Discover and read the best of Twitter Threads about #PLAx

Most recents (3)

Young pt โžก๏ธ ๐Ÿฅ worsening shortness of breath

PMH: ESRD. Only 1 HD session/week. However, residual urine volume has now decreased substantially

On exam: BP 134/94, 2L O2,๐Ÿง โœ…, elevated JVP, decreased ๐Ÿซ sounds at bases, No murmurs, very mild edema. Functional left BC AVF

1/13
Careful examination of neck veins reveals no pulsations, even with pt sitting up ๐Ÿค”

What could explain the absence of venous pulse? 2/13
Answer is all of the above. JVP examination can be complicated in pts with ESRD.

In the absence of pulsations, I find #POCUS much helpful. Let's enhance our physical examination of congestion:

3/13
Read 13 tweets
1/ Basic #CadiacUS models (color coded / labeled) for Educators or Beginners

At least 2 options when learning any #IMPOCUS โ€“ memorize or ๐—ฐ๐—ผ๐—ป๐—ฐ๐—ฒ๐—ฝ๐˜๐˜‚๐—ฎ๐—น๐—ถ๐˜‡๐—ฒ.

Both will get you there but IMO the latter allows for taking next step into advanced imagingโ€ฆ
2/ This is especially true in Cardiac POCUS โ€“ 4 basic views, but actually so many more. #ECHOFirst

Firm understanding of anatomy and spatial relationships is key!

โžฃNote axis of the heart
โžฃ๐—ฅ๐—ฉ the most ๐—ฎ๐—ป๐˜๐—ฒ๐—ฟ๐—ถ๐—ผ๐—ฟ structure
โžฃ๐—Ÿ๐—” the most ๐—ฝ๐—ผ๐˜€๐˜๐—ฒ๐—ฟ๐—ถ๐—ผ๐—ฟ
3/ #PLAx is ๐™๐™ƒ๐™€ view to learn, if any

Major chambers in view
โžฃLA
โžฃLV
โžฃAorta
โžฃRV(OT)
Read 9 tweets
1/Tweetorial on #TMVR for #ASEchoJC 12/11 8 pm
bit.ly/2EiJQ1v

transcatheter mitral valve replacement #TMVR for failed valve & โฌ†๏ธ #STS risk

#VHD 2017 update reoperationโžก๏ธ reintervention bit.ly/2P9bX4G

๐ŸŽˆexpandable SAPIEN S3 only @FDA bioprosthesis for implant
2/#Transeptal developed @MayoClinicCV 48 pts

After ๐Ÿ‡จ๐Ÿ‡ฆ initial experience with #transapical 2009

sick patients with โฌ‡๏ธ 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
๐Ÿ‘€ origin MRโžก๏ธ#TMVR may ๐Ÿšซresolve severe paravalvular MR
#Apical
#CWD #MV proximal flow convergence location: on ventricular side in regurgitation & on atrial side in stenosis
Read 10 tweets

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