Discover and read the best of Twitter Threads about #HeartFailure

Most recents (24)

#Nephrology consult for worsening creatinine in the context of diuresis in a patient with #heartfailure
Documented weight 3 kg ⬇️ than the previous day. No accurate urine output. Pt feels OK (has some unrelated issue).
Question: over diuresis?
#POCUS #MedEd #VExUS see thread 👇
So, there is decreased LV systolic function and obviously diastolic dysfunction. Bi atrial enlargement. No significant pericardial effusion (there was trace on PLAX).
Next step in the hemodynamic circuit #POCUS assessment?
btw repeat weight was similar.
Next: IVC #POCUS assessment to assess right atrial pressure.
Here it is 👇
Big and plethoric (take it as 15 mmHg in a spontaneously breathing person - we get RVSP of ~41 mmHg based on the above tricuspid gradient)
Read 10 tweets
About your partners' Rhesus factor

Rh+♂+ Rh+♀=✅
Rh-♂ + Rh+♀=✅
Rh-♂ + Rh-♀ =✅
Rh+♂ + Rh-♀=⚠️ Caution when pregnant!

Rhesus incompatibility between a woman♀ & her man♂ can cause baby jaundice, repeated miscarriages, stillbirths & more.

A thread 🧵

{Retweet!}
2/

Humans belong to blood groups 'A', 'B', 'AB', or 'O'.

Also, we're either
- Rhesus positive (Rh+), or
- Rhesus negative (Rh-)

The "+" or "-" sign usually attached to your blood group represents your rhesus status!
3/

Being Rh+ or Rh- depends on you having certain proteins called #RhesusAntigens on the surface of your red blood cells.

If you have the rhesus antigens, you're Rh+

If you don't have the rhesus antiges, you're Rh-
Read 19 tweets
Checkout my slides from our #TCTConnect abstract presentation. Learn how we use #3Dprinting @KidsAtColumbia to care for our patients with #CHD. Abstract TCT196 for full video clips! 1/10
#TCT2020 @ColumbiaSurgery @MartyMleon @mmamas1973 @jgranadacrf @Drroxmehran @mirvatalasnag Image
Our J750 @Stratasys is housed in the Vagelos Center and is a multimaterial multicolor #3Dprinter. We reviewed our #3Dmodeling and #3Dprinting cases over 2 years. 2/10
#TCTConnect #TCT2020 #crf @purviparwani @PushpaShivaram @ShelbyKuttyMD @DrJenniferCo_Vu @iamritu @MaterialiseNV Image
We have created 32 models over 2 years for indications of 👉complex #CHD
👉#VAD planning
👉AAOCA or
👉other #CHD 3/10
#TCTConnect #TCT2020 #CRF #3Dprinting
#womeninmedicine #WomenInSTEM
@ebrosenzweig @ShannonNNees @kt_heartfailure @Heart_SCCT @SCMRorg Image
Read 11 tweets
Hey, #MedTwitter! We've been thinking a lot about SGLT2i (more coming up on your Friday email) in heart failure, and wanted to give space for overview of the evidence and potential mechanisms.

So without further ado, here's a #tweetorial on #SGLT2i and #HeartFailure!
1/ SGLT2 inhibitors show clear benefits in heart failure, in patients with and without Diabetes. So what are the underlying mechanisms, we wondered?
2/ A Background:

SGLT1 and SGLT2 are co-transporters that move glucose and Na+ into the tubular lumen. SGLT2 is responsible for 90% of glucose reabsorption, while SGLT1 is responsible for 10%, and also found on intestinal epithelial cells. Enterocyte and S3 proximal renal tubules have SGLT1 cotransp
Read 25 tweets
This nationwide complete analysis of all adult deaths in #England & #Wales has found that the #COVID pandemic has resulted in an abrupt inflation in acute #cardiovascular deaths above that expected for the time of year. heart.bmj.com/content/early/…
That is, about 2000 additional deaths over a 4 month period.
Nearly half of the deaths occurred outside of the #hospital setting, either at #home or in #carehomes.
Read 23 tweets
β blockers & mortality after #heartattack in patients without #heartfailure: multicentre prospective cohort study @bmj_latest bmj.com/content/354/bm…
β-Blockers and Mortality After Acute Myocardial Infarction in Patients Without Heart Failure or Ventricular Dysfunction @JACCJournals @UoL_LICAMM #heartattack #betablocker @CardiacAudit onlinejacc.org/content/69/22/…
Read 3 tweets
❤️Enjoyed watching the #HeartFailure: Looking Back and Moving Forward webinar.
❤️Dr. Braunwald summarized his 70 years of experience in ~20 minutes.
❤️So much has happened before I was even born!
❤️Yet, so much more to look forward to! Thank you for a tour back in time!
❤️I thoroughly enjoyed Dr. John McMurray’s overview of “the five alive” & his emphasis on moving away from vertical integration approach.
❤️Up-titrating each medication should not interfere w/ adding meds w/ complimentary benefits.
❤️No excuses, because #GDMTworks.
❤️Loved how Dr. Milton Packer went back in time to highlight the origin of LVEF cut-offs & the confusion that followed.
❤️He then advised using strain & myocardial contraction fraction, compared & contrasted common diseases using the same.
❤️HFpEF:disease of something else!
Read 5 tweets
(1/11) #AFibAwareness #Tweetorial: Today is #AFibAwarenessDay and we’re sharing facts about atrial fibrillation! Follow this thread to learn more & answer Qs about #AFib symptoms, treatments & more in “Treatment of Atrial Fibrillation: Is Timing Everything?”

#ACCEP #HRSOnline
(2/11) #AFibAwareness #Tweetorial: AFib is the most common sustained heart rhythm problem & affects 43.6 million patients across the 🌎.

#AFib can be associated with significant symptoms & an ⬆ risk of #stroke, #heartfailure, dementia & mortality. bit.ly/3eShyZl
Questions: Given high prevalence of #AFib, what is the optimal screening strategy for AF? When and how? What is the role for wearable technology? bit.ly/3hlcv5b
Read 17 tweets
📌 Controversies in #HeartFailure

SGLT2 Inhibitors Should Be Given to All Patients⁉️

What is the best glucose lowering therapy to treat T2D in👥with #HFpEF⁉️
Prof. McMurray

#ESCCongress
@paomorejon @ESC_Lavinia @escardio @ShelleyZieroth @hvanspall @HanCardiomd @MihaiTrofenciuc ImageImageImage
📌 SGLT2 Inhibitors Should Be Given to All Patients⁉️

#DAPA -HF
Not representative of all HF
Subgroups where iSGLT2 don’t work
👥were undertreated
Prof. De Boer

#ESCCongress
@paomorejon @escardio Image
📌 SGLT2 Inhibitors Should Be Given to All Patients⁉️

We aren’t making changes

#ESCCongress
@paomorejon @escardio ImageImage
Read 3 tweets
‘Effects of #empagliflozin & #dapagliflozin on hospitalisations for #heartfailure were consistent in the two independent trials & suggest that these agents also improve renal outcomes & reduce all-cause & #cardiovascular death in patients with #HFrEF’. thelancet.com/journals/lance…
The pooled treatment effects showed consistent benefits for subgroups based on age, sex, #diabetes, treatment with an ARNI & baseline #eGFR.
However, pooled treatment effects suggested treatment-by-subgroup interactions for subgroups based on NYHA functional class & race. Meta-analysis @TheLancet.
Read 3 tweets
‘Hospital tests & procedures used to diagnose & monitor a range of #heart & circulatory conditions are often among the vital first steps in someone's treatment journey. Delaying them could have a domino effect on the rest of their care’ by ⁦@TheBHFdailymail.co.uk/news/article-8…
“All areas of #cardiology service provision sustained significant reductions, which included outpatient clinics, investigations, procedures & cardiology community services such as #heartfailure & #CardiacRehab.”
Read 5 tweets
In reply @VijayKunadian : 1) we know there is an excess of deaths (when all-causes as a single group are studied) (@d_spiegel);
2) there will also be an excess of #cardiovascular deaths (we will release a pre-print shortly for external review @mmamas1973). I think it is very likely people did not come to #hospital - we know that failure to treat MI results in premature death.
(However, limitations in arbitration of cause, ‘default’ to #COVID19 as a cause, & latent effects of missed #heartattack will produce mis-classification bias & an underestimation of the extent of the deaths from not seeking help)
Read 8 tweets
#COVID19 pandemic & admission rates for & management of acute coronary syndromes in #England @TheLancet #heartattack #Covid19UK thelancet.com/journals/lance…
By the end of March, 2020, the average weekly number of acute coronary syndrome admissions fell by 40% compared with the average weekly number observed during 2019.
Measured against this baseline, from January, 2020, until the end of May, 2020, there had been around 8000 fewer admissions for acute coronary syndromes than would be expected.
Read 13 tweets
EuroHeart will provide continuous #data collection of standardised &/or harmonised variables in common #cardiovascular diseases, including therapy, interventions, & devices. This will enable quality improvement, device surveillance & registry-based RCTs.
It will cover the common disease areas ACS-PCI (#heartatrack), #heartfailure, valve disease & #AFib.
Read 10 tweets
Long-term β-blocker therapy & clinical outcomes after #heartattack in patients without #heartfailure: nationwide cohort study @ESC_Journals academic.oup.com/eurheartj/eurh…
In this Korean nationwide cohort, β-blocker therapy for ≥1 year after #heartattack was associated with reduced all-cause death among patients with MI without HF.
Conflicting messages from observational data, @ehj_ed. Thankfully, a suite of randomised controlled trials are in progress, including, but not limited to @RebootTrial, @YndigegnY
Read 3 tweets
It's finally published!

The results of our Randomized Controlled Trial of Lung Ultrasound Guided Therapy in Heart Failure #CLUSTERHF, are now available!

I'll give you a glimpse of the results (1/3)
@AmericanHeartJ
#heartfailure @escardio @HFSA
In this RCT, we randomized 126 patients with HF to either a LUS-guided protocol vs. conventional care.

In the LUS-guided arm, LUS was performed in every visit and results allowed the clinician to titrate therapies.

In the conventional arm, LUS was blinded.
The primary outcome was the composite of urgent HF visits, rehospitalization for worsening HF and death from any cause.

LUS guided treatment was associated with a 45% risk reduction in the primary endpoint, mainly driven by a reduction in urgent HF visits (HR 0.28, P = 0.001)
Read 7 tweets
Decline in admissions with #heartfailure & cardiac arrhythmias during #COVID19; by @GerdHindricks, @ABollmannMD et al published in @ESC_Journals #EHJQCCO academic.oup.com/ehjqcco/advanc…
The authors studied data for 17417 consecutive admissions to 66 #hospitals in the #German-wide Helios network between March 1, 2020 & April 30, 2020 (study period), March 1, 2019 & April 30, 2019 (previous year control) and January 1 & February 28, 2020 (same year control).
Cause-specific hospitalizations were defined on the basis of primary diagnosis according to International Statistical Classification of Diseases & Related Health Problems [ICD_10_GM (German Modification)] codes.
Read 8 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
We are happy to share our first contribution to the #cardiology field.
@roramirezf94 & Jan Lanzer, et. al. present: “A Consensus Transcriptional Landscape of Human End-Stage Heart Failure” (medrxiv.org/content/10.110…) (1/7)
In our pre-print we compared and integrated 16 public transcriptomic studies of the last 15 years that profiled over 900 left-ventricle biopsies of #heartfailure (HF) patients and control individuals (2/7)
We demonstrated that single studies reported highly dissimilar gene expression markers (A), however, a common disease signature became apparent with the use of transfer learning approaches (C) (3/7)
Read 7 tweets
Break from difficult cases but the #VExUS #POCUS series continues....this time #heartfailure with classic images.
#tweetorial
1/ Pulsatile portal v - 100% pulsatility in this case with bidirectional flow. Note the waveform change (on top) with ⬆️ RAP (Tang. et al 2016) #IMPOCUS
2/ How does the normal portal vein Doppler #POCUS look like? - above the baseline (flow towards the transducer) and gently undulates. Like this 👇
3/ Here is the hepatic vein waveform from our #heartfailure patient. Looks biphasic indicating severe congestion like that of portal vein. #POCUS
Note the RAP meter on top from Tang, et al. again.
Read 10 tweets
Seeing this discussion, thought of doing a short #tweetorial on the lung #POCUS scan zones I've come across. Some of them (like 24-zone method) have been utilized to study lung congestion in #dialysis patients
1st slide: 👇
24-zones: better illustrated. #POCUS
Additional zone (#4) added to the commonly used 8-zone method to include the right middle lobe. #POCUS
Read 6 tweets
1/9 Tweetorial Concepts of Na in #HeartFailure
👉Failing Heart prefers ketones
👉Ketones have osmotic diuretic effect
👉#Keto #LowCarb need to ⬆️ Na Intake
👉Same holds true for HF patients
👉Even more so due to diuretic effect of ketones, low carb,
and in insulin Image
2/9 @DrMarthaGulati shared #Interesting pics of on presentation of how Salt Restriction in worsened outcomes on HF. This struck many Cardiologists by surprise but this is not new

This is the link to her Tweet:

Some pics here. ImageImageImageImage
3/9 Our colleagues in Europe have been doing this for quite some time with excellent results btw. Here are some references addressing this as well
1)
2)medscape.com/viewarticle/83…
3)
4) ImageImageImage
Read 12 tweets
موضوعنا اليوم رح يتكلم عن أحد أهم الأمراض القلبية🧐 :

ويشكّل مرض لا يستثني أي منطقةٍ من العالم🌎، و يعتبر من أهم أمراض العصر الخطيرة، 😔
حديثنا اليوم عن ⏳:

الفشل القلبي أو ما يدعى ب #Heartfailure

تعالوا كملوا معنا الثريد خلينا نتعرف ونتعلم عن هالمرض أكثر

⬇⬇⬇⬇⬇ Image
وهذي العناوين اللي راح يتم شرحها في هذا الثريد بإذن الله :

1- راح نعرف وش يعني فشل القلب ؟ 📝
2- كيف ممكن يصير الفشل القلبي
3- وش الأسباب اللي ممكن تسبّب هذا المرض؟
4- وش أعراض مرض الفشل القلبي ؟ 🔍
5- كيف ممكن نشخّص المرض؟ 📋
6-مضاعفات الفشل القلبي؟
7- هدفنا من العلاج ؟
8- تقسيم المرض 📑
9- كيف ممكن نسيطر على HFrEF & HFpEF?🧐
10- ماهي أنواع الفشل القلبي 📍
11- follow up for patient ✅📝
12- ماهي الخطة العلاجية للحامل المصابة بالفشل القلبي؟ 📝💡
13- اخر نقطة وش الأدوية اللي ضروري يتجنبها مريض الفشل القلبي ❌💊

والحين بسم الله نبدأ مع الثريد 🤩👏🏻
Read 40 tweets
The Conservative Party of Canada supports a 3 year prohibition on embryonic stem cell research.

They claim adult stems cells are more promising, so let's look at their claims.

#cdnpoli #elxn43 #NeverScheer #stemcells #research #science
The Ford Government has already cut funding for stem cell research.

"Scientist working on treatment of premature babies calls move 'extremely short-sighted and uninformed'"

cbc.ca/news/canada/to…
What are embryonic stem cells?
"Embryonic stem cells exist only at the earliest stages of embryonic development and are capable of making any cell type in the body."

via @UMich

stemcellresearch.umich.edu/overview/faq.h…
Read 9 tweets

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