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📌REVIEW. MIOCARDIOPATÍA HIPERTRÓFICA💪

🔹Prevalencia 1:200-1:500, ≈ 20M🌐, 10%-20% se identifica 🩺
🔸Tratable y consistente c/longevidad normal
🔹⚠️Diagnóstico oportuno y preciso ⚠️
🔸#echofirst y #WhyCMR 👉 sinérgicos

🧵👇
🆓sciencedirect.com/science/articl…

#CardioTwitter @SAC_54 Image
🚩4⃣ Perfiles Clínicos:
🔹Estable benigno, no requiere tto (46%)
🔸Obstrucción del TSVI con signos de IC, candidato a intervención (43%)
🔹FA con indicación de ACO (17%)
🔸Riesgo de MS☠️, eventual CDI⚡️(6%)
🔹Etapa final IC (4%)

⚠️10% ptes tienen mas de un perfil clínico Image
🚩Evaluación inicial de MCH:
🔸Morfología y función VI💔
🔹Severidad de síntomas
🔸Riesgo de Muerte Súbita☠️
🔹Antecedentes familiares
🔸Modificación del estilo de vida
Read 9 tweets
What's going on with the Impella?

As a follow up to my previous #tweetorial on the IABP, this🧵 will explore the nuts and bolts of the Impella for those in the CCU

Special thanks to @AHajduczok for helping with this🧵.
#medtwitter #cardiotwitter
@AHajduczok Learning objectives:
💔 history of the Impella
💔 learn how it works
💔 how to troubleshoot when it doesn't work
@AHajduczok The Impella is based on concept from Egypt in the 3rd Century BC

The Greek mathematician Archimedes, developed a machine to raise water up while in Egypt. The machine consists of a screw within a hollow cylinder that transfers water upwards by each segment of the screw.
Read 25 tweets
A patient with heart failure that you have been following for the last five years no longer has a low EF. What changed ? What medications do you add/stop ?

A #MedTwitter #Tweetorial on HFimpEF (HF with improved EF).

First let’s talk the nuances of calculating EF. 🧮

(1/14)
EF = (EDV-ESV)/EDV or the percentage of EDV ejected by the LV. This volumetric analysis is performed by echocardiography. However in some cardiac diseases, the EF calculated can be falsely ⬆️/⬇️.
This can happen in which of the following conditions ?
2/n
That’s right ! Both MR and AR can produce a wrong EF reading. The calculation fails to account for the portion of blood that is ejected into the LA in MR (⬆️EF) and the regurgitant back flow from Aorta in AR (⬇️EF).
Cardiac MRI can more accurately predict EF in these patients.
Read 18 tweets
#OncTwitter
NCI Pooled analysis (N=6.9K) of antiPD1/PDL1:
👉0.6% incidence CPI-related major cardiac AEs, 77% grade 3+
👉Almost half were myocarditis
👉 Twice as common w/ combos vs monotherapy & w/ CPI + targeted agent vs CPI + antiCTLA4…
#ImmunoOnc
ascopubs.org/doi/full/10.12…
#OncTwitter
👉Major cardiac AEs were mostly early events (1-2 months) occurring after median of 2 doses of CPI
👉1/4 of cases of myocarditis were fatal, all preceded by myositis 👀
👉Diverse clinical presentations so have high index of suspicion to diagnose & intervene early…
#OncTwitter
My commentary: It’s also concerning (& not surprising given what we know about pro-inflammatory metabolic syndrome as a cardiac risk fx) that markedly ⬆️ risk of MI has been reported in pts with multi-yr use of CPIs. I predict this follows a course much like HIV…
Read 6 tweets
🥃 🍺
🥃 🍺
🥃 🍺
Read 16 tweets
We all know that stress is bad for our hearts.⚠️❤️

But did you know there is actual evidence of this heart-brain connection on FDG PET/CT?

A #Tweetorial 🧵 #CardioTwitter #MedTwitter #MedEd
We know that the stress response begins in the 🧠 salience network - the AMYGDALA is a 🔑 component.

Activation of this network ⬆️ SNS output, which ⬆️ immune cell output from the bone marrow.

Amygdalar activity ⬆️ in chronic stress conditions e.g., PTSD, anxiety & depression.
In other words, chronic psychologic stress causes ⬆ activation of the amygdala which, in turn, activates systemic inflammation.
Read 18 tweets
State-of-the-Art JACC
Revisión de Infarto prematuro
🧵 1/8
@clinicasac por @matiasrg
#CardioTwitter
jacc.org/doi/epdf/10.10… Image
2/8
Epidemiología, 
▪️sin corte específico de edad 👉🏻45-55 años.
▪️👩🏻‍🦰y🧑🏻‍🦰diferentes fenotipos
🧑🏻‍🦰 > carga de placa, lesiones no culpables. 
👩🏻‍🦰 < ruptura de placa, mas erosión y SCAD
2/7 Image
3/8
F d R:
🚬🚬🚬
16%Dislipimidemias 👨‍👩‍👦‍👦 
1 de cada 3 tiene👆🏻 LpA y non-HDL (LpA aumenta x 3 chances de IAM en <50a)
Abuso de sustancias💉💉
bajo nivel económico (X2)
En 👩🏻‍🦰 pensar MINOCA 
En 🤰🏻 pensar SCAD
Read 8 tweets
2/9 Being a fibroelastic sac the pericardium covers & protects the #heart

In constrictive pericarditis:
1️⃣healing of acute pericarditis
2️⃣granulation tissue
3️⃣obliteration of pericardial cavity
4️⃣loss of pericardial elasticity
5️⃣restriction in ventricular filling

#CardioTwitter
3/9
Correspondingly #cardiacimaging with #cardiacMRI in T1 mapping shows ⬆️ extracellular volume in myocardium, suggestive of global myocardial fibrosis, as shown by doi.org/10.1016%2Fj.jc… 10.1016/j.jccase.2018.06.001
Read 9 tweets
1) Welcome to an #accredited #tweetorial on optimizing the use of #SGLT2i in the management of #T2D. This program is accredited for 0.50 🆓credits for #physicians #nurses #physicianassociates #nursepratcitioners #pharmacists by @academiccme! I am @tmodarressi of @HeartDoctorNJ.
2) This program is intended for healthcare professionals and is supported by an educational grant from Boehringer Ingelheim Pharmaceuticals Inc. and Eli Lilly Company. See archived programs, all by expert authors, still available for credit at cardiometabolic-ce.com.
Read 47 tweets
📌NEJM. REVIEW. Autor: Dr. E. BRAUNWALD
GLIFOZINAS EN EL MANEJO DE ENFERMEDAD CV

⚠️SGLT2i⚠️ Cambio de Paradigma
⬇️ Eventos CV💔 y Hospitalizaciones🏥 por IC, independiente DBT2, en amplia gama de FEYs
⬇️ Progresión de falla renal

nejm.org/doi/pdf/10.105…
#CardioTwitter
🚩≈57k ptes. ⬇️Eventos CV en 6 trials mas relevantes en ptes con DBT2.
-📉RRR Eventos CV mayores 11%
-📉RRR Muerte CV 14%
-📉RRR Hospitalización por IC 32%
🚩 Renoprotección. Meta-análisis ≈38k ptes.
⬇️Eventos renales en 4 trials mas relevantes en ptes c/ DBT2.
-📉RRR 33 %👉progresión a diálisis, trasplante o muerte renal
- 💡Beneficios en todo el rango de función renal, diabético o no e independiente del control glucémico
Read 3 tweets
❌please read and share:hugely important study ❌ mortality rate for ST elevation MI 🫀(type of heart attack) has increased from 5% to 33% of women and 27% of men during #COVID19 infection and at least 4 weeks afterwards jscai.org/article/S2772-…🧵
2/ This should be the front page of every newspaper 📰 right now. Instead of 5/100 dying it’s now 30/100. This is huge and this is not good news given the prevalence of Covid-19 and the fact we don’t keep immunity/new variants.
3/ COVID-19 significantly increases the risk of arterial and venous thromboembolic events up to 2-fold, including the risk of myocardial infarction (MI) in the 7  days after COVID-19 diagnosis.
Read 6 tweets
The spectrum of Marfan syndrome and related connective tissue disorders is intriguing and mind-bending 💫✨

Here is a🧵exploring it

@CPSolvers @rabihmgeha @DxRxEdu @Sharminzi @AnnKumfer @rav7ks @sargsyanz @DrCindyCooper @jackpenner @MatthewHoMD @ASanchez_PS

#MedTwitter
#2 Skeletal manifestations

-Tall stature
-Long slender arms & legs
-Arachnodactyly
-Pectus excavatum
- Pectus carinatum
-Joint hypermobility
-Pes planus
-Camptodactyly (bent fingers)
-Kyphoscoliosis
-Micrognathia & Retrognathia
-Dolichocephaly
-Malar hypoplasia

#MedTwitter
#3 Cardiovascular

-Mitral valve prolapse (can lead to CHF & arrhythmias)
-Aortic aneurysms
-Aortic root dilation
-Aortic dissection
-Aortic regurgitation
-Pulmonary artery dilation (often asymptomatic)

#MedTwitter #CardioTwitter @Gurleen_Kaur96 @KannuBansalMD @this_is_svenka
Read 19 tweets
🧵 1/8 Myocardial bridging is present when part of coronary artery dips into & underneath heart muscle. Let’s dig deeper. 📖
Educational thread 🧵 1/8
#MedEd #CardioEd #CardioTwitter #MedTwitter #radialfirst @JACCJournals @YoungDgk @DGK_org @AGIKinterv @CardioNerds @escardio
📍2/8 Myocardial bridging is a congenital coronary artery anomaly, in which a segment of the artery (tunnel segment) dips into the myocardium (myocardial bridge). https://doi.org/10.1253/circj.cj-10-1278
📍3/8 Methods of detection vary greatly in sensitivity.
Myocardial bridging is seen in

🥇30% of pts in autopsy
🥈20% of pts in coronary CT-scan
🥉5% of pts in coronary angiography
#CardioTwitter #MedTwitter #RadialFirst https://doi.org/10.1253/circj.cj-10-1278
Read 9 tweets
2/ what is the left atrial appendage?

The LAA is derived from the left wall of the primary atrium (embryo). Its diff from the true LA and its suited to function as a decompression chamber during left ventricular systole and during other periods when left atrial pressure is high
3/ the appendage is like your fingerprint. No two are the same.

Common shapes are:

🥦Cauliflower/Broccoli (hardest)
💨Windsock (easiest)
🐓Chicken wing
🌵Cactus

#LAAO #Watchman #Structural #Cardiotwitter #EPeeps @EPeeps_Bot @TAVRBot @RadialFirstBot @EchofirstB
Read 25 tweets
63. For Part 4 of our #Tweetorial on the basics of mechanical circulatory support (MCS) we will look at some case examples and clinical indications. 🏥

Follow along below ⬇ Image
64. This 71 yo man had chest pain, shortness of breath, and inferior STEMI & based on BP has what looks like an RV infarct. Treatment began with IV fluids, and vasopressors but BP remains low & HR is actually low for the condition. What do you do? 🤒 Image
65. I know some have used left-sided Impella for this type of shock patient with RV infarct, but I would not choose this path as unloading the LV would not help without RV function. Image
Read 19 tweets
1) Welcome to our #accredited #tweetorial on optimal mgt of #hyperkalemia in the patient with #CKD. Earn 0.5h #CME/CE credit by following this thread. I am Sourabh Sharma MD DNB FASN 🇮🇳 @iamnephrologist & u have found the ONLY source for CE credit delivered entirely on Twitter!
2) This program is supported by educational grants from AstraZeneca and Bayer & is intended for #healthcare providers. See faculty disclosures ckd-ce.com/disclosures/. Educational credit for #physicians #physicianassociate #nurses #nursepractitioners #pharmacists 🇺🇸🇨🇦🇪🇺🇬🇧
3) Potassium was first isolated by Humphry Davy in 1807 by electrolysis (Coined word from “Potash” [Dutch]). The periodic table symbol K was derived from kali (alkali) [Arabic].
en.wikipedia.org/wiki/Potassium
#NephroNotes #NephPearls #FOAMed #MedEd @MedTweetorials #CardioTwitter
Read 36 tweets
32. For Part 3 of our #Tweetorial on the basics of mechanical circulatory support (MCS) we will look at PV loops. ➰

Follow along below. 🧵
33. Let’s start with the metrics of LV function.

Looking at the cycle🔁 of contraction you can see pressures using the Wiggers diagram, named after Carl Wiggers.
34. LV pressure isovolumetric contraction (a-b) begins after the A wave to AV opening at B. Ejection occurs across systole until AV closes at C. The T wave signals repolarization. Isovolumetric relaxation (c-d) follows, ending at MV opening & diastole refills the ventricle at D.
Read 31 tweets
Dad bleed to death 5 years ago today.
I usually prefer to remember his life, but ever since I got the letter from @CVSHealth PBM Caremark saying I couldn't continue on the anticoagulant with the lowest risk of major bleeding, Dad's final moments have been heavy on my mind. 🧵
I got the call around 4am from my parent’s neighbor saying there was blood everywhere in Dad’s bedroom. Mom was hysterical. EMS were on the scene. 2/
Dad was stabilized at their small rural hospital before being transported an hour to a large academic hospital. He had a major bleed in his lungs. Despite best efforts over the next 48 hours, he had one final traumatic bleed out which could not be stopped.3/
Read 22 tweets
17For Part 2 of our #Tweetorial on the basics of mechanical circulatory support (MCS), we will look at different device options. 🦾⚙
18We are in a wonderful time when we have many different devices available to us, so it is worth looking at the differences in these devices and what they can & can’t do. ⚖
19The balloon pump 🎈 produces counter-pulsation in the aorta, inflating during diastole, deflating in systole. It can be left in place for days & is relatively small. It requires cardiac synchrony or a rhythm to really function well.

Its output is modest at 0.5 L/min.
Read 15 tweets
1) Welcome to a #tweetorial on what every #ICU #nurse should know about #hypertensive crisis, or #hypertensive #emergency as it is now more properly termed. I’m Bryan Boling @bryanboling, ICU #NP, & co-host of the @icuscenarios podcast. Follow this 🧵for 🆓CE/#CME credit!
2) This accredited educational activity is intended for healthcare providers & is supported by grants from AstraZeneca, Bayer, & Chiesi. Faculty disclosures cardiometabolic-ce.com/disclosures/. Like ❤️this topic? More CE/#CME on #hypertension mgt at cardiometabolic-ce.com/category/hyper….
3) So let's start with a case: 65yo ♂️, presents to the #ED with #headache, lethargy & confusion. PMH: #HTN, #hyperlipidemia, #DM2, COPD. Initial VS: HR 85, BP 205/120, T 37.2 RR 12, SpO2 92% on RA. Family reports that he has been more lethargic over the past 2 days.
Read 37 tweets
Balloon rupture, 26mm - 1cc for area 425-440, moderate at most calcium. Heard about this but have not had it happen. My step-by-step: @IvanHansonMD @amrabbasmd @LuaySayed @sean_stewartmd @noon_boiler55 @dhrosenbaum #CardioTwitter
1/assess valve stability, is it fully deployed/secure?
2/assess patient stability, annular rupture/effusion?
3/get fractured balloon out of ventricle, 👁 as 👃cone comes through valve, likely winged and plastic is rigid. Prepare to snare from contralateral to deflect if needed
4/get balloon into sheath. DO NOT FORCE, this will mushroom the edge of the e-sheath and significant complicate removal of system. Try to twist delivery system to resheath the balloon

For this case, the 👃cone would not resheath and started splitting the expandable portion
Read 4 tweets
Results of the randomized #ADVOR trial are soon coming your way! It's the largest diuretic trial in acute #heartfailure ever conducted (N=519) and will test acetazolamide on top of loop diuretics. Recruitment is finished and full database lock is anticipated. Find out more (1/9). Image
Appropriate and thorough decongestion is class I recommendation in HFA-ESC guidelines (2/9).
academic.oup.com/eurheartj/arti…
#Cardiotwitter #Cardiology #FOAMed #Cardiorenal #MedEd #MedTwitter #Nephrology #ADVOR #HeartFailure2022 #HFA_ESC Image
Only 15% of AHF included in DOSE trial were decongested after 72 hours of high-dose loop diuretic (LD) therapy (3/9).
nejm.org/doi/full/10.10… Image
Read 9 tweets
Non-medical drug switching--born not of clinical reasons but out of the revenue-maximizing contract negotiations between pharma & PBMs--has tangible human impact. I am one of those impacted. #CardioTwitter #StopTheSwitch #MedTwitter #TwitterRx onlinelibrary.wiley.com/doi/full/10.10…
2) Shared decision making necessitates that no one stand between a patient & clinician making decisions based upon the clinical evidence.
yet
Non-medical drug switching= the insurance PBM knows better than patient & doctor.
#MedTwitter #CardioTwitter #TwitterRx #StopTheSwitch
3) If clinical evidence cannot be acted upon at the point of care at the dictates of a profit-motivated third party, can clinicians really be said to be practicing evidenced-based medicine?
🚨Clinical decisions MUST be between a patient & physician only.#MedTwitter #CardioTwitter
Read 5 tweets

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