Discover and read the best of Twitter Threads about #EchoFirst

Most recents (13)

After a lot of work, so proud to finally share this work on #troponin, LV function (#echofirst) and inc HF in the general pop (#ARIC)

1. ⬆️trop is assoc with LV hypertrophy and diastolic (but not systolic!) dysfx

@JAMA_current @JAMACardio @scottdsolomon
ja.ma/2MVFXns
👉🏻Subjects with ⬆️trop AND diast dysfx are at particularly high risk of HF
👉🏻 LV diastolic dysfunction accounts most of the association between troponin and #HFpEF
👉🏻LV Mass accounts for most of the association between troponin and #HFrEF
Read 5 tweets
Hypertrophic Obstructive Cardiomyopathy #HOCM🚧

#Symptoms
Profound exertional dyspnea

#Imaging
▪️SAM/LVOT obstruction #whyCMR
▪️Classic #Doppler🗡#echofirst

#Hemodynamics
▪️Brockenbrough-Braunwald-Morrow sign, explained

#Treatment
▪️Alcohol🍷septal ablation #RadialFirst
Question:
Why wouldn’t more filling time⏱ prior to post PVC beat lead to less obstruction, less gradient, & ↑ arterial pressure?

After all, doesn’t ↑LV volume in #HCM ↓gradient and improve symptoms?

Cornerstone tx is hydration/💊s that ↑ diastolic filling time ...
Read 6 tweets
For all those unable to make my 7 AM presentation on Speckle Science yesterday, here's the requested #Tweetorial on Strain basics #ASE2019 @ASE2019 as promised.
Read 27 tweets
A new #echofirst #POCUS #medthread CASE!

55 yo woman with hx of metastatic lung CA, known malignant pleural/pericardial effusions presents as a transfer in shock with associated encephalopathy. HR 120s-130s (sinus), cool extremities, MAP 65 on 8-10 mcg/min norepi. O2 4L NC.
What are you going to do based on the above image?
The LV cavity appeared small/underfilled to you in the first image, not sure why, but you elect to bolus IV fluids while you complete your exam. You move to the A4C view and notice this:
Read 9 tweets
Do you use #whyCMR in your patients undergoing #TAVR. More slides in the thread #CVimaging #ACCImaging #ACC19
Annular assessment by #whyCMR accuracy similar to #YesCCT

data from @JACCJournals
#ACCimaging #ACC19 #Cvimaging
Peripheral calcification is the limitation for #whyCMR use in #TAVR #ACCimaging #CVimaging #ACC19
Read 7 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/Tweetorial on #TMVR for #ASEchoJC 12/11 8 pm
bit.ly/2EiJQ1v

transcatheter mitral valve replacement #TMVR for failed valve & ⬆️ #STS risk

#VHD 2017 update reoperation➡️ reintervention bit.ly/2P9bX4G

🎈expandable SAPIEN S3 only @FDA bioprosthesis for implant
2/#Transeptal developed @MayoClinicCV 48 pts

After 🇨🇦 initial experience with #transapical 2009

sick patients with ⬇️ EF #transeptal preserves EF better avoids apical purse string suture

Currently #TMVR registry
>50 % are transeptal & in house mortality 7%
3/#EchoFirst #TTE
#PLAX & off-axis( inflow can be II to septum not apex/posteriorly & eccentric/coanda
👀 origin MR➡️#TMVR may 🚫resolve severe paravalvular MR
#Apical
#CWD #MV proximal flow convergence location: on ventricular side in regurgitation & on atrial side in stenosis
Read 10 tweets
Assessing the whole body with #ultrasound #WBU impacts the outcome? a look at the literature part 1 Van Der Horst I at #LIVES2018 #FOAMus #FOAMcc #FOAMed @ESICM #echofirst #FOAMcc
Assessing the whole body with #ultrasound #WBU impacts the outcome? a look at the literature part 2 Van Der Horst I at #LIVES2018 #FOAMus #FOAMcc #FOAMed @ESICM #echofirst #FOAMcc
Assessing the whole body with #ultrasound #WBU impacts the outcome? a look at the literature part 3 Van Der Horst I at #LIVES2018 #FOAMus #FOAMcc #FOAMed @ESICM #echofirst #FOAMcc
Read 3 tweets
1/#Tweetorial #papillary #fibroelastoma for
#ASEchoJC 10/23

🐙= #PFE 1975 named #papillary #fibroelastoma by #armed #forces #institute of #pathology

#papilloma 1973

#Collagen core with elastic fibers & matrix covered by endothelium sheath
Attached by stalk
multiple fronds
2/ What is the incidence of #PFE 🐙 compared to #myxoma (diagnosed in same time period)?

#PFE 511 vs. #myxoma 112

#PFE incidence ~1/1000

common “benign”primary ❤️tumor #modern #EchoFirst (Most common @MayoClinicCV)

#myxoma (autopsy based prevalence)

bit.ly/2Am05Y9
3/How to tell if a #PFE🐙by #echofirst ?
(Vs.Atypical myxoma,SBE,
Llambl’s)
small mobile mass attached #endocardial surface frondlike extensions #independent motion stippled border
Usually on atrial surface of AV valves or either side of semilunar valves,🚫interfere valve Fxn
Read 10 tweets
Evaluation of Cardiac Masses:
A Tweetorial for #FITSurvivalGuide 🚨 #ACCImaging @ASE360 @SCMR @journalofCMR @ACCinTouch
Dedicated:@dr_chirumamilla & all #ACCFIT in #CardioTwitter
Main Ref: link.springer.com/article/10.100… Palaskas, et al. Curr Treat Options Cardio Med (2018) 20: 29.
Usually, it all starts with an abnormal finding in an echo suggestive of intracavitary mass. How can we tell one from the other? It can be confusing.
For artifacts, I did a Tweetorial already that describes the most common ones. Basic understanding of ultrasound physics is needed to be able to explain them: twitter.com/i/moments/1030…
Read 24 tweets
#FITSurvivalGuide on Restrictive Cardiomyopathy (RCM) vs Constrictive Pericarditis (CP).

In both:

💠Diastolic RV & LV impaired; systolic function preserved
💠HFpEF phenotype, predominant “R sided” signs (­JVP, edema, ascites)

1/12
@dr_chirumamilla @Pooh_Velagapudi @bcostelloMD
🔑 to understanding different filling:
RCM = myocardial disorder
CP = pericardial disorder.

2/12
@majazayeri @fawazalenezi55 @SanChris999 @GuruKowlgi @Nidhi_Madan9 @sabeedak1 @noshreza @SaggerMawri @nsivcd @DrManiCardio @khandelwalMD @drjohnm @heartdoc45 @zainasadEP @docaward
RCM

💠Stiff myocardium➡️early diastolic ⏫­­LV and RV pressure w/small vol ∆
💠 Echo: early diastolic abnormalities
💠High initial flow (= E wave; so E/A >2); ends abruptly (⬇️E decel time)

⚠️Restrictive pattern also in stage 3 HFrEF w/abnl early diastole

3/12
Read 12 tweets
#FITSurvivalGuide: The Forgotten Valve-#TricuspidRegurgitation (#TR) #tweetorial for the new #ACCFIT!

1⃣ Anatomy
2⃣ Etiologies
3⃣ Classification
4⃣ Diagnosis
5⃣ Treatment

Resources: @ASE360 @JACCJournals @CircAHA @ACCCardioEd @UMNews @Medtronic

1/10
cc: @dr_chirumamilla
[2/10] Impt to understand #TricuspidValve 1⃣ Anatomy

3 leaflets ⬇️ + fibrous annulus + 2 papillary 💪🏽 + chordae tendinae + RA/RV ❤️

⬛️ Anterior 🍃 (largest)
◾️Posterior
▪️Septal (smallest)

(note: throughout #tweetorial, see image descriptions for more content) TV is largest and most apically displaced valve (normal TV area is between 7 and 9 cm^2).  Tricuspid annulus = complex nonplanar 3D structure w/low posteroseptal portion (towards the RV apex) & high anterolateral portion.TV has 2 distinct pap muscles (ant & post) + 3rd variable septal pap muscle. Largest pap = typically anterior w/chordae supporting ant & post leaflets. Posterior pap supports post + septal leaflets. Septal pap is variable: absent in up to 20% of normal patients or small, or multiple.Note attachments of leaflets/chordae to papillary muscles, RV free wall, moderator band.
[3/10] 2⃣ Etiologies = Structural (1º) vs. Functional (FTR)

Keep chart ⬇️ DDx in mind when reading #EchoFirst

~80% of significant TR = FTR/2º to TA dilatation + leaflet tethering ⬅️ RV remodeling ⬅️ volume and/or pressure overload

Structural (1º) cause = less common
Read 12 tweets
1/11
Today's #FiTSurvivalGuide for basic #EchoFirst views

Parasternal Long Axis:
Left lateral decubitus
3rd L intercostal space. Move⬆️or⬇️ to find window
👀descending aorta, coronary sinus, pericardium, LV, both leaflets of MV, LA, aortic valve & root, RV
2/11
RV Inflow View:
Medial angulation of scan plane

👀RA, Tricuspid valve, RV
Further angulate probe to remove portion of LV (seen in A, but not in B)
3/11
Parasternal short
👀annulus, 3 cusps of aortic valve (open in systole, close in diastole), coronary ostia (LM at 4 & RCA at 11), LA, IAS, RA, TV, RVOT, pulmonary valve, proximal pulmonary artery (slight superior angulation for R & L branches)

#FiTSurvivalGuide
Read 12 tweets

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