Discover and read the best of Twitter Threads about #cardiology

Most recents (24)

Dato importante 馃毃
Si tienes un paciente hospitalizado con falla card铆aca aguda y est谩 cerca del egreso hospitalario, entonces IN脥CIALE a la mitad de la dosis los medicamentos esenciales en falla card铆aca cr贸nica (IECA/ARA2/ARNI + BB + ARM) y c铆talo a mas tardar en 2 semanas馃У馃憞
Si bien las gu铆as recomiendan un seguimiento ambulatorio temprano (2 a 4 semanas) luego del egreso por falla card铆aca aguda, el nivel de evidencia de esta recomendaci贸n es bajo y no aclaran c贸mo se debe iniciar y titular los medicamentos de falla card铆aca cr贸nica.
Sin embargo鈥︷煈
El estudio STRONG-HF mostr贸 que los pacientes asignados al grupo de cuidado de alta intensidad (iniciando la mitad de las dosis antes del egreso y titulando a la totalidad de la dosis a las 2 semanas) presentaban menos el desenlace primario.
Read 9 tweets
馃└馃└ Get Together ~ Hemagglutination 馃└馃└

Come on people now sssmile 馃悕 on your brother

I鉂わ笍these people.

The sugars of blood cells are protective and attach to the SC2馃. But this attachment causes them to clump or agglutinate together, which obstructs capillaries. > https://www.biorxiv.org/con...
"with trillions of RBCs each circulating through narrow pulmonary capillaries about once per minute, even small, dynamically aggregating and disaggregating RBC clumps...can impede RBC oxygenation. Peripheral ischemia, endothelial damage and vascular occlusion are indeed >
observed in serious cases of COVID-19...DAMAGED ENDOTHELIUM OF PULMONARY CAPILLARIES IS OFTEN OBSERVED ADJOINING RELATIVELY INTACT AVEOLI while hypoxemia is manifested despite normal
breathing mechanics." >
Read 18 tweets
Three #cardiology cases with diagnostic ECGs in our resus room today and some learning points for emergency clinicians

#ecg #ekg
1. Sudden onset palpitations

ECG shows regular narrow complex tachycardia with rate around 140
We suspected this was atrial flutter
Rather than subject a patient to the horror of iv adenosine (which only reveals flutter - it can鈥檛 convert it), we moved the ECG limb leads around to get a 鈥楲ewis lead鈥 which better shows atrial activity

(See litfl.com/lewis-lead-s5-鈥 )
Read 13 tweets
Empagliflozin is now my go-to SGLT2i for pts with #diabetes and #CKD or #CHF, over cana or dapa or ertu.

Why?

A: EMPA-KIDNEY: nejm.org/doi/full/10.10鈥
and EMPEROR-Reduced and EMPEROR-Preserved
1/
EMPA-KIDNEY is unique because it enrolled GFR 20-45 *without* proteinuria whereas others (DAPA CKD, CANVAS) enrolled pts with CKD+proteinuria, though DAPA-CKD conducted a subgroup analysis for UACR < and > 1000
The primary outcome was a composite of progression of #kidney disease (defined as #ESRD, a sustained decrease in eGFR to <10, a sustained decrease in eGFR of 鈮40% from baseline, or death
from #renal causes) or death from #cardiovascular causes
Read 7 tweets
1/ For the fellows and #ACCEarlyCareer!

It鈥檚 a coronary thrombus! When to consider thrombectomy? What do you do? Let鈥檚 walk through this鈥#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鈥檚 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

馃攽 contrast staining
馃攽 Lack of calcium on non con image
馃攽 ovoid filling defect (complete lumen)

#Cardiotwitter #STEMI #TIMI
Read 25 tweets
馃挃 Heartbreaker - Fulminant My0carditis 馃挃

An early explanation of the fulminant (lymphocytic) my0carditis seen in Acute COVID supports the finding of sp!ke induced my0carditis arising Post COVID 馃拤 of Dr. Arne Burkhardt. A possible explanation for SAD.

鈽濓笍IL6 & 鈿帮笍. https://link.springer.com/article/10.1007/s00059-020-04909-z
鈽濓笍troponin and new onset arrhythmias https://link.springer.com/article/10.1007/s00059-020-04909-z
鈽濓笍N-terminal pro B-type natriurietic peptide
(NT-proBNP.) What is NT-proBNP?

"If your NT-proBNP levels were higher than normal, it probably means you have heart failure. Usually, the higher the level, the more serious your condition is." https://link.springer.com/article/10.1007/s00059-020-04909-zhttps://medlineplus.gov/lab-tests/natriuretic-peptide-tests-
Read 6 tweets
馃挃 Only The Good Die Young 馃挃

An interesting article interviewing different MDs
(finally! thank you @FLSurgeonGen) talking about the my0carditis risks from 馃拤. Some thoughts:

science.org/content/articl鈥
Standard Meaningless Mr Magoo Disclaimer:
"A tiny number of deaths have been tentatively linked to vaccine myocarditis around the world"馃槃 https://www.science.org/content/article/heart-risks-data-gap
Come out Virginia, don't let me wait

"In June, Portman and his colleagues reported in The Journal of Pediatrics that 11 of 16 patients had LGE about 4 months after their bout of my0carditis...

a CDC team reported that among 151 pts who had follow-up cardiac MRIs after 3 mos
Read 30 tweets
馃拤 Mack the Spike 馃拤

You know when that shark bites, 馃
With his teeth dear
Read 13 tweets
馃У on the Algorithmic Localisation of Accessory Pathways from ECG

A concept I鈥檓 getting to grips with made easier by a beautiful review by #Crinion & @adribaran in Card Electrophysiol Clinic (PMID 33161996)

#EPeeps #MedEd #Cardiology
馃珋Considerations of AP localising algorithms:

A. Only apply to manifest antegrade AP & not concealed AP which conduct retrograde

B. Algorithms focused on atrioventricular AP & not other rarer AP

C. Depend on the degree of preexcitation with

D. Cautions with multiple APs
馃┗ Anatomic Nomenclature

- AP locations is described in the LAO view
- Older algorithms use anatomical descriptions derived from the Valentine heart position & not attitudinally correct nomenclature which can be confusing
Read 6 tweets
Joint British Society consensus recommendations for magnetic resonance imaging for patients with cardiac implantable electronic devices.

1. Recommendations for MRI workflows in patients with cardiac implantable electronic devices.

#CardioEd #Cardiotwitter #CardioScience
2. Workflow for provision of MRI to patients with MR Conditional cardiac implantable electronic devices.

3. Suggested additional steps required prior to performing MRI for patients with CIEDs that are MR Unlabelled or do not fulfil MR conditions.

#CardioEd #Cardiology #Cardio
4. Suggested consent statement for implanting cardiologists when potentially implanting an MR Unlabelled device, or revising/upgrading a device that may then become MR Unlabelled.

#MedEd #MedTwitter #FOAMed #cardio #CardioEd #Cardiology #CardioScience #Cardiotwitter
Read 5 tweets
When your heart is the most important organ. #Pathologists #Cardiology #cardiologist #MedTwitter #Histopathology #pathology ImageImageImageImage
The heart shows inflamation and lymphocytes attacking the organ seeking the combat the SP #Cardiotwitter #MedTwitter #Pathologists #Cardiology #Histopathology ImageImageImageImage
Read 3 tweets
#啶え啶啶班啶掂_啶灌ぞ啶班啶︵た啶昣啶呧き啶苦え啶傕う啶 馃挐 #Congratulations 馃コ

"饾悑饾悽饾惎饾悶 饾悜饾惃饾悰饾惃饾惌饾悽饾悳饾惉 饾惏饾惃饾惈饾悿饾惉饾悺饾惃饾惄 饾悽饾惂 饾惉饾悶饾惎饾悶饾惂 饾悁饾惉饾悽饾悮饾惂 饾悳饾惃饾惍饾惂饾惌饾惈饾悽饾悶饾惉."

#healthcare #cardiacarrest #cardiaccare #cardiaccathlab #cardiacsurgery #CardiacSurgeon#
A cardiologist from Nashik 饾悆饾惈. 饾悓饾悮饾惂饾惃饾悾 饾悅饾悺饾惃饾惄饾悵饾悮 performed a 饾惀饾悽饾惎饾悶 饾悜饾惃饾悰饾惃饾惌饾悽饾悳 饾悳饾悮饾惉饾悶饾惉 饾惏饾惃饾惈饾悿饾惉饾悺饾惃饾惄 at 饾悓饾悮饾悹饾惂饾惍饾惁 饾悋饾悶饾悮饾惈饾惌 饾悎饾惂饾惉饾惌饾悽饾惌饾惍饾惌饾悶.
饾煏 饾悁饾惉饾悽饾悮饾惂 饾悳饾惃饾惍饾惂饾惌饾惈饾悽饾悶饾惉 participated for
2 consecutive days (28 & 29 Aug.2022) to learn 饾悳饾惃饾惁饾惄饾惀饾悶饾惐
饾悘饾悡饾悅饾悁'饾惉 饾惏饾悽饾惌饾悺 饾悗饾悅饾悡 饾悮饾惂饾悵 饾悎饾悤饾悢饾悞.
Read 5 tweets
For those who can't get enough from #ADVOR, below the promised Tweetorial!

Acetazolamide in acute #HeartFailure w volume overload on background high-dose loop diuretics:
馃憤Increases diuresis & natriuresis
馃憤More euvolemia after 3 days & discharge
馃憤猬囷笍LOS
#ESCCongress #Cardiology
First, the unsung hero's of this trial, done with a little bit over 2 million 鈧, bargain for largest diuretic #RCT ever!
@KatrienTartagl2 & her team, with only 3FTE, they ran the most successful trial in #AHF
@PieterMartensMD & @JeroenDauw who did most fieldwork
馃憦
How did we come up with the idea? Actually, cause we all love #physiology. Credits go to Prof. Em. Paul Steels who teached us all how kidneys work.
@GLW_UHasselt

65% of sodium is reabsorbed in the proximal tubules, can be up to 85% in #HeartFailure
Read 12 tweets
Welcome everyone to our 2nd Pediatric on Squares Board Review Course
We are starting today until the coming 8 days
Hope it鈥檒l be helpful and enjoyable course
鉁忥笍 Note that you still can join and register on the course with accessibility to all recorded session until 27th of August ImageImage
Day 1
1st session: Pulmonology Review
By Dr. Bassem Kurdi @Bassemkurdi

#Pediatric #Pulmonology #MCQ ImageImage
Day 1
2nd session: Keys to Answer MCQs
3rd session: Neonatology review
By: Prof. Abdulrahman Alnemari @aalnemri
#Pediatric #Neonatology #NICU #MCQ ImageImage
Read 23 tweets
Excited to see our paper in @CircAHA online ahead of 馃枿锔!

Multimodal approach including #PVloops and #MRI shows differences in physiology between #HFpEF pts w/ 猬嗭笍 vs. 猬囷笍 LVEF ! - implications for therapy?!

馃攽messages in the 馃У below...

ahajournals.org/doi/10.1161/CI鈥

1/7
2/7 Problem:

馃拪responses attenuated in #HFpEF pts w/ 猬嗭笍 versus 猬囷笍 LVEF.

Differential pathophysiologic considerations elusive.
3/7 Approach:

#HFpEF pts w/ LVEF 50-60% (n=21) and LVEF鈮60% (n=35)

Multimodal characterization including #MRI, #PVloops (rest/preload猬囷笍/馃弸锔), EBM (in subset).
Read 8 tweets
Oh my, sit tight & let's unpack how this case illustrates how medicine is an incredibly unsafe training environment for ppl with intersectional vulnerability. 1/9
#metoo #equity #psychologicalsafety #cardiology #MedEd
1) The power gradient creates no ability for learners to speak up against a preceptor. Trainees in specialty programs want to get hired & can't risk pushing back, esp if you are equity deserving. 2/9
2) The culture forces trainees to be submissive to preceptors in clinical settings, you have to follow their lead. If you can't challenge or speak up, you have a psychologically unsafe space & abuse will happen. 3/9
Read 9 tweets
#啶え啶啶班啶掂_啶灌ぞ啶班啶︵た啶 #啶呧き啶苦え啶傕う啶 馃挐 #Congratulations啶嗋い啶 #啶啶椸啶ㄠぎ
啶げ啷嵿啷啶膏啶啶多ぞ啶侧た啶熰 啶灌啶膏啶た啶熰げ鈩笍 啶ㄠぞ啶多た啶曕ぐ啷嬥ぁ
啶曕ぐ啶距啶氞啶ぞ 啶膏啶掂啶 啶︵ぞ啶栢げ 24X07X365
啶膏啶掂ぞ 啶夃お啶侧が啷嵿ぇ 啶曕ぐ啷傕え 啶︵啶 啶嗋す啷
啶ぞ啶啶班啷嵿ぐ啶苦く啷囙い #啶∴_啶溹く啶︵啶猒啶啶ぞ啶班
啶忇ぎ. 啶∴.啶た啶溹た啶多た啶呧え 啶嗋ぃ啶
#啶∴_啶掂た啶ㄠ啶啶掂ぞ啶ㄠ啷囙ぁ啷 啶膏ぐ 啶忇ぎ. 啶∴.
啶た啶溹た啶多た啶呧え 啶灌 啶︵啶栢啶 啶夃お啶膏啶ムた啶 啶灌啶む
啶啶椸啶ㄠぎ 啶げ啷嵿啷啶膏啶啶多ぞ啶侧た啶熰 啶灌啶膏啶た啶熰げ
啶ㄠぞ啶多た啶曕ぐ啷嬥ぁ 啶膏ぞ啶犩 啶灌 啶す啶苦げ啷 #啶曕啶ムげ啷呧が
啶啶班啶膏た啶溹ぐ 啶灌啶む
Read 8 tweets
Got some time to read up a bit. So here we go -

Sustained Monomorphic Ventricular Tachycardia

CF as described in my case - hypotension, syncope & some might even be able to maintain BP
Usually VT with HR > 200 - Hypotension
<150 - can be compensated unlesd LV dysfunction
1/n
Pathophysio - usually focus is an area of fibrosis due to old infarct/inflammation or prior cardiac surgery
Rarely reentry in a diseased purkinje system.

Mechanism - Re entry circuits

DDs
1. SVT with LBBB or RBBB
2. SVT with an accessory pathway
To differentiate 馃憞
2/n Image
Presence of AV dissociation is a reliable marker for VT.

Definitive - electrophysiological study (idk where does this even happen)

Treatment
Initial Mx - ACLS

If Hypotension, Impaired consciousness or pulmonary edema present - Synchronised DC Cardioversion.

3/n
Read 5 tweets
1) Welcome to a new #accredited #tweetorial, Prevention and Management of Heart Failure in T2 Diabetes: The Cardiologist鈥檚 Perspective! Our expert author is Giuseppe Galati MD, MMSc in Heart Failure, @GiuseppeGalati_ , Consultant #Cardiologist #HeartFailure & #Cardiomyopathies Image
2) @GiuseppeGalati_ is at San Raffaele Research Hospital, Milan 馃嚠馃嚬 @SanRaffaeleMI. This program is intended for #healthcare professionals & is accredited for 0.75h CE/#CME credit for #physicians #physicianassistants #nurses #nursepractitioners #pharmacists 馃嚭馃嚫馃嚚馃嚘馃嚞馃嚙馃嚜馃嚭.
3) @cardiomet_CE is supported by educational grants from AstraZeneca, Bayer, Boehringer Ingelheim Pharmaceuticals Inc. and Eli Lilly Company, & Chiesi. Earn credit from archived programs at cardiometabolic-ce.com. Disclosures at cardiometabolic-ce.com/disclosures/.馃檹 FOLLOW US !
Read 56 tweets
Dad bleed to death 5 years ago today.
I usually prefer to remember his life, but ever since I got the letter from @CVSHealth PBM Caremark saying I couldn't continue on the anticoagulant with the lowest risk of major bleeding, Dad's final moments have been heavy on my mind. 馃У
I got the call around 4am from my parent鈥檚 neighbor saying there was blood everywhere in Dad鈥檚 bedroom. Mom was hysterical. EMS were on the scene. 2/
Dad was stabilized at their small rural hospital before being transported an hour to a large academic hospital. He had a major bleed in his lungs. Despite best efforts over the next 48 hours, he had one final traumatic bleed out which could not be stopped.3/
Read 22 tweets
Results of the randomized #ADVOR trial are soon coming your way! It's the largest diuretic trial in acute #heartfailure ever conducted (N=519) and will test acetazolamide on top of loop diuretics. Recruitment is finished and full database lock is anticipated. Find out more (1/9). Image
Appropriate and thorough decongestion is class I recommendation in HFA-ESC guidelines (2/9).
academic.oup.com/eurheartj/arti鈥
#Cardiotwitter #Cardiology #FOAMed #Cardiorenal #MedEd #MedTwitter #Nephrology #ADVOR #HeartFailure2022 #HFA_ESC Image
Only 15% of AHF included in DOSE trial were decongested after 72 hours of high-dose loop diuretic (LD) therapy (3/9).
nejm.org/doi/full/10.10鈥 Image
Read 9 tweets
What to do if the eGFR drops from 50 to 42 ml/min/m2 during decongestive therapy in acute #HeartFailure ?
Short #Tweetorial on worsening renal function (WRF) (1/9).
#Cardiotwitter #Cardiology #FOAMed #Cardiorenal #MedEd #MedTwitter #Nephrology #ADVOR #HeartFailure2022 #HFA_ESC
There is an underappreciated risk of poor outcome in heart failure patients discharged with ongoing congestion and WRF (2/9).
Pivotal paper of @MarcoMetra ahajournals.org/doi/10.1161/ci鈥
Appropriate and thorough decongestion is class I recommendation in HFA-ESC guidelines so DON'T stop decongestive efforts during WRF (3/9).
academic.oup.com/eurheartj/arti鈥
Read 9 tweets
Which statement is correct with regards to the use of diuretics in #HeartFailure with congestion?

Short #Tweetorial on how to use diuretics in heart failure (1/9).

#Cardiotwitter #Cardiology #FOAMed #Cardiorenal #MedEd #MedTwitter #Nephrology #ADVOR #HeartFailure2022 #HFA_ESC
Door to 鈥榙iuretic鈥 time: earlier administration of loop diuretics is associated with improved outcomes independent of HF severity (2/9).
jacc.org/doi/abs/10.101鈥
The first dose of the loop diuretic should be 40 mg furosemide (=1 mg bumetanide) in diuretic na茂ve and twice the home dose in patients on loop diuretic (3/9).
Read 9 tweets

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