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Clinical Pearls & Perspectives
Practical Insights in Contemporary Cardiovascular Care
Short, practical clinical pearls on heart failure, cardiomyopathy, pulmonary hypertension, cardiogenic shock, emerging therapies and systems of care. Every pearl has its own page and shareable link.
Heart Failure Prevention
- August 17, 2026 · Clinical PearlCCTA Is Changing How We Think About Coronary Artery DiseaseFor years, coronary risk assessment focused heavily on the coronary artery calcium (CAC) score. CAC remains an excellent, validated tool—but it tells us primarily about calcified plaque.
- August 7, 2026 · PerspectiveCKM Staging: A Paradigm Shift in Cardiovascular CareThe new Cardiovascular-Kidney-Metabolic (CKM) staging framework from the ACC/AHA represents one of the most important shifts in cardiovascular medicine in decades.
HFrEF
- July 10, 2026 · Clinical PearlShould Cardiac Rehabilitation Be Part of GDMT for Heart Failure?When we talk about GDMT for heart failure, we immediately think of four pillars: ARNI/ACEi/ARB, beta blocker, MRA, and SGLT2 inhibitor. But heart failure is also a disease of physical function and fitness. Two patients with the same EF of 30% can have very different functional reserve and prognosis. Cardiac rehabilitation helps rebuild that functional reserve.
- August 14, 2026 · Clinical PearlExternal Wearable Defibrillators (Vests) May Be Changing the ICD TimelineFor decades, patients with newly diagnosed HFrEF have faced a relatively rigid timeline: GDMT, reassess LV function after a defined waiting period, and if the EF remains severely reduced, consider a primary prevention ICD.
- August 11, 2026 · Clinical PearlAFib Begets Heart Failure. Heart Failure Begets AFib.A vicious cycle. An opportunity to change the trajectory.
- August 10, 2026 · Clinical PearlPOCUS in the Difficult Heart Failure ExamPOCUS is changing how we assess congestion in heart failure.
HFpEF
- August 6, 2026 · PerspectiveObesity and HFpEF: Transforming Care with Cardiometabolic TherapyHeart failure with preserved ejection fraction (HFpEF) remains one of the greatest challenges in cardiovascular medicine, and obesity is increasingly recognized as one of its most important drivers.
- Clinical PearlHFpEF Is Not One DiseaseHFpEF represents a heterogeneous syndrome. Obesity, hypertension, atrial fibrillation, renal disease, pulmonary hypertension, and metabolic dysfunction may drive very different phenotypes.
Right Heart Failure
Shock & MCS
Cardiomyopathy
- July 1, 2026 · Clinical PearlBeyond the Ejection Fraction: The Role of Cardiac MRI in Heart FailureFor decades, much of heart failure imaging has revolved around a single number: the ejection fraction. But EF tells us how the heart is functioning—it does not necessarily tell us why it is failing. This is where cardiac MRI has changed the evaluation of heart failure.
- August 21, 2026 · Clinical PearlAlcoholic Cardiomyopathy: When Is It Reversible?Alcoholic cardiomyopathy is an important reminder that a very low EF does not always mean permanent heart damage.
- August 20, 2026 · Clinical PearlCardiomyopathy: To Exercise or Not to Exercise?For years, patients diagnosed with cardiomyopathy were often given a simple recommendation: 'Don't exercise.' That message is changing. For many patients with cardiomyopathy, exercise is not only possible—it can be beneficial. The key is determining the right type, the right amount, for the right person.
- August 18, 2026 · Clinical PearlWhat if “Idiopathic” Cardiomyopathy Isn't Really Idiopathic?As genetic testing expands in dilated cardiomyopathy, TTN is becoming increasingly important. Genetics creates susceptibility. Environment may determine when—or whether—the disease emerges.
- August 4, 2026 · PerspectiveHypertrophic Cardiomyopathy (HCM) Is Entering a New EraNot long ago, HCM management focused primarily on symptom control and preventing sudden cardiac death. Today, innovation is reshaping how we diagnose, risk-stratify, and treat this complex disease.
- August 2, 2026 · PerspectiveSubstance Use Navigators: The Heroes Helping With Treatment of Methamphetamine Induced CardiomyopathyMethamphetamine induced cardiomyopathy is more than a heart failure diagnosis: it is a chronic disease at the intersection of cardiology, addiction medicine, mental health, and social determinants of health.
- Clinical PearlMethamphetamine Cardiomyopathy: Treatment Beyond GDMTHeart failure therapy is only part of the treatment strategy. Addressing the underlying substance-use disorder may be essential to long-term myocardial recovery.
Pulmonary Hypertension
- August 5, 2026 · PerspectivePulmonary Hypertension: A Serious Disease That Is Too Often IgnoredPulmonary hypertension (PH) is not simply "high pressure in the lungs." It is a progressive disease that places tremendous strain on the right side of the heart and, if left untreated, can ultimately lead to right heart failure and premature death.
- Clinical PearlPulmonary Hypertension Is More Than an Elevated PA PressureAccurate classification requires attention to hemodynamics, right ventricular function, underlying disease, and the clinical context driving pulmonary vascular stress.
Cardio-Oncology
Emerging Therapies
- August 13, 2026 · Clinical PearlThe Next Frontier in Heart Failure: Decongestion at HomeFor decades, worsening congestion in CHF has followed a familiar pathway: oral diuretics → inadequate response → ED → IV diuretics → hospitalization. That pathway may be starting to change.
- August 1, 2026 · PerspectiveAldosterone Synthase Inhibition: Beyond the Mineralocorticoid ReceptorMRAs have earned their place as a cornerstone of guideline-directed medical therapy by blocking the mineralocorticoid receptor. But as aldosterone synthase inhibitors emerge, they raise a compelling question: is blocking the receptor enough, or could suppressing aldosterone production itself produce different clinical effects?
- PerspectiveBeyond Pharmacologic GDMTDevice-based therapies such as cardiac contractility modulation, baroreflex activation therapy, and remote hemodynamic monitoring are expanding the treatment landscape in heart failure.
Systems of Care
- July 10, 2026 · Clinical PearlShould Cardiac Rehabilitation Be Part of GDMT for Heart Failure?When we talk about GDMT for heart failure, we immediately think of four pillars: ARNI/ACEi/ARB, beta blocker, MRA, and SGLT2 inhibitor. But heart failure is also a disease of physical function and fitness. Two patients with the same EF of 30% can have very different functional reserve and prognosis. Cardiac rehabilitation helps rebuild that functional reserve.
- August 1, 2026 · PerspectivePalliative Care Isn't the End of Heart Failure Care. It's an Essential Part of It.One of the biggest misconceptions in cardiology is that palliative care is only for patients at the very end of life. I would argue the opposite.
- August 12, 2026 · PerspectiveThe Missing Link in Heart Failure Care: Social WorkGreat CHF care treats the patient and the circumstances surrounding them.
- August 4, 2026 · PerspectivePharmacy: The Key to GDMT SuccessPharmacy is one of the most powerful drivers of guideline-directed medical therapy success for patients hospitalized with heart failure.
- PerspectiveHeart Failure Outcomes Are Built Between HospitalizationsTransitions of care, medication access, early follow-up, multidisciplinary support, and patient education are critical components of a high-performing heart failure program.