Discover and read the best of Twitter Threads about #Cardiotwitter

Most recents (24)

**VALVE CASE OF THE WEEK**

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 week...no poll I'm afraid, but as always, comments encouraged! 😁

@BrHeartValveSoc
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
Fantastic talk about Sports Cardiology by @MichaelPapadak2 who was inspired by his mentor @SSharmacardio @CRY_UKwith ECG pearls see below. @s_gati @m_piepoli @Drstevenjcox Should #sportscardiology become a subspecialty of cardiology #cardiotwitter?
Athletic adaptation #ECG #sportscardiology in the context of asymptomatic patient without family history:
🏃‍♂️Sinusbradycardia (⬆️vagal tone)
🏃‍♂️high QRS complexes (↔️LVH criteria)
🏃‍♂️J-point / ST segment ⬆️ in all leads
🏃‍♂️tall/ hyper-acute t-waves
The black athlete's heart
🏃‍♂️anterior t-wave inversion
🏃‍♂️J-point/ convex ST-elevation
Differential diagnosis of STEMI, Myocarditis, Brugada
‼️‼️Lateral t-wave inversion needs to be investigated, 20-60% yield of cardiomyopathy
Read 7 tweets
40 year old male - presented with chest pain and one episode of loss of consciousness at home from which he recovered in few seconds spontaneously. Came to ER with ongoing chest pain and hypotension. ECG - SR, extensive AW STEMI #MedTwitter #cardiotwitter #COVID19 #SCA
Given Heparin, loading doses of DAPT and Tirofiban started. Shifted on nor adrenaline infusion to Cath lab. Angio done from RFA. #femoral pt in pulmonary edema .. angio showed thrombus in distal left main with slow flow in LAD
Stented from LMCA to LAD. Intubated and put on ventilator as pulmonary edema worsened. Stable. Pressure 90-100 systolic on Dopa and noradrenaline. EF 35% AW Akinetic. IABP inserted.
Read 10 tweets
1/Here’s a rant about meta-analyses in the CV space. I don’t mean to be disparaging (especially because the first meta-analysis I published was probably the most labor intensive project I’ve ever done), but I want to speak honestly.
2/Meta-analytic software is SO EASY to use these days. Literally anyone with a computer can generate a summary estimate and confidence intervals by just plugging in a few simple and easily accessible numbers (that are also accessible to everyone else).
3/I KNOW for a fact that there are enterprising fellows, residents, and attendings around the world who often have their software loaded up and ready, introduction/methods/much of discussion written, and when the next big trial gets presented at a major meeting the RACE IS ON.
Read 16 tweets
Oh

My

God

I _had_ given up annoying people, forever.

But this one is such a facepalm. And there is now online evidence of me completely failing to debug a numbers thing.

#MedEd #Foamed #cardiotwitter

All blame goes to @mshunshin for my relapse.
I told Matt I had read this paper and I was gonna get some of this eicosapentanoic acid stuff for my TGs.

Then he said, "don't bother, just look at Table 2"
So I looked up the EVAPORATE paper again, and thought the master was merely swatting the grasshopper aside.

"Good try, Matt, but it will be OK - they have an 'out'"
Read 63 tweets
A good review of resistance hypertension. (1 of 3)
✔️ Definition
✔️ How to tackle
✔️ Causes of Pseudo-resistance
✔️ Medications that can ⬆️ BP

#ESCCongress 2020 #cardiotwitter #ACNAP @escardio @ACNAPPresident
(2 of 3) resistant hypertension

✔️ Secondary forms of HTN
✔️ Diuretic therapy
✔️ Spironolactone

#ESCCongress #cardiotwitter #ACNAP
(3 of 3) resistant hypertension
✔️ Amiloride
✔️ Clonidine
✔️ Adherence!

#ESCCongress 2020 #cardiotwitter #ACNAP
Read 3 tweets
When was the last time you were paged about a serum Cl- level? Probably never.

Despite being the most abundant anion in the body, Cl- is under appreciated

🔥Here’s why it matters (esp in heart failure!)

#tweetorial #medtwitter #nephtwitter #cardiotwitter #NSMC
There is evidence supporting the use of hypertonic saline in patients with decompensated heart failure

See excellent blog post by @aldorodrig
👉 renalfellow.org/2019/04/03/the…

Mechanistically it never made sense to me, until I realized I may be focusing on the wrong ion 🤷🏾‍♂️
Chloride MAY be the 🔑 here. Something that will hopefully be more clear after the completion of ongoing trials

👉🏾 clinicaltrials.gov/ct2/show/NCT03…

In heart failure patients ⬇️ Cl- is associated with

1. Poor Prognosis
2. Neurohumoral activation
3. Diuretic Resistance
Read 10 tweets
Hrithik Roshan explains cardiac arrythmias! (😅i wish i had medical students to bug with this!) @iHrithik @JubbinJacob @DrDeepakKrishn1 #medtwitter #cardiotwitter
1. Sinus Rhythm
2. 2:1 AV Block
3. Pacemaker rhythm
Read 7 tweets
Today I gave a talk to our @hopkinsheart cardiology fellows about #SoMe for dissemination of academic research. Here are a few take-away points from the talk and a couple figures from a summary paper on this topic that I wrote with @AChoiHeart
#SoMe in academic research. We have actual RCT data that show that Twitter promotion can increase rates of downloads and traditional citation counts. Also having a graphical abstract increases citations and downloads compared to tweets with no graphic. .
#SoMe in academic medicine - Dr. @purviparwani has been a leader in advocating its use, along with sharing pearls & pitfalls. Here are some slides from some of her papers. Thanks to all your #cardiotwitter collaborators!
Read 3 tweets
**VALVE CASE OF THE WEEK**

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
A valvular lesion can be diagnosed right here at the bedside. Based on the nature of the pulse, is it tricuspid regurgitation or aortic regurgitation? And why?

#PhysicalExam #MedEd #MedTwitter #cardiotwitter
This is a case of aortic regurgitation with Corrigan's pulse. The most striking feature of this pulse is outward. Quick and sharp. Relatively small breadth. There is only passive retraction back to baseline - no active inward movement. These are the features of an arterial pulse. Image
Compare the arterial pulse in the video above with the venous pulse in the following video of Lancisi's sign (CV fusion). Here the movement is undulating, large breadth, and there is an active inward component. You can and will distinguish venous from arterial at the bedside.
Read 3 tweets
(1/22) Acute PE treatment. An ever evolving landscape.

How about a #tweetorial on acute pulmonary embolism (#PE) and how to use mechanical #thombectomy with @InariMedical #FlowTriever?? Lets goooooo!

#InariFellowsEdition #IRad #IC #cardiotwitter
Pic credit @Jonathan_PaulMD Image
2/ From @CDCgov data one American dies of a blood clot every....? #VTE #PE @PERTConsortium #InariFellowsForum
3/ Acute #PE stats

📊100,000–180,000 PE-related deaths annually in US

📊PE is the most preventable cause of death among hospitalized patients

📊3rd leading cardiovascular cause of death after coronary disease and stroke

⏱ 1 American dies of a blood clot every 6 seconds Image
Read 25 tweets
'Shark fin' if no clinical history provided what is your diagnosis based on ECG only and why??#cardiotwitter #EPeeps @smithECGBlog @amalmattu @EM_RESUS @ecgrhythms
Little surprised for every one ( Yes this is not a case of STEMI)
24y/female , 2nd post op day for pyloric stenosis , referred from outside hospital to our institute considering AWMI with shock
Read 8 tweets
**VALVE CASE OF THE WEEK**

@BrHeartValveSoc

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
**VALVE CASE OF THE WEEK**
@BrHeartValveSoc

32yr old lady with moderate mitral stenosis tells you in clinic she is planning on trying for a baby...is that ok? Denies any symptoms, feels well. Echo - mean MVG 6mmHg. RVSP ~ 20mmHg. What would you say / do / advise?
Parasternal X-plane...
Ap 4Ch zoom of MV
Read 14 tweets
The #ISCHEMIA trial has been popular again in recent days on Twitter, but amongst all the controversies & criticisms, it got me thinking about the #STICH trial.

These two trials actually have quite a lot in common and it's worth exploring that in a little detail

A thread...1/
STICH was a government funded trial designed to answer definitively - for once and for all - the role of revascularization in ischaemic cardiomyopathy. Numerous observational and/or retrospective studies suggested benefit on 'hibernating myocardium' but the jury was still out 2/
It was a well-intentioned study with enormous amount of thought put into planning methodology, ensuring only experienced surgeons with proven good outcomes took part, OMT had to be maximized etc etc

Tragically, like other RCTs, STICH suffered from enormous enrollment bias...3/
Read 16 tweets
Understanding Invasive Coronary Angiography:

What it is? Where it is? Where it goes?

🧵 w/ several (usual) projections (full video link at the end).

#CardioEd #CardioTwitter #RadialFirst @PCRonline
@INC_CathLab @EduardoAArias1 @moisesjimenezs @sergiopatronMD
The 3D model:
Coronary arteries segmentation and reconstruction of a patient with left dominance and their relationship with both ventricles (different patients in the CT and the invasive angiography but both with left dominance for an illustrative correlation).
Left coronary: LAO + Cranial.
Good exposure of the LAD and diagonal branches/bifurcations. This case also good for the PD (plus: there is a severe stenosis after the 1st Diag branch).
Read 12 tweets
Cool trick to easily direct a catheter into the left pulmonary artery -- learned from @MarcSintek while I was at @WashU_cards @WUSTLmed

#tweetorial #cardiotwitter #CardioMEMS @AbbottNews @abbottvascular @BonSecours
#1 Pull PA catheter back into proximal right pulmonary artery
#2 Take the (stiff) back end of a standard J-wire and wrap it around a pen/syringe a few times
#3 Insert the (stiff) back end of the wire into the PA catheter and advance carefully to within a few centimeters of the end of the catheter (don't exit the catheter!)
Read 7 tweets
Endothelial-derived microvesicles play a pathogenic role in vascular #inflammation, causing #endothelial barrier dysfunction by impairing adherens junctions and activating #neutrophils

More here: bit.ly/3g1FpH7
#Cardiotwitter #CardiovascularResearch

#Tweetorial below! Image
#Microvesicles (MV) are formed from the outward blebbing of the plasma membrane and carry a diverse cargo that regulate multiple processes.

During #inflammation these are produced by activated endothelial cells and released into the #circulation. TEM image of plasma MVs: (2/8) Image
In this study the authors investigated whether endothelial-derived MVs (EC-MVs) contribute to #vascular dysfunction during inflammation.

The authors used an animal model of #sepsis (CLP) and found that this increased EC-MV production (3/8) Image
Read 8 tweets
Time for my first Twitter Poll!

I believe we should abandon the terms 'sensitivity' and 'specificity' of non-invasive imaging tests. 20th century language, no longer fit for purpose! I'll explain why after poll closes.

Do you agree?

@BSEcho @ASE360 @BritishCardioSo @escardio
Read 11 tweets
🧵#InsuficienciaCardiaca RESISTENCIA A LOS DIURÉTICOS (RD)

Recordatorios pertinentes:

Punto de partida: LA CONGESTIÓN (próximo editorial para SIAC)

Prevalencia de la congestión en #IC aguda 80-90% (Guias ESC)

#CardioEd #cardiotwitter
Los más usados: Diuréticos de asa. Inhiben el NKCC2 generan natriuresis, cloruresis y kaliuresis. Diuresis hipo o isotónica.

La expansión del volumen extracelular tiene una relación linear con la excreción de Na (Walser M Kidney Int. 1985).

#HeartFailure #Cardioed
Caso:
🧔🏻+ disfunción severa del VI💔 + francos signos de congestión
TA 140/80

Furo: 40 mg VO – 🏥 📈40 mg BID primer día y 120 mg BID al 3er día

Diuresis: 1900 y al 2do día 900
Cr basal: 1.3 a las 48 hs 1.6
Persistentes signos de sobrecarga
📉1 1kg de peso ⚖️
Read 25 tweets
#cardiotwitter -need help how would you manage this case. Attempting in 2 hours. EF normal and advanced Parkinson’s 68 yr old male @rwyeh @DKarmpaliotis @ajaykirtane @JAG24851 @mmamas1973
1- support no support 2-bifurcation strategy
Read 8 tweets
#Cardiotwitter @fpmorcerf Thread. The end ejection is also a complex series of events, with interaction between the aortic and mitral valves that is reflected in the septal and ring motions.
1/ The determining AVC by Tissue Doppler has been subject to confusion. In the septum, just after the ejection, there is a short negative spike. This was assumed to be IVR, among other things based on the proximity to peak negative dP/dt, which, however only is a proxy for AVC. Image
2/ This negative velocity is seen in both septal M-mode, spectral Tissue Doppler, colour TDI, and even as a septal elongation in strain rate. It was visual even in colour TDI of the mitral valve. Thus, AVC was assumed to be at the start of this event. Image
Read 12 tweets
18 y old male repaired CHD as a child
Dyspnea class III stable BP and O2 sat 95% LBBB
Echo No Shunt
What is the next step?
@AlkashkariWail @MasriAhmadMD @CincyACHD @purviparwani @cardiopedhnn
#cardiotwitter #whyCMR #echofirst
@iamritu @MayoClinic @ACHDatStanford
This is r-TOF in HF with severe biventricular dysfunction absence of residual valvular stenosis or regruge and no shunt or COA
Provided approach to ACHD patient with HF
sciencedirect.com/science/articl…
#cardiotwitter #whyCMR #echofirst @AHAMeetings
Read 5 tweets

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