Discover and read the best of Twitter Threads about #CardioTwitter

Most recents (24)

1/ Today, at #ESCcongress2019 DAPA-HF trial showed amazing results. I love the complex story behind developing these novel #diabetes drugs and their impact on CVD so I'm going to share it in this tweetorial #cardiotwitter
2/ First let me start by sharing DAPA-HF results. Basically, in pts with HFrEF, Dapagliflozin (SGLT-2i) arm had 26% reduction in primary outcome & 18% reduction in CV death REGARDLESS of #diabetes. Link to tweet w/results thx to @rladeiraslopes

3/ Pre 2008, the FDA approved anti-diabetic medications based on their ability to reduce biomarkers, glucose and A1C, without the need for clinical outcome trials. Basically, anything that lowers A1c in diabetics got approved
Read 11 tweets
💥Current American Diabetes Association guidelines recommend Metformin as the 1st line therapy for all T2DM patients👇🏽
⚡️But should Metformin be the 1st line therapy in T2DM patients with cardiovascular disease?
1/
#Metformin
#endotwitter
#cardiotwitter
💥Let’s review the following about
Metformin:

⚡️Mechanism of action
⚡️Safety profile
⚡️Cardiovascular benefits
2/
💥How does Metformin work?

⚡️It inhibits gluconeogenesis in the liver by mitochondrial inhibition & by ⬆️ activation of AMP-kinase👇🏽
⚡️It ⬆️ insulin sensitivity
⚡️It may have additional pleiotropic
effects👇🏽
3/
Read 12 tweets
38 yo M with IVDA comes in with MRSA bacteria and sepsis. Over 5 cm vegetation on TV.
Surgical options not particularly attractive with platelets of 28K, Hgb of 7.8 and INR 1.5. So #Angiovac performed with 70% reduction of the mass.
A successful result under the circumstances. Patient off pressers in under 24 hours and platelets and petichial rash improving. #Structural #cardiotwitter
Read 4 tweets
⚡️ #YesCCT Coronary Plaque Assessment #Tweetorial ⚡️

By @CoronaryDoc + @AChoiHeart

✅ Why Plaque Assessment?
✅ High Risk Plaque Features
✅ Plaque Characterization/Quantification
✅ Supporting Clinical Data

#CardioTwitter #ACCImaging #SCCT2019 @heart_scct @journalCCT
1/14
2/14
As #SCD or #MI is 1st symptom of #atherosclerosis in 2/3 of pts, early ID of #CAD is of paramount importance

#YesCCT allows for
✅ ID of plaque
✅ Quant. of plaque
✅ Characterization of plaque
✅ Arterial remodeling

Lin, @LubbDup & @lesleejshaw: bit.ly/2x1b5Yz
3/14
Serial angiographic studies have demonstrated an accelerated & rapid plaque progression before most cases of ACS

Rapid plaque growth ➡️ plaque rupture ➡️ thrombus formation ➡️ MI

@LubbDup & @JonathonLeipsic et al: bit.ly/2WIt5Bj
Read 14 tweets
A 68 y o male with type-2 DM, CAD, CCF (EF~35%), PAD, and history of gouty arthritis presented with dyspnea and LL edema.

Which of the following drugs is appropriate therapy for his edema?

A) Furosemide
B) Indapamide
C) Empagliflozin
D) Bumetanide
E) Metolazone

#cardiotwitter
Correct answer is (C)

Hyperuricemia is a common adverse effect of loop or thiazide diuretics and may precipitate acute gouty arthritis.

Treating type-2 DM with an SGLT2 inhibitor promotes osmotic diuresis, natriuresis, and reduces uric acid by increasing its excretion.
Lowering uric acid by SGLT2 inhibition reduces CV events and slows the progression of CKD in type-2 DM.

SGLT2 inhibition is useful in the treatment of gout and gouty arthritis, especially when co‐existent with diabetes.

onlinelibrary.wiley.com/doi/full/10.11…
Read 5 tweets
CTEPH (a thread)

One of the best learning cases of my residency training at Temple with @PForfiaPHDOC , I recently presented this case at a CTCV conference.

HPI: female pt in her 40s, hx recurrent PE/DVT, IVC filter, on anticoagulation, presents with SOB.
Echo
short axis view with PW of the RVOT shows mid systolic notching
Read 17 tweets
Happy Memorial Day Weekend to all cardiology fellows!

I thank m'learned friend Prof Simon Thom for showing me the funniest paper of the year.

I will discuss it tomorrow.

What approach should I take?

#cardiotwitter
Thank you to everyone for paying attention to the buses I sent round that said there would by £350,000,000 per week for your country's health system, if you voted the way I wanted you to.

Now I can tell @rallamee that I am only listening to the Will of the People.
The problem with starting an article with a clear, true and useful statement, like this...
Read 117 tweets
(1/18) A Brief History of Coronary Angioplasty and the Roots of the Interventional Cardiology Field -- a #Tweetorial

#Cardiotwitter #FOAMed #ACCFIT #histmed @ACCCardioEd

Courtesy of @PopmaJeffrey & @ACCinTouch
(2/18) Dr. Werner Forssman (🇩🇪) performs 1st human #RHC (1929) by inserting a 65cm urologic catheter into his own antecubital vein and walking up to the X-ray department for imaging. Reportedly, he did this repeatedly! He left urology for primary care & shared @NobelPrize (1956).
(3/18) Dr. Fariñas (🇨🇺) performs aortography via femoral🔪 cut down (1941). Dr. Euler (🇩🇪) performs thoracic angiography by direct aorta puncture via esophagus (1949). Drs. Cournand & Dickinson (🇺🇸) open 1st US #cath lab (1945), publish extensively, and shared @NobelPrize (1956).
Read 26 tweets
Here is my attempt at organizing the massive number of replies to my request for physicians on Twitter to follow for my #MPLSVAGrandRounds talk “Social Media in Medicine”
Here is the original thread, which has lists of people in just about every specialty you could think of, and quickly went beyond my ability to organize.
When going through these lists, @Doctor_V reminded me this important point:
Read 27 tweets
Interesting take (both in the article and by @Angiologist about telemed. I have a slightly different view. I work in a system (@MdAtlPermanente @KPMidAtlantic) that uses a lot of virtual care. Not just consults, Also telephone, video, secure messaging, remote monitoring etc. 1/n
In fact more than 50% of our patient interactions are non face to face. And here is what we have learned. All of these technologies are just technologies. It is not what they are but how they are used that matters 2/n
For ex, we use virtual chart reviews for all of our preop CV assessments. We worked with our preop team on questions to ask (functional status, etc) and now, we can review the hx/ekg and give an opinion on the same EHR while saving the patient a trip to see a cardiologist. 3/n
Read 15 tweets
THREAD (1) In preparation for the upcoming @AHAMeetings #QCOR2019 early career programming, @mad_sters, @MikeTPhD, and I, wanted to start a conversation around best-practices for collaboration on manuscripts to maximize success and to avoid common pitfalls and missteps
(2) Although this thread is focused on collaboration on manuscripts, we feel that some of the principles can be extended/adapted to grants and other kinds of collaborations
(3) We'd love input and your stories on best practices and also what are your pet peeves when being engaged as a co-author on a manuscript?
@rwyeh @boback @JeremySussman @hmkyale @MuntnerPaul @DaichiShimbo @berthahidalgo @angiefagerlin @rhessmd @JDodsonMD @jordy_bc @kejoynt
Read 52 tweets
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

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