Discover and read the best of Twitter Threads about #ACCFIT

Most recents (24)

On my last day as a trainee, I’m reflecting back on the best advice I’ve received at each stage.

Hopefully this 🧵 may offer something. #MedStudentTwitter #medtwitter #internalmedicine #cardiotwitter #ACCFIT #meded #cardioed

2/ Pre-clinical med students—Immerse yourself in what you’re learning. Remember that you’re building a foundation to be a great doctor, not just preparing for exams.
3/ Clinical med students—Spend time with your patients; you have more time now than ever again. Keep an open mind about each specialty. Once you decide, pay even more attention on all the rotations you won’t pursue. They will be your colleagues one day; learn how they think.
Read 7 tweets
Quiz for fellows and sonographers #MondayMotivation
70 year old male presenting with a systolic murmur. What is this Mitral M-mode redux of? #echofirst @AAH_StLukesCV
#cardiotwitter #ACCFIT Image
Here is another clue! Hint Hint!!! Image
Read 7 tweets
Step-by-step tweetorial on percutaneous post-infarct VSD closure. Late presenting inferior MI.
Cardiac CT can be very helpful in planning the approach and in noting nearby structures. Here, the defect is quite basal - semilunar valves can disrupted.
1- GA and TEE guidance. Note proximity of the defect to the tricuspid valve.
Read 17 tweets

Last case of 2020!

@BrHeartValveSoc @TheBJCA @global_wic @BSEcho @ASE360

This is a tough one! This will separate the men from the boys, the women from the girls...are you Luke Skywalker or are you already the Obi-Wan Kenobi of valve disease?!
Mid 70s patient, known ischaemic cardiomyopathy & aortic stenosis.
⬆️⬆️ dyspnoea.
Clinical signs suggest severe AS.
BP 90/50mmHg, HR 60bpm.
This is the resting ECG (hint - showing this for a reason - 😉)
Here is PLAX view of the AV...👇🏽
Read 25 tweets
#CardioNerds & #EPeeps, ready for an EKG Challenge⁉️⁉️

✍️Answer to follow on Monday 11/23 🗓️

🏥You see this 58 yo🧍‍♂️w/ ischemic CM in clinic.

🤔What's the rhythm❓

Brought to you by EKGaction: Image
Would you use a CardioNerds EKG Case of the Week - shared weekly?
Read 37 tweets
Great 1st session of #SCAISHOCK. @HenrytTimothy started by providing an excellent crash course on shock definitions.

Important to know and communicate using SCAI SHOCK stages.

#ACCFIT #AHAFIT #SCAIFIT @UIowaCVFellows @SrihariNaiduMD @BillONeillMD @ArasiMaran @agtruesdell
. @BurkhoffMd discussing advanced hemodynamics in cardiogenic shock during #SCAISHOCK. Fantastic session!!

Really important to understand the hemodynamic response to drugs and devices which are variable due to baseline characteristics

Dr. Angela Taylor discussing “Inotropes and Pressors” during #SCAISHOCK. Very informative and HY slides. #ACCFIT #AHAFIT #SCAIFIT @UIowaCVFellows
Read 5 tweets

Old case from 2010...but you know what they say...old is gold! 😁

Female, mid 70s, inter-hospital transfer for urgent angiography due to chest tightness with ischaemic ECG. CP came on 12hrs after distressing news of sudden family death. ECG 👇🏽 Image
Exam - loud systolic murmur, so urgent TTE requested before angio. Here is PLAX. Apologies no ECG, cables on portable Vivid-i were broken!

@angularboxoid @JonathanWHinton @hannahcvimaging @cardiodan @hannahzr @TharushaGunawa4 @MayooranShan @DrMarkMills @dorsetcardio @brwcole
PLAX Zoom...
Read 28 tweets

OK, this starts off about valves...but then isn't really about valves...but it's the broader educational point (which is relevant to valves) that I want to make this poll I'm afraid, but as always, comments encouraged! 😁

In my office doing Admin, lot to get through & a very busy morning ahead. Asked to r/v a TTE for helping determine AS severity. Pt admitted with heart failure, clinically severe AS is all I know at this point. Now, the golden rule in this situation is *review the whole study*...
Not just one or two images.

But I was super-busy, I BROKE MY OWN RULE and just looked at the relevant images. Here's the PW and CW Doppler tracings (Pt in AF)...
Read 15 tweets
An #ACCEarlyCareer #ACCFIT #tweetorial from the @WeillCornell Graphics Lab on common ECG Lead Switches (boards ❓favorites).

In case you missed it - we are considering the infarct related artery responsible for the following pattern of injury in a 69yoM presenting with a STEMI: Image
Most guessed the LCx or D1 of the LAD from the STEs in leads 1 & L (as we did) with reciprocal depressions inferiorly - a high lateral (maybe posterolateral with V2 depression) infarction.

The angiogram prompted a welcome phone call from our spicy🌶 interventionalist: "You ECG readers think you are *SO* perfect. Take this!😂It was the RCA all along!": Image
Read 20 tweets
#ACCFIT #AHAFIT #cardiotwitter @MyASNC. This Thursday, follow me for live updates from the #ASNC2020 as we bring you the second session in the series on #SoMe "Steering Your Tweetanic: Basics and Advanced Outline". Don't forget to join us: 4-530p EDT. Image
Join us to learn from the 🌟s of #SoMe including @VietHeartPA @iamritu @RBP0612 @FarrisTimimi @CoronaryDoc @krishnapatel888 @NitiCardio as they bring the discussion regarding various topics related to #SoMe and guide us on carrying out and improving our presence on #SoMe. #cvnuc
Read 3 tweets
When use #ldtra during a #radialfirst approach?

👌if no #STEMI and:
1⃣ dialysis or CABG w/radial graft likely (better
radial artery patency) or
2⃣ left radial preferred (e.g. prior CABG: better pt
and👩‍⚕️comfort) or
3⃣ pt has thick forearm (better hemostasis) When to use #ldtra (distal ...
❓How-to #ldTRA?

Twitterature: @ferdikiem and many others provide great tips from U/S guidance to compression and more

Literature is catching up:
ongoing studies➡️NCT03611725, NCT04232488, NCT04318990, NCT04194606, NCT04171570 Literature vs Twitterature
Read 3 tweets
#EchoBoardPrep #ACCFIT #echofirst #CardioEd @HMHCardioFellow


"Motion mode"

💡Stand-alone M-mode: 2000 fps
💡2D guided M-mode: 1000 fps
💡2D: 100 fps

#EchoBoardPrep #ACCFIT #echofirst #CardioEd

💡EPSS > 1 cm = Abnormal (not valid if MS or AI present)
💡B-bump = LVEDP likely > 20 mm Hg
💡MV closure before electrical depolarization = Severe AI


#EchoBoardPrep #ACCFIT #echofirst #CardioEd

💡SAM-septal contact in HCM
💡MV prolapse = systolic bowing of the leaflet tips >2 mm below C-D line
💡Reduced EF slope = mitral stenosis


Read 6 tweets

In our hospital, we have seen 2 patients over the past 3 years that presented with acute heart failure and who had severe AR on echo with large, characteristic masses on the AV. This week's poll is simply... what do you think these masses are? (1)
Patient 1 - Female, early 60s, no major PMHx, admitted with 2 weeks worsening SOB and palpitations. No fever. In heart failure, BP 110mmHg systolic. AR murmur. Normal white cell count & near normal CRP on bloods. TTE below...zoomed PLAX view of AV (2)
Here is a TOE view...(3)
Read 12 tweets


I'm on holiday (staycation 😫) so I'll keep it brief! No poll. Experienced scanners will know this, but could hopefully be of use to physiologists and Fellows in training.

This case focuses on the concept of physiological MR...(1)
Patient having an echo for a different reason (i.e. not murmur) had this AP4Ch view in 2014...

This was reported as "mild MR" and a repeat echo was advised in 2 years...(2)
So the patient returns in 2016 for an echo...

Again reported as "mild MR" and again follow-up advised in 2 years' time...(3)
Read 10 tweets
#EchoBoardPrep #Echofirst #ACCFIT #AHAFIT

Pulmonary Vein Doppler
⚡️TTE: Find on A4C

⚡️TEE: Right veins at 45 and left veins at 120 (Watch: )

⚡️Flow components: S1, S2, D, A

PV flow patterns #EchoBoardPrep
⚡️Healthy: S>D
⚡️Diastolic dysfunction, normal filling pressure: S>D
⚡️High LV filling pressure: D>S

A: Grade 1 diastolic dysfunction, B: Pseudonormal pattern, C: Restrictive filling

PV flow patterns #EchoBoardPrep
⚡️A: Restrictive cardiomyopathy: No resp variation
⚡️B: Constriction: Resp variation+

Read 6 tweets
"Successful Rotational #atherectomy of an Undilatable Ostial Saphenous Vein Graft Lesion"

Case published @InvasiveCardiol by our team @MHIF_Heart
@evivemmou @esbrilakis…

#ACCFIT #cardiotwitter

See ⬇️⬇️for rationale and treatment strategy 1/3
1. Why #atherectomy?
-Lesion undilatable w/standard & modified balloons.
2. Orbital or rotational?
-Rotational preferred due to prior PCI.
3. Temporary pacemaker?
-Yes, due to RCA SVG.
4. More and shorter runs preferred over fewer and longer.

2/3 Rationale for SVG atherecto...Atherectomy: Keep duration ...
Read 3 tweets
Very glad to participate with 2 posters in this year's online only @cvinnovations!
Both from the PROGRESS CTO registry:


#cardiotwitter #ACCFIT
#1: 1-year outcomes in patients undergoing CTO PCI according to target vessel.
Previous work had identified circumflex lesions as having ⬇️procedural outcomes.
1-year outcomes were similar in our analysis. Image
#2: 1-year outcomes in patients undergoing CTO PCI according to baseline LVEF.
Outcomes worse as LVEF⬇️, mainly driven by ⬆️ mortality, but not MI and revascularization rates.… Here is previous work looking at 2 year MACCE rate. Image
Read 4 tweets
Our most recent analysis of PROGRESS-CTO equipment
use, building on previous work by @ArisKaratasakis et al


Pilot 200/Fielder XT remain most common antegrade GWs but %⬇️due to quick adoption of newer GWs such as Gaia 3rd.

Torquable microcatheters (Turnpike) are the most commonly used ones. Success rates when a microcatheter is used have ⬆️⬆️

2/3 Image
Retrograde approach:

Sion was the most commonly used guidewire for collateral crossing.

Pilot 200 the most commonly used for CTO crossing.

Read 3 tweets
1/6 #Cardiotwitter - check out this #Tweetorial

"CV considerations & #COVID19"

💥Viral cell entry using ACE2
💥ACEi/ARB - don't stop - no evidence of harm/benefit

#ACCFIT #MedEd #Medtwitter #HMHFellow @HMHCardioFellow @HMethodistCV #StayHomeSaveLives #FlattenTheCurveTogether

💥Increased #COVID19 mortality with CVD
💥Association between elevated troponin and mortality
💥#COVID19 + elevated troponin -> older patients, more co-morbidities, higher acuity

💥ACC: Measure troponin & BNP if considering ACS / HF clinically
💥Based on studies, ?consider using troponin as prognostic marker
💥ACS: GDMT, consider cath lab staff exposure, ?fibrinolytics in low risk ACS

Read 6 tweets

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