring to reclassify risk[ME1.1]
✍🏼 @rblument1 @tygluckman @RonBlankstein @PamelaBMorris @pnatarajanmd @AnnMarieNavar @SethShayMartin @APRN_CNS @nyulangone @DrMichaelShapir @kgradneyrd @eugeniagianos @virani_md @KellieMcLain1 @ijeomaheartdoc @SamiaMoraMD @DrHeatherJohn @dmljmd
What a Christmas 🎄 call
VT/electrical storm needing #ECMO
Valvular #cardiogenicshock needing salvage BAV
Mid LAD #STEMI w/ critical LM bifurcation disease
Tamponade w/ hemorrhagic effusion
& a CCU that has not let up, all during a snowstorm!
Wouldn’t have it any other way 🙏🏽
Last weeks complex case:
60s, dilated CDM (LV 6.8cm, EF 20%). P/w refractory angina, limited meds due to low BP on GDMT
Not sick enough for transplant yet (ambulatory, CI 2.5, on oral 💊). Surgical turndown due to risk
🫀team➡️ PCI for QOL/angina
How would you approach? #CHIP
3/
Ostial LM CSA - 3.2, severe dampening. 7Fr w/ SH, single access w/ tMCS
Wiring was tricky! Took an XTA & was able to wire into a septal off the aneurysm, then direct down to LAD
Up-front Rota 1.5 through LM -> mid LAD,
IVUS sized DESx2 mid LAD to Ostial LM. (Bumper wire)
Atul D. Bali, MD retweeted
This week we hosted the first edition of the Northwell Cardiogenic Shock Skills day. Over 50 junior faculty members and fellows from cardiology, IC, CTS & CCM joined a day of hemodynamic simulations, hands-on tMCS and PAC learning and expert discussions of real-life CS cases.
High risk PE on call last night🫀p/w syncope & ⬇️ BP
Heavily impacted bilateral PE w/ saddle, RV/LV 1.6. Opening hemos c/w normotensive shock (on inotropes CI 1.4). MCS on standby.
Immediate response to thrombectomy.
POD1 - walking, normal RV fxn on TTE.
#PERT @PERTConsortium
Atul D. Bali, MD retweeted
“Every physician carries within himself a small cemetery, where from time to time he goes to pray.” — René Leriche
The guilt is real. Each name finds its place there, quiet and heavy.
What surprises me still are the families who meet loss with gratitude—who somehow thank you through their own heartbreak. That grace stays with you far longer than the failure ever does.
Iatrogenic LM ➡️ LAD dissection sent emergently from an outside hospital.
Operator was attempting IVUS of dLM nodularity, resulted in dissection, wire loss (unable to rewire). Long dissection flap & slow flow noted.
Transferred in for salvage PCI. What is your approach? 🫀
4/
On IVUS, LM “appeared” free of dissection.
So I did the following:
- Rota 1.5 of LM into LCx calcium
- pt became ischemic -> Impella CP
- supercross 120 w/ mongo allows me to wire
- balloon to re-establish flow
- stent prox LAD, then mini crush to LM bifurcation
Landscape changing data for oHCM🫀
Aficamten v Metoprolol monotherapy:
No reduction in LVOT gradients with metoprolol, worsening pVO2, worsening NTproBNP
A trial that challenges decades of practice!
#ESCCongress @NEJM @escardio
Aficamten or Metoprolol Monotherapy for Obstructive Hypertrophic Cardiomyopathy: @NEJM #ESCCongress2025
🥸 Aficamten for HOCM
😱 Summary
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