42. Lipid Management with Drs. Ann Marie Navar & Nishant Shah

The CardioNerds discuss Lipid Management with Dr. Ann Marie Navar and Dr. Nishant Shah from Duke Medical Center, Division of Cardiology. Amit, Carine and Dan take a deep dive into the greasy world of lipids and cholesterol, covering lipid metabolism, therapeutic targets, approach across the entire spectrum of predicted risk, and key common management scenarios (statin intolerance, hypertriglyceridemia, elevated LP(a)), and more.

The Cardionerds Cardiology Podcast presents episode 42: Lipids and Cholesterol with Drs. Ann Marie Navar and Nishant Shah from Duke University Medical Center, Division of Cardiology
Episode 42. Lipids and Cholesterol with Drs. Drs. Ann Marie Navar and Nishant Shah

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The Cardionerds CV prevention series will include in-depth deep dives on so many topics related to prevention starting with this case discussion. Stay tuned for upcoming episodes on the ABCs of prevention, obesity, hypertension, diabetes mellitus and anti-diabetes agents, personalized risk and genetic risk assessments, hyperlipidemia, women’s cardiovascular prevention, coronary calcium scoring and so much more!

Key references:

We are truly honored to be producing the Cardionerds CVD Prevention Series in collaboration with the American Society for Preventive Cardiology! The ASPC is an incredible resource for learning, networking, and promoting the ideals of cardiovascular prevention! This series is kicked off by a message from Dr. Amit Khera, President of the American Society for Preventive Cardiology and President of the SouthWest Affiliate of the American Heart Association.

Cardionerds Cardiovascular Prevention Series: by the Cardionerds Cardiology Podcast in Collaborate with the The American Society For Preventive Cardiology ASPC
Cardionerds Cardiovascular Prevention Series

Dr. Ann Marie Navar is a cardiologist and epidemiologist at the Duke Clinical Research Institute focusing on cardiovascular disease prevention. She received an MD from Duke University and a PhD in Global Disease Epidemiology and Control from the Johns Hopkins School of Public Health in 2009 before completing residency in internal medicine and pediatrics and fellowship in cardiology at Duke. Dr. Navar’s research focuses on improving cardiovascular disease prevention through better identification of at-risk populations, targeted interventions to improve quality of care and patient engagement through the electronic health record, and better treatment of hypertension and cholesterol to lower CV risk. She also studies the impact of payer-imposed barriers to novel therapies. Her areas of expertise include risk prediction, patient risk communication, real world data analyses using EHR- and claims-based datasets, and registries. She is an associate editor at JAMA-Cardiology and a board member of the American Society of Preventive Cardiology.

Dr. Nishant Shah obtained his medical degree from Wake Forest University School of Medicine. He completed internal medicine residency training at the Johns Hopkins Osler Program as part of the Barker Firm. He completed his cardiology fellowship training at the Cleveland Clinic. He is currently faculty at Duke Medical Center, Division of Cardiology and is an expert in preventive cardiology as well as a member of the cardiometabolic prevention program. Dr. Shah’s research revolves around the clinical manifestations of  genetic lipid biomarkers and advanced dyslipidemias. He is also interested in ways to make impacts at the primary prevention level. Furthermore, Dr. Shah is involved in many epidemiologic and clinical trial based work with several leaders in the field. He also serves as an associate editor for the American Heart Journal. Dr. Shah is very passionate about clinical education and has won many distinctions in education throughout his training.

41. Women’s Cardiovascular Prevention with Dr. Leslie Cho

The CardioNerds discuss Women’s Cardiovascular Prevention with Dr. Leslie Cho, Interventional Cardiologist and Director of the Cleveland Clinic’s Women’s Cardiovascular Center. She is also Section Head of Preventive Cardiology and Rehabilitation in the Robert and Suzanne Tomsich Department of Cardiovascular Medicine at Cleveland Clinic. Amit, Dan and Carine take a deep dive into women’s cardiovascular prevention and discuss the epidemiology, unique risk factors, different manifestations of CVD and treatment strategies to lower cardiovascular risk in women. Tune in as we discuss cases from the CardioNerds Women’s Clinic to learn more!

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41. Women's Cardiovascular Prevention  with Dr. Leslie Cho

Cardiac Consult Podcast
Tall Rounds Lectures

Key Reference: Cho L, Davis M, Elgendy I, et al (2020) Summary of Updated Recommendations for Primary Prevention of Cardiovascular Disease in Women: JACC State-of-the-Art Review. J Am Coll Cardiol 75:2602–2618

Cardiovascular Disease Risk Factors in Women

We are truly honored to be producing the Cardionerds CVD Prevention Series in collaboration with the American Society for Preventive Cardiology! The ASPC is an incredible resource for learning, networking, and promoting the ideals of cardiovascular prevention! This series is kicked off by a message from Dr. Amit Khera, President of the American Society for Preventive Cardiology and President of the SouthWest Affiliate of the American Heart Association.

Cardionerds Cardiovascular Prevention Series: by the Cardionerds Cardiology Podcast in Collaborate with the The American Society For Preventive Cardiology ASPC
Cardionerds Cardiovascular Prevention Series

Dr. Leslie Cho is a professor of Medicine at Cleveland Clinic Lerner School of Medicine Case Western Reserve Medical School and serves as Director of the Cleveland Clinic’s Women’s Cardiovascular Center. She is also Section Head, Preventive Cardiology and Rehabilitation in the Robert and Suzanne Tomsich Department of Cardiovascular Medicine at Cleveland Clinic. Dr. Cho received her undergraduate degree in interdisciplinary studies from the University of California, Los Angeles, graduating cum laude. She received her medical degree from the University of Chicago Pritzker School of Medicine, and took her residency in internal medicine at the University of Washington Medical Center where she received the John Humphrey Award as Most Outstanding Internal Medicine Resident. Her clinical training continued when she accepted a fellowship in cardiology, followed by a fellowship in interventional cardiology and peripheral disease, both from Cleveland Clinic.

40. The ‘ABC’s of Cardiovascular Prevention with Dr. Roger Blumenthal

The CardioNerds discuss The ‘ABC’s of Cardiovascular Prevention with Dr. Roger Blumenthal, Director of the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease and co-chairperson of the 2019 American College of Cardiology/American Heart Guideline on prevention of cardiovascular disease. Joining the discussion is Dr. David Feldman, Osler housestaff and first author of a beautiful State-of-the-Art review in the American Journal of Preventive Cardiology discussing a comprehensive ABCs of prevention.

The Cardionerds Cardiology Podcast features episode 40. The 'ABC's of Cardiovascular Prevention with Dr. Roger Blumenthal
  • A: Assess Risk, Anti-Inflammatory, Aspirin
  • B: Body weight, Blood Pressure
  • C: Cigarette Cessation, Cholesterol
  • D: Dream (sleep), Diet, Digital Health, Diabetes
  • E: Exercise
  • F: Factors of the Environment
  • G: Genetics

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Key Reference: Summarizing 2019 in Cardiovascular Prevention using the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease’s ‘ABC’s Approach

We are truly honored to be producing the Cardionerds CVD Prevention Series in collaboration with the American Society for Preventive Cardiology! The ASPC is an incredible resource for learning, networking, and promoting the ideals of cardiovascular prevention! This series is kicked off by a message from Dr. Amit Khera, President of the American Society for Preventive Cardiology and President of the SouthWest Affiliate of the American Heart Association.

Dr. Roger Blumenthal is a Professor of Medicine and the Director of the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease for which he was the principal developer. He received his medical degree from Cornell Medical College, where he was awarded the Weiss Prize for Excellence in Clinical Medicine. He completed his internal medicine and cardiology fellowship training at The Johns Hopkins Hospital before joining the Johns Hopkins cardiology faculty. Dr. Blumenthal was the most recent recipient of the Landon School Anthony Kupka Distinguished Alumnus Award. He was co-chairperson of the 2019 American College of Cardiology/American Heart Guideline on prevention of cardiovascular disease.

Dr. David Feldman is a Junior Assistant Resident in the Osler Medical Residency Program at the Johns Hopkins Hospital. Prior to joining the housestaff, David received his MD and MPH degrees from the University of Miami. David first joined the Ciccarone Center as a pre-doctoral fellow in 2013 under the mentorship of Drs. Roger Blumenthal and Mike Blaha. David is passionate about cardiovascular disease prevention and hopes to pursue a career in academic cardiology, with a particular interest in preventive cardiology. 

39. Cardiovascular Prevention: Patient Perspective by Kanak Amin

CardioNerds Amit Goyal and returning guest Dr. Zach Il’Giovine explore the patient’s perspective on cardiovascular prevention with the star patient of this series: Kanak Amin. to explore the patient perspective on cardiovascular prevention. Mr. Amin tells us about his perspectives on being a heart patient and offers important advice for both patients and providers on the. He gives us many pearls, but especially highlights the importance of diabetes education, cardiac rehabilitation, engaging loved ones, and getting to know the patient on a deeper level.

Special messages from Dr. Wael Jaber and Dr. Nishant Shah, who both knew Mr. Amin as a colleague, friend, and patient.

39. Cardiovascular Prevention: Patient Perspective by Kanak Amin

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We are truly honored to be producing the Cardionerds CVD Prevention Series in collaboration with the American Society for Preventive Cardiology! The ASPC is an incredible resource for learning, networking, and promoting the ideals of cardiovascular prevention! This series is kicked off by a message from Dr. Amit Khera, President of the American Society for Preventive Cardiology and President of the SouthWest Affiliate of the American Heart Association.

Kanak Amin is the Program Manager of the Radiochemistry Nuclear Medicine program at Cleveland Clinic. His hobbies and interests include woodworking, learning Wall Street and the financial world as well as computer web design. We are so appreciative this phenomenal patient perspective on cardiovascular prevention!

Dr. Zachary Il’Giovine is a general cardiology fellow at the Cleveland Clinic. He received his medical degree from the Wright State University Boonshoft School of Medicine before completing internal medicine training at Duke University. He has clinical interests in advanced heart failure and cardiac critical care. Outside of the hospital he loves playing soccer and spending time with his wife Clare and son Luca.

38. Cardiovascular Prevention: A Case Discussion by the Cardionerds

This is the first episode in an important series on cardiovascular prevention. It’s no secret that cardiovascular disease is the #1 killer worldwide; the total impact on humanity is just staggering. A focus on preventing CVD is an impetus for every cardionerd. In this episode Dan, Amit, Carine, and Heather discuss an illustrative case discussion and review the Cardionerds 2+4 paradigm of cardiovascular prevention: 2 fundamental principles of management + 4 steps in risk stratification.

The Cardionerds CV prevention series will include in-depth deep dives on so many topics related to prevention starting with this case discussion. Stay tuned for upcoming episodes on the ABCs of prevention, obesity, hypertension, diabetes mellitus and anti-diabetes agents, personalized risk and genetic risk assessments, hyperlipidemia, women’s cardiovascular prevention, coronary calcium scoring and so much more!

Take me to the Cardionerds Cardiovascular Prevention Page
Take me to episode topics page

We are truly honored to be producing the Cardionerds CVD Prevention Series in collaboration with the American Society for Preventive Cardiology! The ASPC is an incredible resource for learning, networking, and promoting the ideals of cardiovascular prevention! This series is kicked off by a message from Dr. Amit Khera, President of the American Society for Preventive Cardiology and President of the SouthWest Affiliate of the American Heart Association.

Cardionerds Cardiovascular Prevention Series: by the Cardionerds Cardiology Podcast in Collaborate with the The American Society For Preventive Cardiology ASPC

TWO principles of management

  1. Emphasize healthy lifestyle for everyone regardless of risk
  2. Escalate Preventive Measures with ↑ Risk 

FOUR steps of risk stratification

  1. Qualitative risk approximation – identify major risk factors and start counseling and education. 
  2. Quantitative risk estimation – use a validated model to quantify a patient’s future risk of CVD. 
  3. Identify Risk Enhancing Factors – personalize risk if patient is in the gray zones after step 2
  4. Measure coronary artery calcium score – selectively if risk remains uncertain
The Cardionerds podcast presents the 2+4 paradigm for cardiovascular prevention
Cardiovascular Prevention

37. Palliative Care in Heart Failure with Dr. Rab Razzak

Episode #37. Palliative Care in Heart Failure

The role of palliative care in the management of heart failure is discussed by palliative care expert, Dr. Rab Razzak, clinical associate professor and clinical director of palliative care at University Hospital Cleveland Medical Center. CardioNerds host Amit Goyal is joined by special guest interviewer, Dr. Arsalan Derakhshan, Assistant Program director at Case Western Internal Medicine residency program and the head of the Global Health Pathway as well as co-host of the Clinical Problem Solvers podcast!

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Dr. Rab Razzak went to medical school at Bangledesh Medical College and internal medicine residency at St. Joseph Regional Medical Center in Patterson, NJ. He worked initially as a hospitalist at Cedars Sinai and was grandfathered into palliative care.  He moved to Maryland to work at Johns Hopkins, where he practiced for 4.5 years. He is now a clinical associate professor and clinical director of palliative care at University Hospital Cleveland Medical Center. He is also a devoted husband, dedicated father, and a stand-up comedian! We could think of no one better to discuss Palliative Care in Heart Failure than Dr. Razzak.

Dr. Arsalan Derakhshan was born in Iran and moved to Atlanta, Georgia as a young child. He loves to travel and considers himself a global citizen. After graduating from Emory University, he attended the Medical College of Georgia and completed internal medicine residency at Johns Hopkins Hospital. He spends his time attending on inpatient team, staffing resident clinic, and working as the global health track director. He enjoys working with medical students and interns to help them discover their passions. His primary interests include clinical reasoning, global health,  and medical innovations. He co-hosts one of the most popular medicine podcast, The Clinical Problem Solvers and has been incredibly instrumental in the launch of The CardioNerds!

36. Diuretics, ARNi, SGLT2/GLP1 therapies and iron for HFpEF with Dr. Robert Mentz

36. Diuretics, ARNi, SGLT2/GLP1 therapies for HFpEF with Dr. Robert Mentz

Dr. Robert Mentz, director of the Heart Failure section in the Duke Division of Cardiology, discusses diuretics, anti-hyperglycemic therapies including SGLT2/GLP1 agents, angiotensin receptor-neprilysin inhibitors (ARNi), iron as therapies for Heart Failure with Preserved Ejection Fraction (HFpEF). Additionally, study design and ongoing research in HFpEF is discussed. At the end of the episode Dr. Mentz provides an additional update that highlights how the COVID-19 pandemic has influenced clinical trials around the world. Special thanks to guest interviewers, Duke cardiology fellows, Dr. Kelly Arps and Dr. Rahul Loungani!

On the CardioNerds Heart Failure topic page you’ll podcast episodes, references, guest experts and contributors, and so much more.

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Acute Decompensated Heart Failure Primer – Youtube

Dr. Robert Mentz completed internal medicine training at Brigham and Women’s Hospital and cardiology fellowship followed by advanced heart failure and transplant cardiology training at Duke University Hospital and the Duke Clinical Research Institute. He is the new director of the Heart Failure section in the Duke Division of Cardiology. His areas of clinical and research focus include treating comorbid diseases in heart failure patients, use of biomarkers and surrogate and non-fatal outcomes in heart failure trials, and novel therapeutic approaches to heart failure. Dr. Mentz is heavily involved in many clinical trials and serves as the associate editor at Circulation: Heart Failure. In addition to his clinical and research endeavors, Dr. Mentz is heavily invested in the cardiology fellowship where he serves as associated program director and renown mentor for which he has won many fellow-nominated awards. Finally, as former director of the Duke University Cooperative Cardiovascular Society, he expanded the network of current and former Duke trainees to be a leading enroller in clinical trials. We are really excited about him joining the show to discuss Diuretics ARNi SGLT2/GLP1 therapies for HFpEF.

Dr. Rahul Loungani completed medical school at the medical university of SC and then traveled to Baltimore for internal medicine training in the Osler Residency Program at the Johns Hopkins Hospital.  Here he fell in love with the management and hemodynamics of critically ill patients. He is currently a third-year cardiology fellow at Duke University Medical Center where he will also be pursuing fellowship in advanced heart failure and transplant cardiology next year. His current interests are in Cardiac amyloid, in particular it’s arrhythmic manifestations, early diagnosis, and novel therapeutics. He also loves teaching the housestaff and was awarded the Cassell-Saperstein award at Duke,  recognizing the fellow who most demonstrates a commitment to teaching and passion for clinical education. Outside of the hospital loves being a new dad to baby Arya.

Dr. Kelly Arps completed medical school at Emory University school of medicine and internal medicine training in the Osler Residency Program at the Johns Hopkins Hospital. She is currently is pursuing her cardiology fellowship at Duke University Medical Center. 

35. Heart Failure with Preserved Ejection Fraction with Dr. Kavita Sharma

Heart Failure with Preserved Ejection Fraction with Dr. Kavita Sharma

We discuss Heart Failure with Preserved Ejection Fraction (HFpEF) with Dr. Kavita Sharma, director of the Heart Failure with Preserved Ejection Fraction Program and interim director of Advanced Heart Failure Transplant section at The Johns Hopkins Hospital. CardioNerds hosts Carine Hamo and Daniel Ambinder are joined by Dr. Beth Feldman (resident at The Johns Hopkins Hospital). Topics discussed include a definitions, diagnosis, phenotypic presentations, inpatient management of acute decompensated heart failure, role of dopamine, advanced therapies of HFpEF, and the Paraglide trial.

References mentioned in this episode can be found here

On the CardioNerds Heart Failure topic page you’ll podcast episodes, references, guest experts and contributors, and so much more.

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Acute Decompensated Heart Failure Primer – Youtube

Dr. Kavita Sharma graduated from the University of Virginia School of Medicine and completed her residency and served as the assistant chief of service, cardiology fellowship and advanced heart failure fellowship at the Johns Hopkins Hospital. She is the Director of the Johns Hopkins Heart Failure with Preserved Ejection Fraction Program and is currently the interim director of Advanced Heart Failure Transplant section at Hopkins. She has a specialized interest in heart failure with preserved ejection fraction (HFpEF), and directs one of the largest programs in the country dedicated to caring for patients with this condition. She is the principal investigator of numerous clinical and translational trials in HFpEF and leads a team of nurses, research coordinators, and fellows-in-training in this multifaceted program. She is an invited speaker at national meetings in topic areas covering advanced heart failure and HFpEF.

Dr. Beth Feldman graduated from Temple University School of Medicine and is currently on the Longcope Firm on the Osler Medical Service at Johns Hopkins University Hospital. Before pursuing a career in medicine, she worked in health care consulting focusing in health systems. She is passionate about health policy and health systems research. She is hoping to pursue a career in cardiology, with a particular interest in critical care.

34. Interventional Cardiology in Heart Failure with Dr. Jeffrey Moses

Cardionerds episode 34 with Dr. Jeffrey Moses discussing interventional cardiology in congestive heart failure.

Interventional cardiology and structural interventions in heart failure are discussed by Dr. Jeffrey Moses, Director of Interventional Therapeutics at Columbia University Medical Center Director of Advanced Cardiac Interventions at St Francis Hospital and Heart Center in Roslyn, NY. CardioNerds hosts Amit Goyal and Daniel Ambinder are joined by Dr. Jackie Latina (Cardiology fellow at The Johns Hopkins Hospital). Topics discussed include percutaneous intervention and complex and high-risk coronary intervention (CHIP), treatment of functional mitral and tricuspid regurgitation, aortic stenosis, and the utility of interatrial shunt devices for the treatment congestive heart failure.

On the CardioNerds Heart Failure topic page you’ll podcast episodes, references, guest experts and contributors, and so much more.

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Acute Decompensated Heart Failure Primer – Youtube

Dr. Jeffrey W. Moses completed medical school at the University of Pennsylvania School of Medicine and his internship, residency and fellowship in Cardiology at the Presbyterian University of Pennsylvania Medical Center. He currently serves as Director of Interventional Cardiovascular Therapeutics at Columbia University Medical Center and as Director of Advanced Cardiac Interventions at St Francis Hospital and Heart Center in Roslyn, NY. Dr. Moses is an Associate Director of the Transcatheter Cardiovascular Therapeutics (TCT) conference. He has served as lead investigator for numerous national and international clinical studies and he has made important contributions in the areas of clinical research and educational activities in interventional vascular therapy. He is also a pioneer in developing approaches involving minimally invasive surgery, angioplasty, gene therapy, novel imaging technologies and various support devices that allow for wider application of interventional cardiovascular procedures.

Dr. Jacqueline Latina was born and raised in the suburbs of Boston, MA, but fortunately escaped without a Boston accent. She is a graduate of Princeton University with an A.B. in chemistry. She earned her M.D. at Tufts University School of Medicine. Her internship and internal medicine residency were completed at Mount Sinai Hospital in New York City, where she stayed on for an American Heart Association postdoctoral research fellowship. She completed an M.S. in clinical research methods at the Columbia Mailman School of Public Health during that time. She is currently a cardiology fellow at Johns Hopkins Hospital, and plans to start interventional cardiology fellowship in June 2020.  She chuckles if you ask “Are you Latina?”

33. Cardiac MRI with Dr. Deborah Kwon

The Cleveland Clinic Director of Cardiac MRI, Dr. Deborah Kwon, discusses the principles and clinical applications of cardiac MRI, taking us from the protons to the bedside with a series of illustrative cases.

The Cleveland Clinic Director of Cardiac MRI, Dr. Deborah Kwon, discusses the principles and clinical applications of cardiac MRI, taking us from the protons to the bedside with a series of illustrative cases. CardioNerds hosts Amit Goyal, Daniel Ambinder, and Carine Hamo are joined by Dr. Nicole Pristera (Cleveland Clinic cardiology fellow). Flutter moment by student doctor Arooma Shahid.

On the CardioNerds Myocarditis page you will find podcast episodes, infographic, youtube videos, references, tweetorials and guest experts & contributors, flutter stars and so much more.

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Check out Amit Goyal’s Myocarditis Tweetorial

Links in this episode:


Dr. Debbie Kwon attended medical school at the University of Michigan and internal medicine residency at the University of Pennsylvania. She completed her general cardiology and cardiovascular imaging fellowships at the Cleveland Clinic. She is the Director of Cardiac MRI At the Cleveland Clinic and serves as the Core Lab MRI director for the Pulmonary Vascular Disease Phenomics (PVDOMICS) multicenter National institution of Health (NIH) Study.

Dr. Nicole Pristera is a cardiology fellow at the Cleveland Clinic.  She earned her medical degree at Case Western Reserve University and completed her internal medicine residency training at Duke University. Her clinical interests include interventional cardiology and cardiac critical care. Outside of the hospital, she enjoys traveling, hiking, and learning foreign languages.

Dr. Arooma Tahir completed her medical degree from Lahore Medical and Dental college in Lahore Pakistan. She went to medical school to pursue her passion and currently she is studying for USMLEs in Fresno, CA. She enjoys hiking, trying out different cuisines, and podcast by cardionerds. 


Interview Questions

  1. How would you give a basic intro to cardiac MRI principles to a first year cardiology fellow? 
  2. What should we know about the common sequences for cardiac MRI?
  3. We all learn about the risks of NSF.  How much of these risks are a reality and when should we truly avoid gadolinium exposure?
  4. What are some challenges to MRI?
  5. What types of information about the heart can we obtain with a CMR?

The role for Cardiac MRI in particular cases discussed with Dr. Kwon

  1. CAD: A 45 year old G1P1 woman with prior preeclampsia and anterior STEMI s/p LAD PCI 3 years ago is being seen for chest pain. TTE shows LVEF 45% with mid-apical anterior hypokinesis and apical aneurysm. How does CMR help delineate ischemic heart disease (perfusion, viability, chambers) 
  1. Pericarditis: her stress MRI shows an anteroapical perfusion defect and apical aneurysm with mural thrombus, with corresponding LGE. On further review, her chest pain is sharp, pleuritic, and worsens with recumbency. EKG on follow-up shows diffuse ST elevations and PR depressions except for in aVR which shows ST depression and PR elevation. ESR and CRP are moderately elevated. 
  1. ARVC: A 35 year old female athlete who is admitted after VF arrest that occurred during a tennis match. Thankfully she received immediate bystander CPR with early defibrillation and prompt ROSC. She has had prior syncope during training and an uncle died suddenly at age 40. Resting EKG shows an incomplete right bundle, right precordial TWIs, and epsilon waves in V1-V3.  On tele she’s had multiple runs of NSVT of LBBB morphology. Echocardiogram shows RV dilation. A heart failure consult is considering EMBx but requests a CMR beforehand. 
    1. Role in select other cardiomyopathies: HCM, Amyloid, hemochromatosis etc (if time)
  1. Valvular Heart Disease: A 28 year old man with no PMH who presents with progressive dyspnea during his routine morning runs. On exam he has a early diastolic decrescendo murmur best heard at end expiration while leaning forward. While concentrating on the murmur you notice a subtle rhythmic head bobbing. TTE shows eccentric AI and a dilated LV, but further characterization is limited.  (CMR shows bicuspid aortic valve, TAA, LV dilation)
  1. Cardiac mass: a 55 year old woman with subacute fevers, chills, and night sweats now presents with acute ischemic left leg pain. Auscultation reveals a mid-diastolic plop.  TTE is limited by poor sonographic windows, but there is a nondescript echodensity in the LA. What is the role of CMR in cardiac masses? 
  2. Myocarditis: Chas Miller is our patient from episodes 31 & 32 who had presented with cardiogenic shock and heart block found to have fulminant myocarditis. Now unfortunately he was too sick to undergo a cardiac mri, but how would it have helped?