Discover and read the best of Twitter Threads about #RadialFirst
Most recents (24)
Superficial Radial Artery - Atypical Alternative to Radial Access: @JACCJournals
This is fun!
6 point summary
👇👇👇
This is fun!
6 point summary
👇👇👇
1/6: The superficial radial artery (SRA) is a rare anatomical variant with a 0.5% to 1% incidence rate.
2/6: When encountering a weak or absent radial pulse, check the lateral dorsal surface of the wrist for the SRA (Figure 1).
@nolanjimradial @DLBHATTMD @mmamas1973 @mirvatalasnag @SVRaoMD F 1947,weight 37 Kg! #radialfirst for anterior STEMI, LAD stent, uneventful,5000 UFH heparin during PCI,marked brachial loops straightened easily by Terumo glidewire, followed by a small unexplained mid arm hematoma
Normal kidney function,cr. 0.7, today a week later arm arteries normal with bluish color, i did Duplex to check, all good, asymptomatic, poll in next tweet!
Now, this is a very low weight F above age 70 , recent STEMI, post successful primary PCI #radialfirst
She is on Ticagrelor 90bd/ASA81 since PCI less than a month ago
She is on Ticagrelor 90bd/ASA81 since PCI less than a month ago
1/ For the fellows and #ACCEarlyCareer!
It’s a coronary thrombus! When to consider thrombectomy? What do you do? Let’s walk through this…#Tweetorial
#Cardiotwitter #Cardiology #STEMI
It’s a coronary thrombus! When to consider thrombectomy? What do you do? Let’s walk through this…#Tweetorial
#Cardiotwitter #Cardiology #STEMI
2/ Middle age patient with hx of CAD and PCI to LAD presents with significant SOB and elevated Hs-Trop. No chest pain. No ECG changes. Echo with inferior hypokinesis.
Here’s the diagnostic with a JR4.
Notice the filling defect in the RCA. This is thrombus. How do we know?
Here’s the diagnostic with a JR4.
Notice the filling defect in the RCA. This is thrombus. How do we know?
3/ Keys of #thrombus on angiogram
🔑 contrast staining
🔑 Lack of calcium on non con image
🔑 ovoid filling defect (complete lumen)
#Cardiotwitter #STEMI #TIMI
🔑 contrast staining
🔑 Lack of calcium on non con image
🔑 ovoid filling defect (complete lumen)
#Cardiotwitter #STEMI #TIMI
#CardioTwitter poll in next tweet, 54 year old male, smoker since age 14(Egypt!) DM, HPN.
Burning chest discomfort at 6 am, woke him up, came to ER, Tn HS normal, ECG normal…
Burning chest discomfort at 6 am, woke him up, came to ER, Tn HS normal, ECG normal…
Now in CCU about to discharge:
#HongKong Complex Case Series
Global representation..thank u for the invitation
Hoping more women next year
@DrSaritaRao2 @drsonyaburgess
Global representation..thank u for the invitation
Hoping more women next year
@DrSaritaRao2 @drsonyaburgess
Case 1: Hydraulic exchange of the roto wire thru a microcatheter & this is the next picture..what's happening?
#ACCIC #EAPCI @mmamas1973 @evandrofilhobr @saraceciliamtz @AntoniousAttall @atunuguntla1 @ArasiMaran @djc795 @sbrugaletta
#ACCIC #EAPCI @mmamas1973 @evandrofilhobr @saraceciliamtz @AntoniousAttall @atunuguntla1 @ArasiMaran @djc795 @sbrugaletta
🧵 1/8 Myocardial bridging is present when part of coronary artery dips into & underneath heart muscle. Let’s dig deeper. 📖
Educational thread 🧵 1/8
#MedEd #CardioEd #CardioTwitter #MedTwitter #radialfirst @JACCJournals @YoungDgk @DGK_org @AGIKinterv @CardioNerds @escardio
Educational thread 🧵 1/8
#MedEd #CardioEd #CardioTwitter #MedTwitter #radialfirst @JACCJournals @YoungDgk @DGK_org @AGIKinterv @CardioNerds @escardio
📍2/8 Myocardial bridging is a congenital coronary artery anomaly, in which a segment of the artery (tunnel segment) dips into the myocardium (myocardial bridge).
📍3/8 Methods of detection vary greatly in sensitivity.
Myocardial bridging is seen in
🥇30% of pts in autopsy
🥈20% of pts in coronary CT-scan
🥉5% of pts in coronary angiography
#CardioTwitter #MedTwitter #RadialFirst
Myocardial bridging is seen in
🥇30% of pts in autopsy
🥈20% of pts in coronary CT-scan
🥉5% of pts in coronary angiography
#CardioTwitter #MedTwitter #RadialFirst
Interventions for Frailty in Older Adults with Cardiovascular Disease – A Comprehensive Review
The first author @NailaIjaz_MD is a humble, hardworking, and just outstanding.
jacc.org/doi/10.1016/j.…
Summary of this @JACCjournal state-of-the-art review is in 🧵below:
(1/17)
The first author @NailaIjaz_MD is a humble, hardworking, and just outstanding.
jacc.org/doi/10.1016/j.…
Summary of this @JACCjournal state-of-the-art review is in 🧵below:
(1/17)
(2/17)
The aging of the United States population is one of four major areas that will change science, clinical medicine, and business in the coming 50 years
@anatlechner @NYUStern
The aging of the United States population is one of four major areas that will change science, clinical medicine, and business in the coming 50 years
@anatlechner @NYUStern
(3/17)
1 in 4 Americans will be above 65 years of age by 2060…
Think about the implications of this on everyday life...
@DEF_gericard
1 in 4 Americans will be above 65 years of age by 2060…
Think about the implications of this on everyday life...
@DEF_gericard
*Logical vs. Emotional Truths on the JACC Cardiovascular Intervention Study*
(1/14)
Let me summarize below...
From @JACCJournals
jacc.org/doi/10.1016/j.…
(1/14)
Let me summarize below...
From @JACCJournals
jacc.org/doi/10.1016/j.…
(2/14)
Aims:
The study used the NCDR CathPCI registry to examine
a.The proportion of patients who met the inclusion criteria for ischemia (versus 4 other groups that did not meet the Ischemia-trial criteria).
b.The association between each group with all-cause mortality
Aims:
The study used the NCDR CathPCI registry to examine
a.The proportion of patients who met the inclusion criteria for ischemia (versus 4 other groups that did not meet the Ischemia-trial criteria).
b.The association between each group with all-cause mortality
(3/14)
Methods:
Patients in the CathPCI registry were categorized into:
1 ACS + Arrest + Cardiogenic Shock (n=538K)
2 Not Ischemia High Risk (n=71K)
3 Not Ischemia (low risk) (n=67K)
4 ***ISCHEMIA-like (n=125k) +stress OR abnormal FFR***
5 Not classified (n=123k)
Methods:
Patients in the CathPCI registry were categorized into:
1 ACS + Arrest + Cardiogenic Shock (n=538K)
2 Not Ischemia High Risk (n=71K)
3 Not Ischemia (low risk) (n=67K)
4 ***ISCHEMIA-like (n=125k) +stress OR abnormal FFR***
5 Not classified (n=123k)
Awesome first day of presentations.
Some of the key slides below from Chapter 1 - Left Main PCI
#TCTAP2021 #APVALVES2021 #COMPLEXPCI2021 @summitmd_cvrf @aayshacader @mirvatalasnag @AmitSinghMD @YongcheolKim2
#CardioTwitter #CardioEd #RadialFirst #ACCFIT #ACC @BotPci @APSIC6
Some of the key slides below from Chapter 1 - Left Main PCI
#TCTAP2021 #APVALVES2021 #COMPLEXPCI2021 @summitmd_cvrf @aayshacader @mirvatalasnag @AmitSinghMD @YongcheolKim2
#CardioTwitter #CardioEd #RadialFirst #ACCFIT #ACC @BotPci @APSIC6
1/4 Left Main bifurcation and PCI by Dr Mario Gaudino
2/
Watch here tomorrow for the launch of a new accredited tweetorial on use of P2Y12 inhibitor monotherapy after PCI! Earn 0.5 CE/CME credits: physicians, nurses, pharmacists! Expert faculty @SVRaoMD. #medtwitter @academiccme #cardiotwitter
1) Welcome to a tweetorial on the use of P2Y12 inhibitor monotherapy after PCI! Accredited for 0.50 credits by @academiccme: physicians, nurses, pharmacists! I am @SVRaoMD.
2) This series is supported by educational grant funding from Abbott, AstraZeneca, Bayer, Chiesi, and NovoNordisk. Follow this thread for credit. And here is a case …
1. Today is #WorldCancerDay our analysis led by @dr_mosama & @hvanspall academic.oup.com/ehjacc/advance… with @AnaBaracCardio @islamelgendy83 @DLBHATTMD @adnanalkhouli @safinmc @dataevan studies disparities in care & outcomes of cancer pts presenting with STEMI @DrMarthaGulati @ShrillaB
2. #WorldCancerDay It builds on our work published last year led by @adityadoc1 showing pts with cancer less likely to be managed invasively, and when they are have better outcomes. academic.oup.com/eurheartj/arti… @MKIttlesonMD @ovidiogarciav @DrPeterOKane @SukhNijjer @CardioIAN
3. #WorldCancerDay The greatest incidence of AMI in cancer pts is within 30d of Ca diagnosis, many treatments can ⬆️risk aswell as shared risk factors. We sought to study whether STEMI pts with cancer are less likley to get PPCI & whether they benefit academic.oup.com/ehjacc/advance…
(1/)—🅰🆁🆃🅴🆁🅸🅾🆂🅰 🅻🆄🆂🅾🆁🅸🅰
➡️Arteria Lusoria or aberrant right subclavian artery (ARSA) is the most common congenital arch anomaly in which the right subclavian artery originates from the descending aorta, distal to the left subclavian at the ductus arteriosus.
➡️Arteria Lusoria or aberrant right subclavian artery (ARSA) is the most common congenital arch anomaly in which the right subclavian artery originates from the descending aorta, distal to the left subclavian at the ductus arteriosus.
(2/)On its course towards the R arm, the aberrant vessel travels retrotracheal +retroesophageal. The prevalence of ARSA ranges from 0.6 to 1.4%. The prevalence of ARSA rises exponentially to 26–34% in individuals with Down syndrome and other chromosomal defects. Pic: @Tesslagra
(3/) Rarely, ARSA can accompany Kommerell's diverticulum, an aneurysm of the descending aorta at the origin of the ARSA. This can present clinically as dysphagia, dyspnea, or subclavian steal syndrome, often requiring surgical intervention
Today's 8 am #UFE begging to leave hospital at 10.30 am....we found a middle ground 11 am
The secret 🤫: #RadialFirst and #SHNB
#Tweetorial on technique and troubleshooting....
🧵1/
The secret 🤫: #RadialFirst and #SHNB
#Tweetorial on technique and troubleshooting....
🧵1/
Relevant anatomy:
Sup hypogastric nerve plexus- sympathetic nerve plexus anterior to L5 body
Aortic bifurcation-L4
Venous confluence- L5, L5-S1 disc (*overlies the plexus 😱)
2/
Sup hypogastric nerve plexus- sympathetic nerve plexus anterior to L5 body
Aortic bifurcation-L4
Venous confluence- L5, L5-S1 disc (*overlies the plexus 😱)
2/
Although arterial opacification can be avoided with an angiogram, venous opacification is sometimes inadvertent and maybe seen in nearly 1 in 5 cases.
We still go ahead with #SHNB:
➡️ Adjust needle position
➡️ Multiple aspirations
➡️ Test dose
3/
We still go ahead with #SHNB:
➡️ Adjust needle position
➡️ Multiple aspirations
➡️ Test dose
3/
1/ Cherry-picking by Meta-analysis: In a meta-analysis of 23 randomized trials comparing PCI vs. CABG, “Percutaneous coronary intervention was associated with higher all-cause, cardiac, and noncardiac mortality compared with CABG at 5 years”. jamanetwork.com/journals/jamai…
When use #ldtra during a #radialfirst approach?
👌if no #STEMI and:
1⃣ dialysis or CABG w/radial graft likely (better
radial artery patency) or
2⃣ left radial preferred (e.g. prior CABG: better pt
and👩⚕️comfort) or
3⃣ pt has thick forearm (better hemostasis)
👌if no #STEMI and:
1⃣ dialysis or CABG w/radial graft likely (better
radial artery patency) or
2⃣ left radial preferred (e.g. prior CABG: better pt
and👩⚕️comfort) or
3⃣ pt has thick forearm (better hemostasis)
❓How-to #ldTRA?
Twitterature: @ferdikiem and many others provide great tips from U/S guidance to compression and more
Literature is catching up:
ongoing studies➡️NCT03611725, NCT04232488, NCT04318990, NCT04194606, NCT04171570
Twitterature: @ferdikiem and many others provide great tips from U/S guidance to compression and more
Literature is catching up:
ongoing studies➡️NCT03611725, NCT04232488, NCT04318990, NCT04194606, NCT04171570
Source: sciencedirect.com/science/articl… from our team @MHIF_Heart
#cardiotwitter #ACCFIT #SCAIFIT #ACCEarlyCareer
#cardiotwitter #ACCFIT #SCAIFIT #ACCEarlyCareer
#ESCCongress has ended. A unique conference! An unforgettable conference! These are my highlights!
Firstly, an amazing DIGITAL experience... Brining everyone together, breaking all barriers, diminishing borders.
@Barbara_Casadei @Steph_Achenbach @mmamas1973 @DrMarthaGulati
Firstly, an amazing DIGITAL experience... Brining everyone together, breaking all barriers, diminishing borders.
@Barbara_Casadei @Steph_Achenbach @mmamas1973 @DrMarthaGulati
In an earlier (still ongoing) Poll from today... 77% wished to have a hybrid Digital and In Person conference... That would certainly have lots of attractions especially for those who wouldn't other be able to afford it #ESCCongress
@MarziaRigolli
@MarziaRigolli
Check out the #MINOCA section in updated NSTE-ACS guidelines at #ESCcongress
bit.ly/3bcrixp
Here is a tweetorial on #MINOCA
🧲Class I Recommendations🧲
-> Use of Diagnostic algorithm
-> Use of #whyCMR
-> Use of working dx & Rx according to the underlying Dx
bit.ly/3bcrixp
Here is a tweetorial on #MINOCA
🧲Class I Recommendations🧲
-> Use of Diagnostic algorithm
-> Use of #whyCMR
-> Use of working dx & Rx according to the underlying Dx
MINOCA has MI in it-> DOES the definition allows for the inclusion of non-ischemic causes of troponin elevation?
Given this limitation of the troponin bioassay, the “Fourth 4th Universal of MI" defined Injury from infarction
INJURY IS NECROSIS WITHOUT ISCHEMIA!
#ESCCongress
Given this limitation of the troponin bioassay, the “Fourth 4th Universal of MI" defined Injury from infarction
INJURY IS NECROSIS WITHOUT ISCHEMIA!
#ESCCongress
The hallmark of myocardial injury ⬆️ troponin, However, these entities differ conceptually
▶️ myocardial injury = nonischemic mechanisms of myocyte injury (eg, myocarditis),
▶️MI = ischemic mechanisms (eg,
plaque disruption or supply-demand mismatch).
#ESCCongress
▶️ myocardial injury = nonischemic mechanisms of myocyte injury (eg, myocarditis),
▶️MI = ischemic mechanisms (eg,
plaque disruption or supply-demand mismatch).
#ESCCongress
Understanding Invasive Coronary Angiography:
What it is? Where it is? Where it goes?
🧵 w/ several (usual) projections (full video link at the end).
#CardioEd #CardioTwitter #RadialFirst @PCRonline
@INC_CathLab @EduardoAArias1 @moisesjimenezs @sergiopatronMD
What it is? Where it is? Where it goes?
🧵 w/ several (usual) projections (full video link at the end).
#CardioEd #CardioTwitter #RadialFirst @PCRonline
@INC_CathLab @EduardoAArias1 @moisesjimenezs @sergiopatronMD
The 3D model:
Coronary arteries segmentation and reconstruction of a patient with left dominance and their relationship with both ventricles (different patients in the CT and the invasive angiography but both with left dominance for an illustrative correlation).
Coronary arteries segmentation and reconstruction of a patient with left dominance and their relationship with both ventricles (different patients in the CT and the invasive angiography but both with left dominance for an illustrative correlation).
Left coronary: LAO + Cranial.
Good exposure of the LAD and diagonal branches/bifurcations. This case also good for the PD (plus: there is a severe stenosis after the 1st Diag branch).
Good exposure of the LAD and diagonal branches/bifurcations. This case also good for the PD (plus: there is a severe stenosis after the 1st Diag branch).
#cardiotwitter -need help how would you manage this case. Attempting in 2 hours. EF normal and advanced Parkinson’s 68 yr old male @rwyeh @DKarmpaliotis @ajaykirtane @JAG24851 @mmamas1973
1- support no support 2-bifurcation strategy
1- support no support 2-bifurcation strategy
1/6 #Cardiotwitter - check out this #Tweetorial
"CV considerations & #COVID19"
💥Viral cell entry using ACE2
💥ACEi/ARB - don't stop - no evidence of harm/benefit
#ACCFIT #MedEd #Medtwitter #HMHFellow @HMHCardioFellow @HMethodistCV #StayHomeSaveLives #FlattenTheCurveTogether
"CV considerations & #COVID19"
💥Viral cell entry using ACE2
💥ACEi/ARB - don't stop - no evidence of harm/benefit
#ACCFIT #MedEd #Medtwitter #HMHFellow @HMHCardioFellow @HMethodistCV #StayHomeSaveLives #FlattenTheCurveTogether
2/6
💥Increased #COVID19 mortality with CVD
💥Association between elevated troponin and mortality
💥#COVID19 + elevated troponin -> older patients, more co-morbidities, higher acuity
💥Increased #COVID19 mortality with CVD
💥Association between elevated troponin and mortality
💥#COVID19 + elevated troponin -> older patients, more co-morbidities, higher acuity
3/6
💥ACC: Measure troponin & BNP if considering ACS / HF clinically
💥Based on studies, ?consider using troponin as prognostic marker
💥ACS: GDMT, consider cath lab staff exposure, ?fibrinolytics in low risk ACS
#COVID19
💥ACC: Measure troponin & BNP if considering ACS / HF clinically
💥Based on studies, ?consider using troponin as prognostic marker
💥ACS: GDMT, consider cath lab staff exposure, ?fibrinolytics in low risk ACS
#COVID19
Don’t forget the RV: by #DrJamesGoldstein...
DOI: doi.org/10.1016/j.ijca…
Drs @SukhNijjer, @jerd10 and @RicardoPetraco. What are your views on @DavidLBrownMD fallacies of FFR?
As a budding interventional cardiologist, I like to hear all opinions and sides to the story :)
Drs @SukhNijjer, @jerd10 and @RicardoPetraco. What are your views on @DavidLBrownMD fallacies of FFR?
As a budding interventional cardiologist, I like to hear all opinions and sides to the story :)
“In conclusion, FFR in isolation is of no proven clinical value in the evaluation of patients with suspected ischemia. The ESC guidelines continue to promote an outdated paradigm for the evaluation of suspected ischemia that focuses on the focal epicardial stenosis.”
The 4 fallacies
1/4 - The first fallacy is the foundational premise of FFR that ischemia caused by a focal obstructive epicardial coronary stenosis is on the direct pathway to death or MI and therefore should be a target of revascularization
1/4 - The first fallacy is the foundational premise of FFR that ischemia caused by a focal obstructive epicardial coronary stenosis is on the direct pathway to death or MI and therefore should be a target of revascularization
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
#Symptoms
Profound exertional dyspnea
#Imaging
▪️SAM/LVOT obstruction #whyCMR
▪️Classic #Doppler🗡#echofirst
#Hemodynamics
▪️Brockenbrough-Braunwald-Morrow sign, explained
#Treatment
▪️Alcohol🍷septal ablation #RadialFirst
🙏 @hopkinsheart @JonResar @RaniKHasan @kman8585 @DoctorLatina for unlocking these concepts for me!
@PushpaShivaram @AnastasiaSMihai @HeartOTXHeartMD
@DavidWienerMD @DrJayMohan @DxRxEdu @MasriAhmadMD @onco_cardiology @NadeenFaza @dr_chirumamilla @mirvatalasnag @TheVeggieMD
@PushpaShivaram @AnastasiaSMihai @HeartOTXHeartMD
@DavidWienerMD @DrJayMohan @DxRxEdu @MasriAhmadMD @onco_cardiology @NadeenFaza @dr_chirumamilla @mirvatalasnag @TheVeggieMD
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 ...
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 ...
#WeeklyCardioReview Left main: #PCI or #CABG? A methodological review of #EXCELtrial and #NOBLEtrial, research in context and final answer to what should I do with my patient with #LMdisease. Stay tuned, enjoy and comment
#EXCELtrial Intended population: 2010-2014
1. LM >70% visually, or >50% hemodynamically significant
2. Heart team suitable for both Tx
3. SYNTAX score <32
1. LM >70% visually, or >50% hemodynamically significant
2. Heart team suitable for both Tx
3. SYNTAX score <32
Actual population:
Core lab detected high SYNTAX score (≥33) in 24.2%
Distal LM 80.5%
2 or 3 VD 51.3%
Most common exclusion criteria: Disease too complex for PCI (31.9%)
1905 pts randomized, small cross overs, balanced LTFU
Core lab detected high SYNTAX score (≥33) in 24.2%
Distal LM 80.5%
2 or 3 VD 51.3%
Most common exclusion criteria: Disease too complex for PCI (31.9%)
1905 pts randomized, small cross overs, balanced LTFU
