Despite an extensive body of literature, there are still many gaps in the evidence surrounding the lifetime management of aortic stenosis (AS) and upstream interventions to prevent or slow down the progression of the disease are yet to be developed.

His bundle pacing is the most physiological form of pacing as it replicates the patient’s natural ventricular activation. Its adoption has significantly grown over the last years. However, the technique has several limitations, including suboptimal thresholds. Left bundle branch area pacing has been introduced more recently and has gained much interest as it also delivers physiological pacing but with more favorable electrical parameters. However, there are also several unresolved issues with this technique. This article compares these strategies and highlights their advantages and disadvantages to provide guidance on which technique to select for a specific patient.

Takotsubo cardiomyopathy is a type of stress cardiomyopathy that is usually seen in postmenopausal patients and can be triggered by emotional stress, hypoglycemia, hypothyroidism, and surgery. A patient post cardiac surgery can present with multiple complications causing hemodynamic compromise. Hence, takotsubo cardiomyopathy remains a diagnostic dilemma. Here, we present an interesting electrocardiogram (ECG) of the same condition in a patient after mitral valve replacement with normal patent coronaries but presenting with anterolateral massive infarction with shark fin pattern in the ECG.

In this issue of Cardiovascular Medicine, Bashir Alaour and Thomas Pilgrim take on the demanding task of summarizing the challenges involved in the management of patients with aortic stenosis over the course of their lives. In their engaging review, the authors emphasize the importance of a patient-tailored approach in the lifetime management of aortic stenosis. As a result, it is essential that not only interventional cardiologists and surgeons but also resident cardiologists and general practitioners are involved in finding the best management for each individual patient, from the diagnosis to intervention and any potential re-intervention.

Dose-dependent statin-related myotoxicity (SRM) is a rare adverse effect of statin treatment. Differences in the pharmacokinetics and interactions with environmental and genetic factors constitute important risk factors for the development of SRM. We present the case of an 82-year-old female patient with severe simvastatin-related myotoxicity and several risk factors of SRM, namely a pharmacokinetic interaction with verapamil, a pharmacogenetic interaction with a SLCO1B1*1/*5 variant, high age, female gender and impaired renal function. A comprehensive evaluation of distinct pharmacokinetic and pharmacogenetic properties of different statins and a pharmacogenetic panel test guided the diagnosis and options for further clinical management. Inspired by this and other similar cases, we developed a pocket card as practical companion for statin prescribing in clinical practice and provide it as an addition to this report.