Discover and read the best of Twitter Threads about #ACCMedStudent
Most recents (8)
1/ 😱😱😱 Why is this valve in the ascending aorta⁉️
Join me as we learn about TAVR complications.
Another @Cardionerds thread….
Farley et al: rb.gy/zu3ay3
#CardioTwitter #ACCMedStudent
Join me as we learn about TAVR complications.
Another @Cardionerds thread….
Farley et al: rb.gy/zu3ay3
#CardioTwitter #ACCMedStudent
2/ 🌟We know the TAVR success story has been extraordinary and is continuously evolving
⚠️⚠️BUT... like all procedures, TAVR has its fair share of complications we have to keep in mind
jacc.org/doi/10.1016/j.…
⚠️⚠️BUT... like all procedures, TAVR has its fair share of complications we have to keep in mind
jacc.org/doi/10.1016/j.…
3/Keep reading to:
▶️Understand the periprocedural TAVR complications
▶️Appreciate the prevalence of TAVR complications
▶️Recognize the late complications of TAVR
▶️Understand the periprocedural TAVR complications
▶️Appreciate the prevalence of TAVR complications
▶️Recognize the late complications of TAVR
1/ We clinched the Dx, but how do we treat it?
Are these clot 📸 the best approach for #PE Rx?
Let’s dive into the 🌎 of "escalation of care" therapies
@CardioNerds 🧵 part 2...
Hold on to your 🎩 for this one
@PERTConsortium #PERT #CardioTwitter #ACCMedStudent
Are these clot 📸 the best approach for #PE Rx?
Let’s dive into the 🌎 of "escalation of care" therapies
@CardioNerds 🧵 part 2...
Hold on to your 🎩 for this one
@PERTConsortium #PERT #CardioTwitter #ACCMedStudent
![Courtesy of @GoldbergJBCTMD [Dr. Joshua Goldberg]](https://pbs.twimg.com/media/Fp_aVGwX0AY9WNZ.jpg)
2/ Why is PE so dangerous❓
⚠️thrombus in 🫁 ➡️obstruction ➡️ sudden ⬆️ RV afterload ➡️ pressure➕volume overload ➡️ ⬇️RV output➕RV ischemia ➡️ ⬇️LV preload ➡️ ⬇️ 🫀output ➡️ shock ❤️🔥
⚠️Hypoxic & neurohormonal mediated pulmonary vasoconstriction ➡️ ⬆️ RV afterload
⚠️thrombus in 🫁 ➡️obstruction ➡️ sudden ⬆️ RV afterload ➡️ pressure➕volume overload ➡️ ⬇️RV output➕RV ischemia ➡️ ⬇️LV preload ➡️ ⬇️ 🫀output ➡️ shock ❤️🔥
⚠️Hypoxic & neurohormonal mediated pulmonary vasoconstriction ➡️ ⬆️ RV afterload
3/ How do we treat❓
Based on risk stratification, we have several options: ⭐️Anticoagulation (AC) alone
Escalation of Care (EOC) therapies:
⭐️Systemic Thrombolysis (ST)
⭐️Catheter Directed Therapies (CDT)
⭐️Surgical Embolectomy (SE)
⭐️ECMO
Based on risk stratification, we have several options: ⭐️Anticoagulation (AC) alone
Escalation of Care (EOC) therapies:
⭐️Systemic Thrombolysis (ST)
⭐️Catheter Directed Therapies (CDT)
⭐️Surgical Embolectomy (SE)
⭐️ECMO
1/ A 40-year-old man presents with Dyspnea and this finding on CTPA ⬇️. How do we treat?
WOAHHH hold your 🐎! Although the CT is black & white, the approach to pulmonary embolism (PE) is more nuanced
Let's talk about PE diagnosis - A @CardioNerds 🧵...
@PERTConsortium #PERT
WOAHHH hold your 🐎! Although the CT is black & white, the approach to pulmonary embolism (PE) is more nuanced
Let's talk about PE diagnosis - A @CardioNerds 🧵...
@PERTConsortium #PERT
2/ Let’s start with PE Epidemiology 🧮
👉3rd leading cause of CV mortality
👉Annual incidence worldwide is 1 in 1000
👉120 per 100,000 in US
👉PE diagnosis continues to 📈
ahajournals.org/doi/10.1161/CI…
👉3rd leading cause of CV mortality
👉Annual incidence worldwide is 1 in 1000
👉120 per 100,000 in US
👉PE diagnosis continues to 📈
ahajournals.org/doi/10.1161/CI…
3/ Let’s follow the 5️⃣ steps of PE management:
1️⃣Suspect PE
2️⃣Estimate Risk of PE
3️⃣Diagnose with imaging
4️⃣Risk Stratification
5️⃣Treatment
Shoutout to @AmitGoyalMD for this framework
1️⃣Suspect PE
2️⃣Estimate Risk of PE
3️⃣Diagnose with imaging
4️⃣Risk Stratification
5️⃣Treatment
Shoutout to @AmitGoyalMD for this framework
The #WorldCup2022 ⚽️ finals are set 🇦🇷vs🇫🇷 & is just a few days away, but don't forget about Christian Erikson 🇩🇰 and what happened to his heart in June of 2021.
A 🧵on Sudden Cardiac death (SCD) in athletes 💔….
with edits from @AHajduczok @MichaelEmeryMD and @CardioNerds
A 🧵on Sudden Cardiac death (SCD) in athletes 💔….
with edits from @AHajduczok @MichaelEmeryMD and @CardioNerds
We will talk about:
⚡️Global incidence of SCD and sudden cardiac arrest (SCA) in the general and athlete populations
⚡️Etiologies implicated in SCD/SCA
⚡️If and how we can prevent SCD/SCA
⚡️Global incidence of SCD and sudden cardiac arrest (SCA) in the general and athlete populations
⚡️Etiologies implicated in SCD/SCA
⚡️If and how we can prevent SCD/SCA
Poll:
How do you feel about the following statement:
I feel comfortable with my knowledge of sudden cardiac death in athletes and the role prevention plays
How do you feel about the following statement:
I feel comfortable with my knowledge of sudden cardiac death in athletes and the role prevention plays
Essentials of Stable Ischemic Heart Disease
♦️Plaque Characteristics & Progression
♦️Choosing From Imaging Toolbox
♦️Perils of Polypharmacy
♦️Who & When To Revascularize
♦️Overview of Guidelines
🧵on this great @ACCinTouch session from today #ACC21 #ACCMedStudent
♦️Plaque Characteristics & Progression
♦️Choosing From Imaging Toolbox
♦️Perils of Polypharmacy
♦️Who & When To Revascularize
♦️Overview of Guidelines
🧵on this great @ACCinTouch session from today #ACC21 #ACCMedStudent
1/Plaque Progression #ACC21
Non-atherosclerotic intimal lesions➡️progressive atheroscl. lesions (fibroatheroma)➡️lesions w/ acute thrombi
Plaque rupture = lesion growth
Lumen area maintained till 40% narrowing
Narrowing beyond 40% occurs w/ plaque rupture+intraplaque hemorrhage
Non-atherosclerotic intimal lesions➡️progressive atheroscl. lesions (fibroatheroma)➡️lesions w/ acute thrombi
Plaque rupture = lesion growth
Lumen area maintained till 40% narrowing
Narrowing beyond 40% occurs w/ plaque rupture+intraplaque hemorrhage
2/Plaque Characteristics #ACC21
Coronary artery calcification begins as micro-calcification➡️fragment➡️sheet➡️nodular
Stable plaque?
🔸Associated with DM, HTN, smoking
🔸Most common is fibrocalcific plaque (mostly sheet Ca)
Unstable plaque is mostly fragmented Ca
Coronary artery calcification begins as micro-calcification➡️fragment➡️sheet➡️nodular
Stable plaque?
🔸Associated with DM, HTN, smoking
🔸Most common is fibrocalcific plaque (mostly sheet Ca)
Unstable plaque is mostly fragmented Ca
💥The Ultimate Guide to Lipids💥
🟢Lipid biology
🟢Physical exam clues for lipid disorders
🟢Lipid tests & interpretation
🟢CV risk assessment
🟢Fundamentals of lipid management
🟢Review of guidelines
🧵on this great @ACCinTouch session from today #ACC21 #ACCMedStudent #ACCPrev
🟢Lipid biology
🟢Physical exam clues for lipid disorders
🟢Lipid tests & interpretation
🟢CV risk assessment
🟢Fundamentals of lipid management
🟢Review of guidelines
🧵on this great @ACCinTouch session from today #ACC21 #ACCMedStudent #ACCPrev
1/ Lipid Biology #ACC21 #ACCMedStudent
Lipoprotein-central core of cholesterol ester/TG surrounded by apolipoprotein
Dietary fat➡️chylomicrons➡️TG metabolized in muscle & adipose by lipoprotein lipase➡️chylomicron remnants liver uptake➡️VLDL➡️FFA & IDL ➡️LDL➡️LDL receptor uptake
Lipoprotein-central core of cholesterol ester/TG surrounded by apolipoprotein
Dietary fat➡️chylomicrons➡️TG metabolized in muscle & adipose by lipoprotein lipase➡️chylomicron remnants liver uptake➡️VLDL➡️FFA & IDL ➡️LDL➡️LDL receptor uptake
2/ Lipid Biology continued...#ACC21 #ACCMedStudent
HDL formed by liver/intestines - acquire cholesterol through reverse cholesterol transport
Lp(a) - modified LDL particle w/ additional apolipoprotein (a). Oxidation pro-inflammatory,⬆️atherosclerosis.
HDL formed by liver/intestines - acquire cholesterol through reverse cholesterol transport
Lp(a) - modified LDL particle w/ additional apolipoprotein (a). Oxidation pro-inflammatory,⬆️atherosclerosis.
#ACCMedStudent, it's Day 2 of #ACC21! Benefits of virtual meeting⏪old sessions available onDemand.
Great @ACCinTouch session yesterday on Advanced Heart Failure Therapies, ending w/ debate on Transplant vs. LVAD! #ACCHFT
🧵on some take-home points from the 6 presentations
Great @ACCinTouch session yesterday on Advanced Heart Failure Therapies, ending w/ debate on Transplant vs. LVAD! #ACCHFT
🧵on some take-home points from the 6 presentations
1/ Moving Beyond NYHA Class #ACC21
Vague w/ wide inter & intra observer variability
Utility breaks down in advanced HF
🌟Reclassifying advanced HF: INTERMACS Profiles (lower score = sicker) helps prognosis/triage
🔑Assign profile after identifying features of advanced HF
Vague w/ wide inter & intra observer variability
Utility breaks down in advanced HF
🌟Reclassifying advanced HF: INTERMACS Profiles (lower score = sicker) helps prognosis/triage
🔑Assign profile after identifying features of advanced HF
2/ Cardiac Transplantation #ACC21
♦️ Strategies to expand cardiac donor pool➡️ donation after circulatory death (DCD) - first performed in Duke Dec 2019
♦️ Advances in post-transplant care➡️prevention of cardiac allograft vasculopathy & molecular tools for rejection monitoring
♦️ Strategies to expand cardiac donor pool➡️ donation after circulatory death (DCD) - first performed in Duke Dec 2019
♦️ Advances in post-transplant care➡️prevention of cardiac allograft vasculopathy & molecular tools for rejection monitoring
🌟Future of Dyslipidemia Management🌟
🧵on this great session from #ACC21 #ACCMedStudent
1/ Team-based approach to improve CV outcomes
🔸pharmacist interventions reduce LDL-C
🔸sessions with dietitian improves lipids &📉costs
🔸Multi-D lipid clinic⬆️guideline-directed treatment
🧵on this great session from #ACC21 #ACCMedStudent
1/ Team-based approach to improve CV outcomes
🔸pharmacist interventions reduce LDL-C
🔸sessions with dietitian improves lipids &📉costs
🔸Multi-D lipid clinic⬆️guideline-directed treatment
2/ Familial Hypercholesterolemia (FH)
♦️ Genetically inherited, autosomal dominant
♦️ LDL-C >190 mg/dL
♦️ Family hx of premature coronary disease
Presence of corneal arcus (ring of cholesterol precipitate) or tendon xanthoma (>8mm Achilles tendon) before age 45 highly suggestive
♦️ Genetically inherited, autosomal dominant
♦️ LDL-C >190 mg/dL
♦️ Family hx of premature coronary disease
Presence of corneal arcus (ring of cholesterol precipitate) or tendon xanthoma (>8mm Achilles tendon) before age 45 highly suggestive
3/ Genetic Testing for pts at risk due to family history or w/ FH phenotype
🌟Up to 30% of patients with very high LDL-C have high polygenic risk score (PRS) vs. single gene mutation🌟
🌟Up to 30% of patients with very high LDL-C have high polygenic risk score (PRS) vs. single gene mutation🌟
