All articles.
Working notes from a practicing ACNP and graduate-program faculty member. Clinical practice, NP education, and the parts of AI showing up in both.
Cardioversion Without TEE: What the Guidelines Actually Say
The 48-hour rule is not a safety net. One in seven patients with AF of more than two days has a clot on TEE. Here's what the 2023 guidelines actually require.
Read the piece →The Cardiology Gap
How much cardiology did your NP or PA program include? Almost always: not enough. Here's what the gap looks like, why it exists, and what to do about it.
HFmrEF and the Untreated Middle Category
Heart failure with mildly reduced ejection fraction sits outside the spectrum the trials studied. That's a reason for closer attention, not to wait.
The Subspecialty-Generalist Mismatch
NP and PA programs are designed to produce generalists. A growing number of graduates take their first job in a subspecialty. Nobody built the bridge.
The ECG Confirms. The History Diagnoses.
The physical exam gets the eulogies. In cardiology, the history is where the diagnosis lives — a skill built through supervised repetition with real patients.
New-Onset Atrial Fibrillation: What the First Visit Should Cover
The standard first AF visit skips why-now triggers, the lenient rate target, early rhythm control, and an honest fall-vs-stroke conversation.
LDL Goals Are Back, and the Follow-Up Lipid Panel Matters More Than the Prescription
The 2026 ACC/AHA dyslipidemia guideline restores numeric LDL-C goals, which makes the repeat lipid panel 4 to 12 weeks after the prescription the visit that decides outcomes.
The Smoker's Question Changed in July
The 2026 JAMA recommendations put nicotine e-cigarettes in the cessation conversation; the number that should shape that conversation is the one-year dependence rate.
Why Smart Clinicians Still Miss the Upstream Cause
The clinicians who miss the aortic valve are the fast ones.
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