Discover and read the best of Twitter Threads about #cardiotwitter

Most recents (24)

Time for my first Twitter Poll!

I believe we should abandon the terms 'sensitivity' and 'specificity' of non-invasive imaging tests. 20th century language, no longer fit for purpose! I'll explain why after poll closes.

Do you agree?

@BSEcho @ASE360 @BritishCardioSo @escardio
Read 11 tweets
馃У#InsuficienciaCardiaca RESISTENCIA A LOS DIUR脡TICOS (RD)

Recordatorios pertinentes:

Punto de partida: LA CONGESTI脫N (pr贸ximo editorial para SIAC)

Prevalencia de la congesti贸n en #IC aguda 80-90% (Guias ESC)

#CardioEd #cardiotwitter
Los m谩s usados: Diur茅ticos de asa. Inhiben el NKCC2 generan natriuresis, cloruresis y kaliuresis. Diuresis hipo o isot贸nica.

La expansi贸n del volumen extracelular tiene una relaci贸n linear con la excreci贸n de Na (Walser M Kidney Int. 1985).

#HeartFailure #Cardioed
Caso:
馃馃徎+ disfunci贸n severa del VI馃挃 + francos signos de congesti贸n
TA 140/80

Furo: 40 mg VO 鈥 馃彞 馃搱40 mg BID primer d铆a y 120 mg BID al 3er d铆a

Diuresis: 1900 y al 2do d铆a 900
Cr basal: 1.3 a las 48 hs 1.6
Persistentes signos de sobrecarga
馃搲1 1kg de peso 鈿栵笍
Read 25 tweets
18 y old male repaired CHD as a child
Dyspnea class III stable BP and O2 sat 95% LBBB
Echo No Shunt
What is the next step?
@AlkashkariWail @MasriAhmadMD @CincyACHD @purviparwani @cardiopedhnn
#cardiotwitter #whyCMR #echofirst
@iamritu @MayoClinic @ACHDatStanford
This is r-TOF in HF with severe biventricular dysfunction absence of residual valvular stenosis or regruge and no shunt or COA
Provided approach to ACHD patient with HF
sciencedirect.com/science/articl鈥
#cardiotwitter #whyCMR #echofirst @AHAMeetings
Read 5 tweets
16 y with Syncope /differential cyanosis / clubbing

@AlkashkariWail @MasriAhmadMD @CincyACHD @purviparwani @AriCedars @FredWuMD
@PushpaShivaram
#cardiotwitter #whyCMR #echofirst
@RoyalFreeNHS @MayoClinic @ACHDatStanford
@threadreaderapp
@ResearchGate
Approach
PDA Eisenmenger (high risk)
Pulmonary Artery aneurysm(PAP) diameter >40 mm
Echo ( RVH- RVSP 81mmHg)
Sagittal CMRI confirm large PDA (R to L shunt)
Cath/hemodynamics and Acute vasoreactivity test (AVT) confirmed Elevated PVR (Non reactive )
#cardiotwitter
Read 4 tweets
My very first #ExerciseIsMedicine #Tweetorial is here: Breaking 鈥渋t makes me feel good鈥 into pieces馃馃榾馃弮鈥嶁檧锔忦煆娾嶁檪锔忦煔#Thread 猬囷笍猬囷笍
#TwitterPoll at the END
1/ Are you exercising馃弮鈥嶁檧锔弔o boost your mental well-being during the pandemic馃? People exercise because it makes them feel good馃檭, but what exactly happens in our body? Keep reading to satisfy your curiosity & learn about the #mechanisms behind aerobic exercise & #mentalhealth
2/ Anxiety and depression are common mental health conditions. The prevalence in cardiac patients is ~20-30% & 2x higher in 鈾锔 vs 鈾傦笍. Social roles (e.g. caregiver role), cultural norms (e.g. societal sexism) and more pronounced hormonal shifts in 鈾锔 influence this sex-difference
Read 28 tweets
My team recently asked WHY we give Fe to pts with HFrEF+anemia.

First answer: b/c someone told me so
Better answer: let me get back to you on that

Let鈥檚 explore and try to understand, #medtwitter #medstudenttwitter 0/14
1/First off, it helps to review a general schema for anemia.

Blood loss, decreased production, increased destruction

So, why are patients with HFrEF anemic?
2/Controlling for other co-morbids or meds that can lead to blood loss and destruction, it turns out that 鈫揜BC production drives anemia in HFrEF.

Why?
Read 17 tweets
Does this sound familiar? In 1918 the "Spanish flu" Pandemic hit the world amid WWI. The global losses caused by the pandemic far exceeded those of the war. The economy froze, meetings were banned and the healthcare system was overwhelmed. #Pandemic Newspaper scrapbook from 1918 Chicago Eagle, March 1919The Su, October 1918The Washington times, October 1918The Post, October 1918
Hospitals suffered doctor and nurse shortages, many sacrificed their lives on the frontlines. The post, October 1918The New York Herald, January 1919
Many denied the epidemic existed and some came up with None-scientific remedies for it! Some blamed it on the enemies (Germany at the time). The Rock Island Argus, July 1918The Washington times, Oct 1918
Read 6 tweets
It鈥檚 been over 2 months since the first descriptions of cardiac manifestations of Covid-19. There have been many papers and reviews on this topic. What have we learned about how SARS-CoV-2 can affect the heart? #whyCMR #cardiotwitter
Troponin elevations and low EFs are frequently described. Why do they happen? Most papers use the term Covid-19 myocarditis. But can SARS-CoV-2 cause fulminant myocarditis (= extensive focal myocardial necrosis, as seen with viral lymphocytic or giant cell myocarditis)?
I tried looking at published CMR images and autopsy studies to get some insights into what happens in the hearts of Covid-19 patients. I鈥檒l share my thoughts on 10 papers with CMR images and 2 papers each with autopsy data in >10 patients:
Read 28 tweets
#Cardiotwitter: Continuing with timing. Timing can easiest be determined by Doppler, by the start of flows and the closing clicks of valves. The timing by Tissue Doppler is less obvious, but can be done, when the correct events are understood.
1/ IVC duration is shortened by rate of force development, which again is a function of preload and contractility, however also increased HR, by force-frequency relationship. Time to AVC depends on the SBP, I.e. afterload, so IVC is both preload, afterload and HR dependent.
2/ LVET is related to SV. Thus, just as IVC, it increase with preload and contractility. But on the contrary, LVET decreases with afterload (猬囷笍 SV). And finally, it decreases with HR. Thus, for LVET to be useful, HR correction must be applied (LVETc).
Read 10 tweets
Cardiac electrophysiology as cats, a thread. (With apologies to @jeanqasaur). #epeeps #medtwitter
#cardiotwitter

AVNRT
AVRT #EPeeps
AVNRT with block in lower common pathway
Read 14 tweets
#Cardiotwitter Prompted by a question earlier, I would like to go through the dynamics of the pre ejection dynamics of the mitral annular movements.
1/ Electrical activation occurs earliest in mid septum and inferolateral base through the left anterior and posterior bundles, delay 5 - 15 ms. Additional elerctromechanical delay, 30 - 40 ms: Active contraction could be expected to start after about 50 ms; before the end of ECG.
2/ Pressure increase starts in accordance with this, before mitral valve closure, and as LV pressure at this point is low, some shortening would be expected too. By M-mode of the Mitral ring, a small, initial motion towards the apex can be seen.
Read 9 tweets
#COVID19 Damages So Many Organs at 3 Different Stages/Time Points!

New Post on Multiorgan #POCUS Approach with ED/Outpatient and Inpatient Algorithms. #tweetorial #medtweetorial馃憞 (1/6)

pocus101.com/multiorgan-poc鈥

#POCUSforCOVID #cardiotwitter ImageImageImage
1) Knowing the 3 Stages #COVID19 can help figure out when to look for specific diseases during the admission process

Stage 1: Constitutional symptoms
Stage 2: Pulmonary Complications
Stage 3: Cardiac/Thromboembolic Complications

Figure by Akhmerov 2020
pocus101.com/multiorgan-poc鈥 Image
2) ED/Outpatient Setting should initially focus on Stage 2 (Pulmonary Complications) on #POCUS but still screen for Stage 3 Cardiovascular Complications Using Cardiac/DVT ultrasound.
pocus101.com/multiorgan-poc鈥 Image
Read 7 tweets
THREAD
1/ I hope no one believes that I am an expert on #SARSCoV2 or believes that 鈥淚鈥 think I am an expert on #COVID19

In an effort to contribute to the greater good of this #pandemic pandemic, I have been trying to utilize my clinical research experience and help remotely
2/ ...in lieu of actively seeing patients on the front line.

My role has been asking questions, synthesizing ideas, and hoping to catalyze discussion amongst colleagues. Am I actually helping anyone? Who knows? lol

So again, more thinking, more questions鈥 (#neuro #ENT focus)
3/ I was thinking about those 2 neurological cases:

24yo M, Meningitis/Encephalitis -NP swab, +CSF (JAPAN)
sciencedirect.com/science/articl鈥

58yo F, Acute Hemorrhagic Necrotizing Encephalopathy +NP swab, CSF unable to be tested for SARSCOV2 (USA/MI)
pubs.rsna.org/doi/10.1148/ra鈥

Bizarre.
Read 29 tweets
Happy Easter Sunday!

Today's tweetorial is short and nasty, like me.

#FOAMED #MEDED #Cardiotwitter

Last night I broke into a pharmacy to steal some drugs.
After crowbar'ing my way in, I was in an Alladin's cave of stuff.
With my full-face Covid Scarf (漏 Donald Trump), I couldn't read the names of the medications.

So I just loaded up my backpack full of any medications I could lay my hands on, and ran for it.
Read 62 tweets
1/
猸愶笍How do we manage CAD in advanced CKD?

In this #Tweetorial, @BUMedicine classmates/future coresidents @RahulAggarwalMD and I review:

馃敺#ISCHEMIA-CKD @NEJM #ACC2020
By @SripalBangalore @nyulangone & et al!

#MedTwitter #CardioTwitter #MedEd #COVID19 @MedTweetorials
2/
First off, a refresher pop-quiz on the #ISCHEMIA (Outcomes) trial @NEJM we summarized in last week's #Tweetorial!

Q: Patients with stable CAD and moderate/severe ischemia have better outcomes with which intervention?
3/
If you missed our #Tweetorial last week, here is the link to review our summary of the #ISCHEMIA Outcomes main trial results:

Read 15 tweets
1 - #coronatsubo : A patient followed by my friend @BrunoSband: (Thread)
Female, previously healthy, 42 yr, admitted to ICU w/fever, weakness, nausea, cough and dyspnea, sat O2<75%. PCR positive for SARS-Cov-2. Take a look at admission CT scan:
2 - Admission Chest CT. Intubated, mechanical ventilation. Started on chloroquine, azythromicin and ceftaroline (ground glass opacities but also consolidation)
3 - 3.Baseline EKG and also shown EKG on 5th day, w/scary ST elevation. Troponins only slightly elevated. IL-6 on 5th day: 790 pg/ml 鈥 Extremely elevated (Cytokine storm?).
Read 8 tweets
馃梻锔廡HREAD: U.S./global #COVID19 clinical/research patient/healthcare worker registries seen on #medtwitter

Many specialty-society/focused registries launched in last few weeks, attempt to collect them here

List 馃憞馃徑

1/n
2/n: @SCCM's VIRUS: Viral Infection and Respiratory Illness Universal Study @covid19registry

Inclusion criteria 馃憞馃徑

sccm.org/Research/Resea鈥

Find out if your site is already enrolled: docs.google.com/spreadsheets/d鈥

#Pulmonology #Pulm #CriticalCare #PCCM
3/n: International #COVID19 Dermatology Registry led by @DrEstherFreeman @AADskin

Looking for:
1. #COVID19 pts who develop #skin findings
2. #dermatology pts who develop #COVID19

h/t @DrStevenTChen #dermtwitter
Read 11 tweets
1/6 #Cardiotwitter - check out this #Tweetorial

"CV considerations & #COVID19"

馃挜Viral cell entry using ACE2
馃挜ACEi/ARB - don't stop - no evidence of harm/benefit

#ACCFIT #MedEd #Medtwitter #HMHFellow @HMHCardioFellow @HMethodistCV #StayHomeSaveLives #FlattenTheCurveTogether
2/6

馃挜Increased #COVID19 mortality with CVD
馃挜Association between elevated troponin and mortality
馃挜#COVID19 + elevated troponin -> older patients, more co-morbidities, higher acuity
3/6

馃挜ACC: Measure troponin & BNP if considering ACS / HF clinically
馃挜Based on studies, ?consider using troponin as prognostic marker
馃挜ACS: GDMT, consider cath lab staff exposure, ?fibrinolytics in low risk ACS

#COVID19
Read 6 tweets
Although #COVID19 is horrific and changed everything for all of us including #acc20 #WCCardio I just wanted to take a second to reflect on a few things.
1. Social distancing has not been isolating in this day & age. We have been able to gather strength from being in touch #SoMe
2. We have been able to be resourceful & use technology to stay connected with colleagues worldwide, our families and friends. Never before had I felt connected to the world despite being slightly alone physically
3. Did we ever have happy hours together before this, virtually?
4. Did you ever call your parents or siblings so often that you ran out of things to catch up on? Sometimes we have sat in silence and that has been nice. Or watch movies from afar but together. 鈾ワ笍
5. Working together via @zoom_us has been better than just quick call, text, email
Read 8 tweets
Lessons from past #coronavirus & #influenza #epidemics suggest that #viral #infections can trigger acute coronary syndromes, arrhythmias, exacerbation of heart failure owing to a combination of a significant systemic inflammatory response plus localized vascular inflammation.
#COVID19 may either induce new cardiac pathologies &/or exacerbate underlying cardiovascular diseases. A large proportion of patients have underlying cardiovascular disease &/or cardiac risk factors. Factors associated with mortality include male sex, advanced age, comorbidities.
Acute cardiac injury determined by elevated high-sensitivity #troponin levels is commonly observed in severe #COVID19 cases & strongly associated with mortality. Acute respiratory distress syndrome is also strongly associated with mortality in patients with #SARSCoV2 infection
Read 6 tweets
Day 2 after #COVID19 diagnosis.
My thoughts: cases like mine likely pose the greatest threat to society. I鈥檓 still quite functional, mobile and moderately symptomatic but COVID+.

The absolute truth:
YOU DONT KNOW WHO HAS #coronavirus

1/
I鈥檝e read so many #CardioTwitter nightmares that I feel like I鈥檓 waiting for other shoe to drop. Very grateful for benign course so far.
For those of you working and interacting with others outside your home, it is impossible to assess based on how someone looks/feels. #PPE
2/
This is the reason social distancing and staying at home is so important. You can鈥檛 infect or be infected if you stay at your house.

You don鈥檛 know who has it. You cant.

Take pains to protect yourself and others in all of the places you go, as much as possible. #PPE
Read 6 tweets
1/17
SARS-CoV-2 and the RAAS System

Curious about the role of ACE2 in the pathophysiology of #COVID19? Read on!

#medtwitter #cardiotwitter #tweetorial @MedTweetorials @boback @gcfmd @kewatson @datsunian @AliNsairMD @tony_breu @JeffHsuMD @uclaimchiefs @drtishawang
2/
What is the role of angiotensin converting enzyme 2 (ACE2)?
3/
What do ACEi/ARBs do to ACE2 levels?
Read 17 tweets
What explains these heat rates? Image
This was another case of pseudobradycardia.
https://t.co/PDCySjskME
Those of y鈥檃ll postulating a bifid pulse getting read twice per beat by the pulseox - that can happen too like in this post, but usually happens in more hyperdynamic (and this true-tachycardic) patients:
Read 4 tweets

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