Discover and read the best of Twitter Threads about #EchoFirst

Most recents (24)

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

Correspondingly #cardiacimaging with #cardiacMRI in T1 mapping shows ⬆️ extracellular volume in myocardium, suggestive of global myocardial fibrosis, as shown by… 10.1016/j.jccase.2018.06.001
Read 9 tweets
📕Month Review on Fabry Disease (FD) via @RCMjournal

🟡Mechanisms Beyond Storage & Forthcoming Therapies
🟡Cardiac Imaging
🟡Echocardiography #echofirst
🟡Cardiac Magnetic Resonance #WhyCMR

📂OPEN LINKS⬇️ & Thread🧵(1/13)
@mauripieroni72 @torresviera @SVCardio @DeBakeyCVedu
✅FD X-Linked inherited Lysosomal Storage disorder
✅Mutations (>900) alfa-GAL gene (GLA)
✅🚫or⬇️ alfa-GAL A enzyme activity
✅Incidence 1/40,000-1/117,000
✅Newborn Screening 🇮🇹🇹🇼 1/8,800
✅FD storage GB3
✅Intracellular glycosphingolipids organize➡️concentric lamellar bodies (🦓bodies)
✅lysoGB3➡️Pathogenic factor
✅Ion Channel Dysfunction
✅⬆️conduction velocity (atrial 🫀ventricular🫀)➡️short PR in absence of an accessory pathway
Read 17 tweets
Take a look this thread about MR assessment in a young patient referred for systolic murmur 🧵
A single #3Decho clip can explain your brainstorming in few minutes.
🔜 Never without 3D #echofirst
2D-TTE shows an important prolapse of PML, likely P2 according to PLAX.
Leaflets are thickned, LA dilatated and everything seems easy.
Let's push the color, but any huge jet can be detected despite a clear systolic murmur.
Read 11 tweets
#POCUS #echofirst quiz:
In this PLAX view, what structure does the arrow indicate? + what's abnormal about it (if any)?
Clinical: 71y pt with fever/cough, initially thought to be pneumonia, later developed chest pain. BP 134/83 Pulse 106
Will post the answer/source tonight
Tweet 1/3
Dilated coronary sinus with a mobile echogenicity (vegetation/infective endocarditis in this case)
Full case: 🔗…
From #POCUS standpoint, 2 main causes: persistent left superior vena cava & pulmonary HTN. This pt had the former.
Normally on PLAX view, coronary sinus is barely visible. But when dilated, it can be confused with descending aorta (esp. by users who never encountered this scenario)
Read 4 tweets
1/⚡️How to assess tricuspid valve by TOE #echofirst?

➡️What's the role of X-plane?
➡️How to get the best 3D image?
➡️Tips and tricks about transgastric view
➡️What we need to know about pacemaker lead

Take a look this thread 🧵
@NMerke @iamritu @hahn_rt @denisamuraru @lpbadano
Usually 3 leaflets, but is not rare to find different morphologies (2 or 4 leafleats)
ANTERIOR➡️largest and longest in radial direction, most mobile
SEPTAL➡️shortest in radial directios and less mobile
POSTERIOR➡️often many scallops, shortest circumferentially
Start with ME TOE 4Ch view
Attached to IVS ➡️ SEPTAL
The other one near free wall ➡️ ANTERIOR
⚠️(Sometimes with probe in retroflextion position we can see the posterior one)
Read 10 tweets
Tuesdays Tweetorial:
You are in cardiothoracic theatre doing a mitral valve replacement for severe MR

The anaesthetic consultant is doing a TOE and keeps saying 'PISA'

U know its in Italy but have no idea why he keeps saying it

What is PISA and why is it used?
PISA = Proximal Isovelocity Surface Area

Blood is ejected -> LA

It converges at the mitral regurgitant orifice it forming hemispheres -> different blood velocity in each hemisphere

RCCs that are equidistant from the orifice(in each hemisphere) travel at similar speed
Each hemisphere has a radius

The radius that matters for calculations is the one where aliasing occurs (where color changes from blue to red or red to blue)
Blue: RCCs moving Away from probe
Red: Towards the probe
Read 9 tweets

How many causes of posterior MR do you know?

Let's take a look in this mini 🧵 first!

#echofirst #cardiotwitter #MedTwitter @ASE360 @BSEcho @TheBJCA @BJCA_Women_LTFT @global_wic @WessexSpRs
1. Anterior MV prolapse

Probably the first thing that occurs to most people

AMVL prolapse is less common than PMVL prolapse
Here you can see the highly eccentric, posteriorly directed jet of MR
Read 16 tweets
Small thread 🧵illustrating #POCUS based hemodynamic assessment. Relatively a classic case of pulmonary HTN and right heart failure but would like to get some insights from the experts.

1/ Parasternal long axis (PSAX) showing D-sign
#VExUS #MedEd #Nephpearls #IMPOCUS
2/ Parasternal long axis (PLAX) view demonstrating RV dilatation.
One of the three musketeers is big. Don't know what I'm talking about? Here is a brief reminder: 🔗…
(Mobile thing in the RVOT is PA catheter; M-mode quiz from this morning is actually this)
3/ Apical 4-chamber view #POCUS
Note how RV is dilated - bigger than LV and forming the cardiac apex.
Inter-atrial septum is bowing to the left indicating high right atrial pressure (not unexpected).
Read 21 tweets
Do you routinely measure #MAPSE?

Did you know that MAPSE beats #GLS and #LVEF regarding prognosis?

A new multicenter collab study out, led by @KellmanPeter


#WhyCMR 🫀🧲 #EchoFirst 🫀🔊

A thread 🧵. 1/n
We know that GLS is a composite measure correlated w LVEF, LVEDV, LVESV, LV mass, infarction, non-ischemic scar, aortic stenosis, mitral regurg, ECV.

So, not surprisingly, GLS associates with poor prognosis.

Ref: Suppl Table 2

Notably, mitral annular plane systolic excursion #MAPSE has been measurable by #EchoFirst since 1986 by M-mode (

3/n From, Figure 3-4B, M-mode recording of th
Read 11 tweets
TOP 🔟 ECHOCARDIOGRAPHY CASES ➡️ January 2022 (in my opinion) #medtwitter #pocus #echofirst #cardioed #cardiotwitter #medicaleducation #ENARM

⬇️🧵 Image
10. Septal bounce - In effusive constrictive pericarditis - @ahmed_ellaien
9. Pulmonary embolism and right ventricular thrombus in transit @carlosjuanatey
Read 14 tweets
🧵In our paper “Intraventricular Vector Flow Imaging with Blood Speckle Tracking in Adults: Feasibility, Normal Physiology and Mechanisms in Healthy Volunteers” , findings were not only qualitative as described in previous threads, but also quantitative.
1/ Measures of kinetic energy (KE), vorticity (VO), energy loss (EL) and pressure gradients (PG) can be calculated. The figure from the paper shows the curves from all subjects in the study. What does these measures mean, and are they likely to add useful information?
2/ Starting with kinetic energy, this is the kinetic energy per volume, and can be integrated from the individual velocity vectors. As this was integrated over the 2D area only, the energy is given in J/m. The upper panel shows all subjects, the lower a curve from one subject.
Read 19 tweets
Why we #pocus: unexpected complications and daily changes. A thread.

70 year old male presented with hypoxic respiratory failure. Initially diagnosed with bilateral pneumonia and started on zosyn. Very hypoxic requiring 15L. The following morning #pocus revealed:
Large bilateral pleural effusion a with compression atelectasis. Clinically was never pneumonia. Was upgraded to ICU and intubated. R sided thoracentesis drained 1.8L of fluid and was stepped out of ICU
The following morning lung #pocus exam done. Left lung: lung sliding with diffuse lung rockets consistent with pulmonary edema
Read 11 tweets
The more you understand, the less you need to memorize. Take this 🫀 example:

Severe AR and MR are both defined by a regurgitant volume of 60mL. YET, another criterion, effective orifice area, must be 0.3cm^2 for AR but 0.4 for MR.

#Medtwitter #cardiotwitter #POCUS #Echofirst
I kept mixing up which is 0.3 and which is 0.4. We can keep trying to memorize this, or ask why? Why is the regurgitant volume the same, but the effective regurgitant orifice area (EROA) different?

Here's the pearl:
It's because AR occurs in diastole, MR occurs in systole, and diastole is longer than systole. Therefore, in diastole, a smaller EROA (0.3) can generally yield the same 60mL of regurgitation as a larger EROA (0.4) can during the shorter systole.
Read 5 tweets
Patient with flank pain, hematuria and significant leg edema


Lung Ultrasound #LUS 2/10
#IVC long axis 3/10
Read 10 tweets
ICU stories: Middle-aged pt w PMHx of rheum fever/A fib underwent MV+AV replacement, TV repair w ring, Maze procedure + LA appendage closure. At the end of surgery, TEE was “fine”; pt was transferred to the ICU intubated (fio2 40%) on low-dose levo (0.04). Could not be extubated
because few h later, lactate began to ⬆️ and ivf were given. Levo gtt did not ⬆️ much (just @ 0.1 next am) but lactate was up to 17 mmol/l & pH was 6.98. I was told that pt was probably still "under-resuscitated". When I 👀the chart, pt had received multiple NS, bicarb & albumin
boluses and was > 8 liters positive. I first pulled the bed sheets to look at the legs and feel the skin temp:
Read 22 tweets

Last case of 2021!

If EVER you needed an example of why not to judge a 3-dimensional structure with 2-dimensional imaging...this it it!

I think you'll like this one...😁

#echofirst #cardiotwitter #MedTwitter
Male, late 60s, underwent biological MVR (29mm) 11 yrs previously for
Severe MR. Has permanent AF & VVIR pacemaker

Admitted to local hospital with breathlessness

This is admission chest x-ray
Treated with diuretics, offloaded successfully

Rpt CXR after a week - nearly normal
Read 19 tweets
A tale of two hearts: Physiological observations on AV shunts and congestion 🧵

These are 2 patients on IHD I saw in the outpatient clinic

🔷 Both with severe venous congestion (#VExUS = 3)
🔷 Both with tortuous brachiocephalic AV fístula

What I found remarkable was the diametrically opposed effects of manual AVF compression on JVP! 🤯

🔴 Patient A: AVF Compression improves venous congestion
🔵 Patient B: AVF Compression worsens venous congestion

🔴 Patient A: SLE + Lupus Nefritis ➡️ ESRD in HD

#echofirst: Plethoric IVC, good LVEF, paradoxical septal motion, ventricular interdependence, severe RV/RA dilation, torrential TR

Read 13 tweets
Ecografía pulmonar 🫁. Guía fácil y práctica de como utilizarla. ABRO HILO
#POCUS #CardioEd #echofirst #ENARM #medicaleducation #ultrasound #MedEd #Cardiology Image
Es curioso porque clásicamente se decía que la ecografía pulmonar no era posible. Harrison afirmaba que " los ultrasonidos (US) se disipan rápidamente en el aire por lo que carecen de utilidad en la evaluación del parénquima pulmonar" ¿Qué ha cambiado? Image
Daniel Lichtenstein, un intensivista francés, redescubrió la ecografía pulmonar. Es cierto que los US no se transmiten bien por el aire, pero Lichtensein descubrió que pequeñas alteraciones en la relación aire-agua a nivel pulmonar formaban artefactos ecográficos característicos. Image
Read 25 tweets
It was so great to give a (virtual) talk to the Hellenic Society of Cardiology on #covid and #whycmr- hopefully next year in person with no more need 4 Covid talks! Short 🧵 on CMR use #epeeps #cardioed #echofirst #tavr #metaanalysis …/2
#covid is bad for many organs- including the heart. The role of ACE2 receptors to facilitate entry to the cells is well known! But for the heart Covid does lead to #infarction #arrhythmias #heartfailure #myopericarditis What can you do to avoid this? GET A #VACCINE
Hospitalized patients with high troponin are the sickest ones. Great study from #london hospitals showing that in this cohort - late gadolinium enhancement indicating scar (an adverse prognostic factor) is present in 1/2 patients. How to avoid it? GET A #VACCINE …4
Read 9 tweets
ICU stories (this story includes the answer to the quiz from yesterday): Young pt w PMH of HTN/HLD/DM2/CAD (stent of obtuse marginal) presented with chest/abd pain, N/V. Stat EKG (infero-lateral "changes"; ST elevation in inferior leads?): Image
Emergent cath: "diffusely diseased LAD w stenosis 40%, non-dominant Cx with diffuse disease and stenosis <40%, widely patent OM stent, dominant RCA w diffuse disease and stenosis 50%. Pt did not have hemodynamically significant stenosis to explain symptoms and was admitted to CCU
... on nitro drip (for BP control). Next am, pt went into a wide-complex tachycardia that deteriorated in seconds to V fib. CPR started. Defib x1 back to SR. The post-ROSC ECG (that I posted yesterday) showed: Image
Read 28 tweets
Post holiday season, @ICUltrasonica, @wilkinsonjonny & I are back to take you through the most most critical clinical questions on #haemodynamics that ultrasound can answer

We’re now on to question 3 of FUSIC HD

’Is the aorta abnormal?’

#FUSIC #echofirst #POCUS #FOAMus
Aortic dissection is easily missed, carries a high mortality and should be on the differential of any patient with shock, abdo pain or chest pain. Contrary to popular belief the entire aorta can be imaged via transthoracic and abdominal ultrasound. Let’s start with some anatomy
Asc aorta:
Visualised from PLAX view with depth ⬇️ & probe tilted to focus on the root. Tilting superiorly, or moving up a rib space, may help. Examine the AV and look for a dissection flap. Measure the diameter 3-4cm from the AV. The root can also be seen from A5C & A3C views
Read 20 tweets
You are asked to preoperatively assess a patient with known primary severe mitral regurgitation for an hip replacement

Which of the following new findings might result in you postponing surgery:

Dilated LV
Impaired LV sys fxn
Pulmonary HTN
New Afib Image


Any/all of the above

If known severe MR – these are the NEW findings that should prompt you to speak to you friendly cardiologist colleagues Image

Valvular Heart Dx (VHD) AHA guidelines : Image
Read 9 tweets
Following yesterday's #echofirst images of SAM, it’s time for another #tweetorial!

By senior fellow @NoahHaroian

#ACCFIT #Meded #FOAMed #cardiology #cardiotwitter

In this tweetorial, you will learn:
🟢The “ingredients” for SAM
🟢Who is at-risk for SAM
🟢How to treat SAM
Why are humans a set up for SAM?

Simple - because we have a cardiac loop.
Wait, what is the “cardiac loop”?

Answer: blood’s “U-turn” through the left ventricle. Image
Read 16 tweets

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