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Controversies in Cardiology

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John A. Ambrose
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This book will consider several clinical and interventional topics for which there is uncertainty, continued debate and/or no consensus based on current guidelines. While there are numerous guidelines in cardiology, new and on-going trials that address new drugs treatments and procedures raise many unanswered questions.  Furthermore, most practicing cardiologist taking care of the patients are likely unable to digest all of these studies or guidelines and necessarily correctly apply them to their patients. If one considers in the guidelines the frequent use of Level C (consensus), there are many areas or situations where no trial exists. Also, when applying the results of a trial to an individual patient, there can be uncertainty of how this patient should be managed based on the present body of evidence.
​Section 1.  Special situations of controversial, increased, or unknown cardiovascular risk.- Optimal management of old and new CV risk factors.- Angiographic narrowing prior to ST elevation MI. Are the lesions non-obstructive?.- Preventing future acute coronary events - Identify and treat vulnerable plaques or vulnerable, high risk patients?.- Treatment of diabetes and coronary artery disease.- Elevated triglycerides and atherosclerosis.- Patent foramen ovale and stroke.- Systolic hypertension in the elderly.- Section 2. Cardiovascular diagnosis.- CT angiography vs routine stress testing in patients with chest pain seen in the emergency room to exclude coronary artery disease.- Takotsubo cardiomyopathy- frequency, diagnosis and management.- Chest pain in women – evaluation and management.- Section 3. Cardiovascular management.- Myocardial infarction and “normal” coronary arteries on angiography.- Management of intractable angina when PCI or CABG is not an option.- Invasive management of CAD in patients on anticoagulants.- Managing intracoronary thrombus during PCI.- Optimal management of multivessel disease – PCI vs CABG vs medical therapy alone.- Appropriate therapy for severe left main disease.- Radial vs femoral procedures for angiography and PCI.- DAPT after stenting in stable and acute coronary syndromes – does the drug combination really matter?.- CAD management in patients with significant renal dysfunction or on dialysis.- What is the optimal stent design?.- Oral pharmacotherapy in the prevention of restenosis: prednisolone, rapamune, colchicine and   cilostazol.- When should ablation be considered in the treatment of atrial fibrillation?.- Use of advanced and expensive cardiac procedures in the very elderly- Can or should we limit access?.- Cost benefits of TAVR- Should the indications be expanded?.