Discover and read the best of Twitter Threads about #ECHOfirst
Most recents (24)
🧵 1/17 - Thread: Echo for Diagnosis and Management of obstructive HCM
Mechanisms of MR in these patients
Please, share your comments and experience
#echofirst #cardiotwitter #echothread
@NMerke @echo_stepbystep @iamritu @JaeKOh2 @dr_benoy_n_shah @EACVIPresident @StellEkaterina… twitter.com/i/web/status/1…
Mechanisms of MR in these patients
Please, share your comments and experience
#echofirst #cardiotwitter #echothread
@NMerke @echo_stepbystep @iamritu @JaeKOh2 @dr_benoy_n_shah @EACVIPresident @StellEkaterina… twitter.com/i/web/status/1…
🧵 2/17 - Echo in obstructive HCM - Diagnosis / Management
✨Maneuvers (Valsalva, standing from Squatting) + Exercise Echo may unveil 33% latent obstructive HCM (37% rest -> 70% provocable)
@nat_echo @OAB1967 @echo_batman @papadocardio @robertomlang @fpmorcerf @mariovar55… twitter.com/i/web/status/1…
✨Maneuvers (Valsalva, standing from Squatting) + Exercise Echo may unveil 33% latent obstructive HCM (37% rest -> 70% provocable)
@nat_echo @OAB1967 @echo_batman @papadocardio @robertomlang @fpmorcerf @mariovar55… twitter.com/i/web/status/1…
🧵 3/17 - In a study of Maron BJ et al - JACC 2016 with 573 HCM patients, patients with rest obstruction had more progressive HF (7,4%/year), followed by patients with provocable obstruction (3,2%/year) and less in nonobstructive HCM (1,6%/year)
sciencedirect.com/science/articl…… twitter.com/i/web/status/1…
sciencedirect.com/science/articl…… twitter.com/i/web/status/1…
ICU pictorials: A patient was admitted for "weakness". Unimpressive vitals / phys exam / labs. A few days later because of temp 101 F, a fever w/u was initiated. Due to "SOB", a CT chest angio was done:
👆Massive saddle PE extending in both sides w evidence of R heart strain
Echo findings:
T1/11
#Cardiotwitter #MedEd @MedTweetorials #EchoFirst
Multi-fenestrated ASD- mfASD
The prevalence of ASD is 0.88 per 1000 adults. The most common type of ASD is a secundum - a true deficiency in the region of the fossa ovalis. @iamritu @echo_stepbystep @alexsfelixecho @NMerke
#Cardiotwitter #MedEd @MedTweetorials #EchoFirst
Multi-fenestrated ASD- mfASD
The prevalence of ASD is 0.88 per 1000 adults. The most common type of ASD is a secundum - a true deficiency in the region of the fossa ovalis. @iamritu @echo_stepbystep @alexsfelixecho @NMerke
T2/11 mfASD
Standardized #EchoFirst evaluation includes TTE, TEE, Doppler & 3DEcho for assessment of rims for suitability for device closure, drainage of pulmonary veins, exclusion of sinus venosus-type ASDs, etc.
pubmed.ncbi.nlm.nih.gov/26239900/
Standardized #EchoFirst evaluation includes TTE, TEE, Doppler & 3DEcho for assessment of rims for suitability for device closure, drainage of pulmonary veins, exclusion of sinus venosus-type ASDs, etc.
pubmed.ncbi.nlm.nih.gov/26239900/
T3/11 mfASD
Clinical case: 65yo, female, referring shortness of breath.
TT #EchoFirst findings: right chambers enlargement, preserved sistolic function, QP:QS: 2,5; deficiency in the region of the fossa ovalis sugestive of complex ASD
@VLSorrellImages @GARCIAEDINSON95 @almasthela
Clinical case: 65yo, female, referring shortness of breath.
TT #EchoFirst findings: right chambers enlargement, preserved sistolic function, QP:QS: 2,5; deficiency in the region of the fossa ovalis sugestive of complex ASD
@VLSorrellImages @GARCIAEDINSON95 @almasthela
On the left is a conventional adult transoesophageal echo probe
On the right is a neonatal TOE (TEE) probe
Occasionally, just occasionally, the latter is your friend (for an adult cardiologist/physiologist)...
A brief 🧵 on safe performance of TOE
#ECHOFIRST #cardiotwitter
On the right is a neonatal TOE (TEE) probe
Occasionally, just occasionally, the latter is your friend (for an adult cardiologist/physiologist)...
A brief 🧵 on safe performance of TOE
#ECHOFIRST #cardiotwitter
TOE/TEE is actually one of the safer procedures we do, complications are less likely than with:
- Coronary angiography
- Pacemaker insertion
- Ablations
- PCI
- Valve interventions
And that's natural as it's an investigation, not a treatment/therapeutic procedure
- Coronary angiography
- Pacemaker insertion
- Ablations
- PCI
- Valve interventions
And that's natural as it's an investigation, not a treatment/therapeutic procedure
Pharyngeal or oesophageal perforation/rupture is the most feared complication of TOE/TEE
It's incredibly rare - but does happen
TOE technique varies & how it is performed is crucial to minimizing the risk of major complication
It's incredibly rare - but does happen
TOE technique varies & how it is performed is crucial to minimizing the risk of major complication
Otro casito bueno pa la colección, abro 🧵 Mujer 37 años PO miomectomía laparoscópica, sin APP. Refiere anestesio que se le dió AGB, se resecaron los miomas pero aparentemente quedaban restos, se volvió a irrigar con glicina en cavidad uterina para distenderla y posterior a esto
…inicia con bradicardia de 30 lpm, SAT 60% y poliuria, sangró 700, se le transfunde 1 PG, 1 L Hartmann e inicia vasopresor, la hiperventila tratando de mejorar SAT y posterior pasa a UCI. Donde la recibimos con efecto residual de sedación, RASS -4 pupilas isocóricas de 6 mm…
… con PAM 69, FC 40, FR 16 SAT 60%, con nore a 0.2 mcg/k/min, ritmo sinusal por telemetría pero con extrasístoles ventriculares aisladas, llc de 5 segs, VMI, Fio2 al 60%, csps crepitantes, abdomen con hx qx sin datos de dehiscencia o sangrado. Solo con GV en ese momento…
M mode in echo is a bliss
Gives a grt temporal resolution
ie.,Relation of structures with respect to time.
At times it's difficult to follow motion of valves in 2D
In this thread let's see about Mitral valve M MODE
A normal mitral valve M mode
#echofirst #pocus @pocus_today
Gives a grt temporal resolution
ie.,Relation of structures with respect to time.
At times it's difficult to follow motion of valves in 2D
In this thread let's see about Mitral valve M MODE
A normal mitral valve M mode
#echofirst #pocus @pocus_today
E &A are two positive waves due to opening of mitral leaflet
E - Early diastole due to LA LV gradient
A - Late diastole due to atrial contraction
C- closure of Mitral valve
D-End systole / Begining of diastole
F-Diastasis
B-Due to Elevated LVEDP in late diastole
E - Early diastole due to LA LV gradient
A - Late diastole due to atrial contraction
C- closure of Mitral valve
D-End systole / Begining of diastole
F-Diastasis
B-Due to Elevated LVEDP in late diastole
Mitral stenosis:
The EF slope is reduced
In earlier times Mitral stenosis severity was assessed with shallowness of the slope. More flatter the slope is , more severe the MS
This semiquantitative method of assessing severity is not used nowadays
A wave is lost in MS with AF
The EF slope is reduced
In earlier times Mitral stenosis severity was assessed with shallowness of the slope. More flatter the slope is , more severe the MS
This semiquantitative method of assessing severity is not used nowadays
A wave is lost in MS with AF
📌#HFpEF. 2023 Consenso de Expertos en toma de decisión.
💡 Definición FEVI ≥50%
⚠️Disfunción diastólica x #echofirst no es suficiente.
🩺No hay un único test para establecer el dx.
🔸#HFpEF 50% de los casos de HF.
🔹Outcomes comparables con #HFrEF
💡 Definición FEVI ≥50%
⚠️Disfunción diastólica x #echofirst no es suficiente.
🩺No hay un único test para establecer el dx.
🔸#HFpEF 50% de los casos de HF.
🔹Outcomes comparables con #HFrEF
📌Definiciones:
🔸HFpEF: Diagnóstico clínico de IC🩺 con FEVI ≥ 50% en ausencia d otras causas como MCH, miocardiopatías infiltrativas, valvulopatías,
e. pericárdicas o IC con alto gasto.
🩺El rol del cardiólogo es excluir los dx alternativos en caso de disnea, edema y BFSVI
🔸HFpEF: Diagnóstico clínico de IC🩺 con FEVI ≥ 50% en ausencia d otras causas como MCH, miocardiopatías infiltrativas, valvulopatías,
e. pericárdicas o IC con alto gasto.
🩺El rol del cardiólogo es excluir los dx alternativos en caso de disnea, edema y BFSVI
1/5
#ESCardioEd challenge correct answer is D: Arrhythmogenic Cardiomyopathy: #echofirst shows right ventricle dilatation & dysfunction.
#whyCMR confirmed #RV dilatation & dysfunction. Also shows #RV fibrofatty infiltration & #LV late gadolinium enhancement. 👇
#ESCardioEd challenge correct answer is D: Arrhythmogenic Cardiomyopathy: #echofirst shows right ventricle dilatation & dysfunction.
#whyCMR confirmed #RV dilatation & dysfunction. Also shows #RV fibrofatty infiltration & #LV late gadolinium enhancement. 👇
2/5
As such, can he participate in competitive sports? Follow #ESCPREV2023 to discover more in #SportsCardiology 😊
As such, can he participate in competitive sports? Follow #ESCPREV2023 to discover more in #SportsCardiology 😊
3/5
Why correct answer is not A: CPVT is an inherited ion channel disorder characterised by polymorphic ventricular #arrhythmias & normal structural heart. The patient has structural abnormalities.
Why correct answer is not A: CPVT is an inherited ion channel disorder characterised by polymorphic ventricular #arrhythmias & normal structural heart. The patient has structural abnormalities.
1/
#echofirst #CardioTwitter
What's your take on AF/AFL cardioversion in HFrEF?
71 yo ♂️
DCM. Recent AF with worsening of HF.
On DOAC >3 weeks. 👌
Would surely benefit from cardioversion, right? 👍
But where there's smoke...
#echofirst #CardioTwitter
What's your take on AF/AFL cardioversion in HFrEF?
71 yo ♂️
DCM. Recent AF with worsening of HF.
On DOAC >3 weeks. 👌
Would surely benefit from cardioversion, right? 👍
But where there's smoke...
3/
ESC AF Guidelines 2020: If already on therapeutic OAC (minimum 3 weeks) - proceed with cardioversion (I-B).
But AF/AFL cardioversion in HFrEF doesn't feel that straightforward.
ESC AF Guidelines 2020: If already on therapeutic OAC (minimum 3 weeks) - proceed with cardioversion (I-B).
But AF/AFL cardioversion in HFrEF doesn't feel that straightforward.
Elderly ♀️.
Syncope at home.
🚫No significant head trauma.
🚫No chest pain.
🏥Admitted on a Friday night.
🧪hsTnI on Saturday >12.000 ng/L. Other labs (including K+) within normal range.
What's happening over the weekend?
⬇️poll below
Syncope at home.
🚫No significant head trauma.
🚫No chest pain.
🏥Admitted on a Friday night.
🧪hsTnI on Saturday >12.000 ng/L. Other labs (including K+) within normal range.
What's happening over the weekend?
⬇️poll below
Sure, complete AV block. But what else?
@juliogilpereira @AslangerE @smithECGBlog @EM_RESUS @RobertHermanMD @The_Nanashi_O @ecgrhythms @EcgOxford
#ECGeducation
@juliogilpereira @AslangerE @smithECGBlog @EM_RESUS @RobertHermanMD @The_Nanashi_O @ecgrhythms @EcgOxford
#ECGeducation
Oh, here's the #echofirst, not the best acoustic window, but enough for some clues.
@NMerke @alexsfelixecho @VerwerftJan @echotalk @echo_stepbystep @EchoSoliman @Ivan_Echocardio @RodrigogpLima @DrRajeshG1 @dr_benoy_n_shah @StellEkaterina @ecocardio_cl
@NMerke @alexsfelixecho @VerwerftJan @echotalk @echo_stepbystep @EchoSoliman @Ivan_Echocardio @RodrigogpLima @DrRajeshG1 @dr_benoy_n_shah @StellEkaterina @ecocardio_cl
1/ Had a great time writing this @EPLabDigest article with @DrCJBradley
tinyurl.com/mryk3cwe
2️⃣ different perspectives (IC And EP) using different devices (watchman/ amulet) for LAAC in the community center.
Let’s take a dive into two different LAAC programs #Tweetorial
tinyurl.com/mryk3cwe
2️⃣ different perspectives (IC And EP) using different devices (watchman/ amulet) for LAAC in the community center.
Let’s take a dive into two different LAAC programs #Tweetorial
2/ #LAAC has come a long way over the past few years and now we have two main players in the space
🔸 @bostonsci #watchman
🔸 @AbbottNews #Amulet
Both are very effective and each has pros/cons
My center focuses on Watchman FLX while @DrCJBradley center focuses on Amulet… twitter.com/i/web/status/1…
🔸 @bostonsci #watchman
🔸 @AbbottNews #Amulet
Both are very effective and each has pros/cons
My center focuses on Watchman FLX while @DrCJBradley center focuses on Amulet… twitter.com/i/web/status/1…
3/ Historically #EPeeps has taken the driver seat in this space (rightfully so) due to experience with the LA/transeptal. HOWEVER the new gen #IC/structuralist have become a vital part of the team.
#LAAC programs require:
📌Implanter
🔎Imager
🧑🏼⚕️Anesthesiologist/Cath lab team… twitter.com/i/web/status/1…
#LAAC programs require:
📌Implanter
🔎Imager
🧑🏼⚕️Anesthesiologist/Cath lab team… twitter.com/i/web/status/1…
ICU stories (a brief one): 60 yo male w lung cancer / CAD / HTN / HLD / status post chemotherapy a month ago presented to the ED w SOB/cough/weakness after failing outpatient tx w azithromycin. CT chest: no PE but positive for bilateral consolidations:
Patient came to the ICU intubated, sedated, on pressors & antibiotics for PNA. Next step: POCUS. PLAX looked "weird", so Doppler and "zoomed" views were recorded:
PSAX & subcostal views:
#Imaging In #Athletes from @mmartinezheart’s phenomenal talk at @LLUHealth
➡️ physiological adaption in athletes common
➡️ not every “abnormal” finding is a pathology #Echofirst #whyCMR must to evaluate
➡️ ekg interpretation jacc.org/doi/abs/10.101…
➡️ physiological adaption in athletes common
➡️ not every “abnormal” finding is a pathology #Echofirst #whyCMR must to evaluate
➡️ ekg interpretation jacc.org/doi/abs/10.101…
➡️ type of cardiac remodeling depend on the sports and activity
Eccentric
Nondilated concentric
LV concentric
➡️ increased LV size and lower EF not uncommon- Stroke volume
Eccentric
Nondilated concentric
LV concentric
➡️ increased LV size and lower EF not uncommon- Stroke volume
ICU stories (from the trenches): 70 yo pt w hx of A-fib/CAD/ICM w EF 25%/VT ablation s/p BiV ICD/CKD/HTN/HLD/peripheral vasc dz/COPD etc presented to outside 🏥 w SOB/weakness/falls. Labs: wbc 15k/creat 3.5 (baseline 2.0)/INR: 8.5/AST/ALT/Tbil: 180/250/3.0, lactate 3.5
RUQ US was obtained to work-up elevated LFTs:
Diagnosed w bilateral PNA/AKI/liver dysfunction. Treated for sepsis w ivf boluses, broad-spectrum antibiotics, steroids, bicarb. Continue to get worse; due to ⬆️O2 needs, transferred to our 🏥. I saw her the next am: in resp distress while on BiPAP 15/10-100%, abg 7.26/50/70/19.
A straightforward, hands-on approach to Portal Vein Pulsed Wave Doppler.
Physiologic and pathologic waveforms
🧵0/7
#doppler #PWD #echofirst #POCUS #VexUs @ButterflyNetInc
Physiologic and pathologic waveforms
🧵0/7
#doppler #PWD #echofirst #POCUS #VexUs @ButterflyNetInc
1/ 7 PHYSIOLOGIC
Physiologic flow should be always antegrade and hepatopetal ( towards trasducer). Could be monophasic or gently ondulating,
In doppler it should be red (get the smallest angle posible).
Physiologic flow should be always antegrade and hepatopetal ( towards trasducer). Could be monophasic or gently ondulating,
In doppler it should be red (get the smallest angle posible).
To Remember:
Fugal: Away
Petal: Toward
Normal velocity: 16-40 cms
Fugal: Away
Petal: Toward
Normal velocity: 16-40 cms
After yesterday's #POCUS quiz, it's time to reshare these cardiac tamponade infographics.
Courtesy of @ACEP_EUS
🔗acep.org/emultrasound/s…
Set of 3
See 🧵for the rest
#Nephpearls #MedEd #FOAMcc
Courtesy of @ACEP_EUS
🔗acep.org/emultrasound/s…
Set of 3
See 🧵for the rest
#Nephpearls #MedEd #FOAMcc
Pulsus paradoxus #echofirst
A 58-year-old woman with no known comorbidities presents with progressive fatigue and shortness of breath x several months. Noted to have bilateral pedal edema; BNP 2,473 pg/mL.
#echofirst 👇❓
Answer and 🔗 to source in thread.
#POCUS #MedEd #FOAMcc
#echofirst 👇❓
Answer and 🔗 to source in thread.
#POCUS #MedEd #FOAMcc
Left atrial myxoma -> pulmonary hypertension (RVSP 93 mmHg) -> RV dysfunction (Note obvious RV enlargement ☝️
cvcasejournal.com/article/S2468-…
cvcasejournal.com/article/S2468-…
PLAX (same case)
Another set of cardiac #POCUS #anatomy illustrations. 🧵
#Nephpearls #FOAMed
Source: sciencedirect.com/science/articl…
1⃣ Parasternal long axis
#Nephpearls #FOAMed
Source: sciencedirect.com/science/articl…
1⃣ Parasternal long axis
3⃣ Apical 4-chamber view #POCUS
ICU stories (a brief one): One hour before the end of the am shift, u walk around in the ICU to make sure thinks look OK before u type your sign-out note. You spot the resp therapist & the nurse bagging the pt in Rm 306. From the hallway, u see the monitor: HR 160, RR/45, Sat 70%
This is a 30 yo pt w hx of a catastrophic brain bleed, s/p trach & PEG, admitted 2 wks ago w MDR Klebsiella UTI. Doing well, on trach mask 28%, until the episode of acute/unexpected desaturation
When u examine the pt, s/he is in extremis (accessory muscle use-tachycardic-tachypneic-diaphoretic). BP: 105/55. You grab the stethoscope that the resp therapist wears around his neck & you hear breath sounds in both sides (pt is skinny...)
#MedEd image of the day. What's wrong with the 🫀?
Clinical: A woman in 40s with h/o severe mitral stenosis secondary to rheumatic heart disease & Afib presented with worsening dyspnea, orthopnea, & chest pain x 7 months
See thread for #echofirst images and source/answer.
#POCUS
Clinical: A woman in 40s with h/o severe mitral stenosis secondary to rheumatic heart disease & Afib presented with worsening dyspnea, orthopnea, & chest pain x 7 months
See thread for #echofirst images and source/answer.
#POCUS
Apical 4-chamber view showing severe right atrial enlargement and annular dilatation of the tricuspid valve during systole.
Severe TR as expected.
Afectación cardiaca en enfermedad de Fabry en 🧔🏻♂️de 52 años. EKG con PR corto + HVI. @VazyurVasquez @MDBeni @CuitlhuacArroy1 @ImagenCardiaca @LiliPosadaM @ASE360 @smexcardiologia @Cardiotweets83 @SISIACOficial @Enrique_Berrios #echofirst #Cardiology #Cardiotwitter
La enfermedad de Fabry es un desorden lisosomal de transmisión ligada al cromosoma X debido al déficit de la enzima alfa galactosidasa A, con acumulación multisistémica de globotriaosilceramida (GB3).
La afectación cardiovascular suele manifestarse en forma de HVI, fibrosis miocárdica, ICC y arritmias, que limitan la calidad de vida y constituyen las causas más frecuentes de muerte. En la imagen se observa los estadios de la afección cardiaca
ICU stories: 70 yo pt without medical hx but tobacco use (2 ppd x 40 y) was admitted w shortness of breath a wk ago. CXR/chest CT without PE/infiltrate. Was in afib/RVR on admission; placed on heparin & dilt/b-blocker (w some hypotension). Remained dyspneic, at times restless,
“requiring” multiple sedatives, & eventually was brought to the ICU. Intubated for "resp distress" & mental status changes. "Formal" echo, the day of ICU transfer, showed “LVEF 20% w global LV dysfunction”. On the vent 50% - peep 10. BP 110-130/60-70. Lactate < 2.0
Cards follow for "well compensated heart failure". A look w POCUS upon ICU admission:
💥Question 10 #ASEchoJC❓
What are the #EchoFirst criteria to determine suitability for PBMV (aka PMBV or PMBC)? After PBMV, how do we define success, and do we identify severe MR?
@SLittleMD @senguptasp @pattypellikka @iamritu @ash71us @JournalASEcho @ASE360
What are the #EchoFirst criteria to determine suitability for PBMV (aka PMBV or PMBC)? After PBMV, how do we define success, and do we identify severe MR?
@SLittleMD @senguptasp @pattypellikka @iamritu @ash71us @JournalASEcho @ASE360
#ASEchoJC
🔺PBMV if symptomatic severe MS, pliable valve, <2+ MR & no LAA thrombus
🔺Consider in asymptomatic severe MS & PASP>50 mmHg
🔺Wilkins score <=8
🔺Importance of careful #iEcho guidance, watch for severe acute MR
🔺PBMV if symptomatic severe MS, pliable valve, <2+ MR & no LAA thrombus
🔺Consider in asymptomatic severe MS & PASP>50 mmHg
🔺Wilkins score <=8
🔺Importance of careful #iEcho guidance, watch for severe acute MR
#ASEchoJC Wilkins score for assessing suitability for PBMV. Can consider >8 in very selected cases based on specific morphologic features.
💥Question 3 #ASEchoJC❓
What are the pitfalls and potential sources of error in assessing rheumatic MS severity by direct planimetry or CWD spectral display of mitral inflow (mean gradient, VTI, PHT)?
@SLittleMD @senguptasp @pattypellikka @iamritu @ash71us @JournalASEcho
What are the pitfalls and potential sources of error in assessing rheumatic MS severity by direct planimetry or CWD spectral display of mitral inflow (mean gradient, VTI, PHT)?
@SLittleMD @senguptasp @pattypellikka @iamritu @ash71us @JournalASEcho
#ASEchoJC
🔺MG influenced by HR (ok only between 60-80 bpm), cardiac output, mixed valve disease
🔺Always report rhythm and heart rate
🔺PHT >150 ~ MVA <1.5 cm2 in RHD, assuming normal LV & LA compliance (unreliable in calcific MS)
🔺Trace mid-diastolic slope
🔺Avoid after PMBV
🔺MG influenced by HR (ok only between 60-80 bpm), cardiac output, mixed valve disease
🔺Always report rhythm and heart rate
🔺PHT >150 ~ MVA <1.5 cm2 in RHD, assuming normal LV & LA compliance (unreliable in calcific MS)
🔺Trace mid-diastolic slope
🔺Avoid after PMBV
#ASEchoJC
🔺2D planimetry should transect leaflet tips perpendicular to LV axis
🔺Overestimation is common; look at the shape of LV in SAX (⭕️vs🥚)
🔺Caution with gain settings
🔺Consider biplane imaging & 3D #EchoFirst
🔺2D planimetry should transect leaflet tips perpendicular to LV axis
🔺Overestimation is common; look at the shape of LV in SAX (⭕️vs🥚)
🔺Caution with gain settings
🔺Consider biplane imaging & 3D #EchoFirst
