Discover and read the best of Twitter Threads about #CardioTwitter

Most recents (24)

Hi guys! I’m kind of in the mood to give a talk this night. So why not talk about #CardioOnc & #whyCMR? #CardioTwitter #JACCCardioOnc
We started our small “shop” in mid 2013, with the help of @DipanJShah, he allowed me to start a small CMR practice at @HMethodistCV. I did that until we got #CardsRads right, then @XRayDUG supported me and I was able to practice CMR at MD Anderson, then our volumes have been ⬆️
In 2017, when we got +300, I got so happy, that we wrote about our CMR experience in a major cancer center. Jon Weinsaft had a great practice at MSK already, so we couldn’t claim it was the first CMR practice in a major cancer center, still we were very happy about it.
Read 10 tweets
#Cardiotwitter thank you for transforming the field of cardiology.

This paper is a testimony of that transformation brought upon by the use of #SoMe in #CV medicine. Published today in @JACCJournals

onlinejacc.org/content/73/9/1…

Here is a tweetorial on why #SoMe in #CVmedicine
If you are new to twitter look at this slide from my #SoMeGR at @LLUHealth
Engagement = Likes +Retweets
Impressions= Users that tweeted the tweet x no of their followers
More in the basics of #SoMe in onlinejacc.org/content/73/9/1…
@adityadoc1 @AdiAJoshi @poojaotherwise @almasthela
Make sure to use the hashtags to increase your engagement
List of the popular hashtags used on #cardiotwitter below- look at the reach of those hashtags!

Don’t forget Imaging hashtags: #echofirst #whyCMR #yesCCT #ACCimaging #CVimaging
More at onlinejacc.org/content/73/9/1…
Read 13 tweets
1/15

For my first #Tweetorial, I will start with a question:

Which of the following medications from the SGLT2 inhibitor class have been shown to decrease cardiovascular morbidity and mortality?

#Diabetes #EndoTwitter #MedEd #MedTwitter #DM2 #T2D #CardioTwitter
2/15

Sodium glucose transporters (SGLT) in proximal tubules mediate glucose reabsorption.

How?
Na/K ATPase moves Na out & K into the cell ➡️gradient for Na to flow intracellular

SGLT uses this potential to move glucose against its gradient from the tubular fluid into the cell.
3/15

SGLT2 inhibitors block glucose reabsorption
➡️renal glucose excretion
➡️glucose levels⬇️

Because this has nothing to do with insulin, they usually don’t cause hypoglycemia or weight gain.

Actually, because of the osmotic diuresis, they decrease blood pressure & weight.
Read 15 tweets
1/ Get your #ECG learning on with this new #12leadthursday today! #FOAMed
2/ What #pathophys helps explains those delta waves? #cardiotwitter
3/ Lets get into #arrhythmia associated with WPW
Read 4 tweets
1/ Happy #12LeadThursday!

Practice your skills and take a swing at our latest EKG. What’s the diagnosis?

Use your system:
🔘Rhythm
🔘Rate
🔘Axis
🔘Intervals
🔘Morphology

#FOAMEd #cardiotwitter #medtwitter
2/ We’re mixing it up today: we’ve got one finding that’s a throwback to a previous #12LeadThursday, combined with a new finding that’s a little more specific.

Low voltage + electrical alternans = ?
3/ Remember, specificity = true negatives / (true negatives + false positives). Highly specific findings rarely produce false positives, so you can be pretty sure this 🚴🏽‍♀️ has developed tamponade physiology.

What do you do next?
Read 4 tweets
A thread.
So the @US_FDA @SGottliebFDA issued a warning re: Fluoroquinolones (FLQ) and aortic dissection (AD) or aneurysm (AA). Do FLQs cause AD/AA? Not really. Is there an association? Maybe. Let’s go throw the evidence and you can decide for yourself.
#CardioTwitter #MedEd
1/ Why was this association even studied? FLQ are known to be associated with Achilles tendon rupture, tendinopathy, retinal detachment. How? 1)decrease collagen synthesis and increase MMP (especially 2, 9) activity (among others). Aorta is affected by these processes
2/First study was published in 2015 using a national database in Taiwan. 1477 cases (662 AD, 850 AA) matched to 147 700 controls. There was signal of the association of FLQ and AD; rate ratio ranging 1.37 - 2.11 with any FLQ use (tinyurl.com/ybhcpexz)
Read 13 tweets
THREAD: Differential diagnosis of tachycardias can be tricky business! Here are some strategies to help keep you between the ditches. Hope you will like and share. #FOAMed #FOAMems #MedEd #CardioTwitter
1/ First let's look at the 2015 AHA ECC Guidelines tachycardia algorithm. It's fairly straight forward but there are some important concepts here that deserve some elaboration.
2/ In the first place we're asked to consider appropriateness of tachycardia for the clinical condition. This is really important! We don't want to attack the heart rhythm if it's a compensatory tachycardia! The second part causes a lot of confusion. What is significance of 150?
Read 29 tweets
1/ Feeling low energy today? Need a late afternoon pick-me-up? This week’s #12leadthursday should elevate your heart rate!

#FOAMEd #Cardiotwitter @smithECGBlog @ecgrhythms
2/ Stop! Differential time! What can cause a low voltage ECG?
3/ It’s helpful to think about WHY the voltage is low - you don’t have to memorize the differential; rather, it can follow logically from your reasoning.
Read 4 tweets
A great case of bicuspid-associated aortopathy.
How common is aortic dissection in BAV? To date, many surgeons operate on patients with dilated aortas in the 4.5-5.0 cm range without concomitant severe valve disease. But, how about the evidence so far?
#cardiotwitter #MedEd
1) IRAD had 1.9% BAV patients in a 2006 report (out of 303 type A dissections)
ncbi.nlm.nih.gov/pubmed/16820599
2) GenTAC registry had 2 dissections / 772 BAV (follow-up 3.6 years, outcome ascertained in 88%)
ncbi.nlm.nih.gov/pubmed/27282895
Read 8 tweets
Hey #cardiotwitter, here’s a thread on my latest publication “Endothelial dysfunction and cellular repair in #HFpEF: response to a maximal #exercise bout” in #EJHF @ESC_Journals @mross013 @AnastasiaSMihai @DrWillWatson @GiuseppeGalati_ @rudolf_deboer doi.wiley.com/10.1002/ejhf.1…
I’ve previously presented parts of this at #EuroPrevent 2018 YIA session and @KeystoneSymp so you can stop here if you attended 😉 #EAPC @SilCastelletti @FlavioDascenzi @merrylindseyphd @mmamas1973 @HH4EHRA @lamcardio @rladeiraslopes @verocornelissen @paolo_emilio @m_piepoli
This is the first time I do this so feedback is very much appreciated! Let’s structure this as follows:
-What did we investigate?
-What were the results?
-Why is this important?
Read 19 tweets
Intro to #CAC Tweetorial!

For #ACCFIT, @FiRSTSCCT @ACRRFS #ACCImaging,
@heart_scct #YesCCT #AHA18 #SCCT2019 #Cardiotwitter 😀😀

*⃣Case
*⃣Basics on CAC
*⃣CAC & prognosis
*⃣ACC/AHA 2018 vs SCCT 2017 guidelines
*⃣Case follow-up
(1/n)
Here’s a case – similar to patients we see everyday in the primary care and cardiology offices. (2/n)

72 year-old asymptomatic healthy 💃
BP 117/74, BMI 22
Lipids: TC 270, TG 100 HDL 90 LDL 155
ACC/AHA ASCVD Risk: 10%

#AHA2018 #YesCCT #CAC #ACCImaging
POLL:

Based on the clinical information, would you (3/n):

#AHA2018 #YesCCT #CAC #SCCT2019 #ACCImaging #Cardiotwitter
Read 14 tweets
1/ Happy #12LeadThursday!

Here’s a chance to practice your skills. Make sure you don’t miss a beat...or drop one 😜

Step 1:
🔘Rhythm
🔘Rate
🔘Axis
🔘Intervals
🔘Morphology

#FOAMEd #cardiotwitter #medtwitter
2/ Is this what you identified?

If yes: good work! What’s your ddx? What additional history do you want?

If no: take a moment to review the ECG. What did you get right? Where did you go wrong? If it hurts, good; that’s what learning feels like!
3/ Major development!

Take a moment to refine your ddx.

What’s your next step?
Read 5 tweets
(THREAD)

By @rwyeh request, I bring you this brief introduction of joint frailty models and their application in the #COAPT trial...
Please be advised that @graemeleehickey and others are more expert than I am in the direct, real-world application of such models, but here I am, so whatever. Read it, or don’t.
Suppose you’re just reading along in the #COAPT primary paper, found here:

nejm.org/doi/full/10.10…

when you encounter this bumfuzzle:
Read 26 tweets
1/ A long thread on LifeVest. I promise it will be entertaining. If you find any inaccuracies please let me know.

Paper of VEST published here - will discuss background to WCD and #VEST but not the trial itself nejm.org/doi/full/10.10…
2/ In 2001, FDA gave approval to Lifecor for the first WCD. Later Lifecor was acquired by Zoll (2004 agreement, 2006 acquisition). Zoll maintains a registry for prescribed LifeVests. But lets go back to the FDA approval process.
3/ Lifecor presented 2 separate prospective studies to the FDA; WEARIT and BIROAD. FDA asked for both to be combined into 1 study, and each study representing a subgroup. A total of 289 patients were included.
Read 18 tweets
The Teaching Tomorrow’s Teachers (3T) program is a unique and forward thinking opportunity for #ACCFIT’s supported by @ACCinTouch @ACCCardioEd to train our growing community of medical educators! @craigalpert @mwcullen @ShashankSinhaMD
Read 3 tweets
Now that the #epibookclub is over, my weekends are free for reading #RCTs. So, how about a #tweetorial about #pragmatic trials, causal questions, and #landmark analyses, inspired by the #SCOTHEART trial?

#epimethodsclub #cardiotwitter
If we’re going to talk about #pragmatic trials, then we need to start with a definition. The simplest definition I’ve seen is from a trialist I interviewed for my recent @JClinEpi paper (authors.elsevier.com/a/1XS1b3BcJPuv…)

pRCTs “...attempt to address effectiveness in real world settings”
Sure, it’s a bit vague but it’s useful because, like Tolstoy’s unhappy families, #pragmatic trials are all different.

So, what makes me think #SCOTHEART is pragmatic?

My 2¢: lack of blinding, inclusion criteria based on symptoms not diagnoses, & standard care as comparator.
Read 20 tweets
1| Good #cardiotwitter on #SCOTHeart. Others have tweeted reasons y believable. Here is my reply tweetorial

@khurramn1 @AChoiHeart @MarcDweck @JWeirMcCall @rwyeh @drjohnm @venkmurthy @DavidLBrownMD @RogueRad
#ESCCongress
Linking my original tweetorial:
2| Let's start with MI def. Billing codes less accurate than adjudicated MI outcomes, yes? Could be nondiff misclassification which bias to null. But could also be diff w/ ascertainment bias (look harder, anchoring) knowing CCTA result, since 2/3rds normal or nonobstruct.
3| It is conjecture. But basis of clinical reasoning is to factor in test results. The posterior probability for this theory moves up much higher when we try to figure out by what mechanism did a diagnostic testing strategy lead to better outcomes, since the radiation did zilch
Read 11 tweets
1/
As #ESCCongress nears, I thought I would do a #tweetorial on amyloidosis. Exciting times for the field and new data/treatments expected next week.

#FITSurvivalGuide #CardioTwitter @tony_breu @rodney_falk @marthagrogan1 @amyloidosisfdn @AmyloidosisSupp @Amyloidosis_ARC
2/
What is amyloidosis?

A protein misfolding disorder in which one of thirty-five distinct proteins pathologically misfolds and aggregates extracellularly as insoluble amyloid fibrils, ultimately leading to organ dysfunction.
3/
You can see that other diseases like Alzheimer’s involve amyloid deposition. We will focus on two types of amyloidosis that affect the heart and nervous system: immunoglobulin light chain (AL) and transthyretin (ATTR) amyloidosis.
Read 16 tweets
Evaluation of Cardiac Masses:
A Tweetorial for #FITSurvivalGuide 🚨 #ACCImaging @ASE360 @SCMR @journalofCMR @ACCinTouch
Dedicated:@dr_chirumamilla & all #ACCFIT in #CardioTwitter
Main Ref: link.springer.com/article/10.100… Palaskas, et al. Curr Treat Options Cardio Med (2018) 20: 29.
Usually, it all starts with an abnormal finding in an echo suggestive of intracavitary mass. How can we tell one from the other? It can be confusing.
For artifacts, I did a Tweetorial already that describes the most common ones. Basic understanding of ultrasound physics is needed to be able to explain them: twitter.com/i/moments/1030…
Read 24 tweets
1/10 “To PCI, or Not to PCI, That is the Question” Will Shakespeare, MD
#FITSurvivalGuide
*Per many contentious #cardiotwitter discussions I realize this is loaded topic but I’m going to attempt an early stage #ACCFIT overview while recognizing there is a lot of nuance.
2/10 Why not “See lesion Fix lesion”?
Poor correlation between est'd visual stenosis & quantitative stenosis. And, without noninvasive ischemic data, coronary angio has limited accuracy w/ regard to identifying significance of many stenoses
*STEMI PCI already done @KhandelwalMD
3/10 COURAGE trial (OMT vs OMT and PCI of visually-estimated significant stenoses): No difference death/MI between OMT & OMT/PCI. PCI demonstrated clinical benefit only when treating relevant myocardial ischemia determined by noninvasive testing.
Read 14 tweets
This is DEEPLY CONCERNING editorial behavior... and
I think its time we start talking about the Use, Misuse and Abuse of Academic Power. [THREAD] #cardiotwitter medscape.com/viewarticle/89…
First, the ISCHEMIA trial is clearly ruffling feathers since the primary endpoint was changed. It is a costly 100mi buck FEDERAL funded trial, and it just switched from a bias resistant to a bias prone endpoint

That's a big deal
I read the article by Murthy and Eagle in FULL
I found it to be a lucid, stellar commentary about the deep and fundamental problems with the trial.

It was a SLEDGEHAMMER of clear thinking & reason
& it was persuasive

perhaps that was the problem
Read 17 tweets
#12leadthursday: 80M with hx #CABG with progressive decreased ET

Quiz urself before scrolling down! ✔️
What’s the rhythm? 🤔
What would you do next? 🤔

#FOAMed #cardiotwitter #MedEd
Read 6 tweets
Risk Ratio, Odds Ratio, Hazard Ratio
========================

2nd and final part of the tweetorial, from ORBITA-HQ!

Fun, easy and informative [*]

#MedEd #FOAMed #cardiology #cardiotwitter
[*] Results may vary and are not guaranteed. See small print.

Not all fears are alike.

* Some fears are one-and-done:
I get a cold which progresses to pneumonia. Will I die, or recover?

* Other things hang over us for much longer, perhaps all your life.
Will you get hit by a bus?
Get a heart attack?
There's no "sell by" date on the fear.
Practice Qs

You are walking through Hyde park, minding your own business.
Hardly causing any trouble at all.
Perhaps the odd humorous tweet.

You get a Direct Message:
"Enough of ur abuse!
You will be hearing form my agent shortly.
kthxbai
AJ Kirtane"

You see the agent:
Read 89 tweets

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