Discover and read the best of Twitter Threads about #echofirst

Most recents (24)

If you're in clinical practice, you've probably coming across an agitated saline contrast (ASC) study today in some way, shape or form - unclear etiology of hypoxemia, cryptogenic CVA, RV dilation, etc. In light of our review 👇, a 🧵 1/…
The principle is simple - agitated saline microbubbles should never be seen in left-sided cardiac structures (i.e. LA, LV, aorta) and if they are, shunting is happening at some level. Classic teaching here is that the lungs act as a sieve for the microbubbles. 2/
This is partially true. The average pulmonary capillary diameter is ~7-8um (👇) so anything larger will be "filtered" out. What about smaller microbubbles (and there are certainly smaller microbubbles made during the agitation process)? 3/
Read 13 tweets

Old case from 2010...but you know what they say...old is gold! 😁

Female, mid 70s, inter-hospital transfer for urgent angiography due to chest tightness with ischaemic ECG. CP came on 12hrs after distressing news of sudden family death. ECG 👇🏽 Image
Exam - loud systolic murmur, so urgent TTE requested before angio. Here is PLAX. Apologies no ECG, cables on portable Vivid-i were broken!

@angularboxoid @JonathanWHinton @hannahcvimaging @cardiodan @hannahzr @TharushaGunawa4 @MayooranShan @DrMarkMills @dorsetcardio @brwcole
PLAX Zoom...
Read 28 tweets
Brilliant presentation by Dr. @PPibarot on Aortic Valve Calcium Score @MonteHeart CT/CMR Lecture on 10/16/20.
💥Important to begin by appreciating burden of AS.
💥#echofirst remains primary modality to assess HEMODYNAMIC severity.
💥Need other tools to assess ANATOMIC severity!
💥JACC 2019➡️Review non-contrast CT to measure AVC in AS.
💥An example protocol by Dr. @PPibarot ⬇️ measuring calcium burden in en-face view of AV.
💥Pitfalls: inclusion of LVOT, sorta, mitral annulus & cors. Multi-planar reconstruction helps carefully exclude non-AV calcium.
💥Women & Men are different! For a given amount of AVC, 🚺 have a ⬆️ peak jet vel. by #echofirst. For a given peak vel. by #echofirst 🚹 have higher iAVC.
💥AVCd didn’t help resolve the discordance.
💥2017 ESC guidelines for severe AVC ➡️>1200 AU 🚺,>2000AU🚹.
Read 10 tweets
#BSEcho2020 Dr. Bushra Rana @ImperialNHS on 3D Assessment of MR
....Type 1: Annular dilatation
....Type 2: Leaflet Proplapse
....Type 3: :leaflet restriction
✅Severity Assessment
✅Haemodynamic consequences
#BSEcho2020 ✅Severity Assessment
↔️Elliptical orifice (average Vena contract in orthogonal views)
↔️Multiple jets (3D Vena contract area)
↔️Late systolic jets (Volumetric methods)
Integrative approach to grading MR severity
VC area x MR VTI = Regurg Vol
#BSEcho2020 ✅Importance of haemodynamic consequences on outcome
or LVEF <60% but >30%, LVEDd >45 mm
- AF, systolic PAP > 50 mmHg, LA > 60mls/m2, flail segment
Read 5 tweets

OK, this starts off about valves...but then isn't really about valves...but it's the broader educational point (which is relevant to valves) that I want to make this poll I'm afraid, but as always, comments encouraged! 😁

In my office doing Admin, lot to get through & a very busy morning ahead. Asked to r/v a TTE for helping determine AS severity. Pt admitted with heart failure, clinically severe AS is all I know at this point. Now, the golden rule in this situation is *review the whole study*...
Not just one or two images.

But I was super-busy, I BROKE MY OWN RULE and just looked at the relevant images. Here's the PW and CW Doppler tracings (Pt in AF)...
Read 15 tweets
Ok let’s give this a try.
A 51 y/o female with severe pulmonary HTN (PASP >100 mmHg). How severe is the TR? #cardiotwitter #echofirst @AAH_StLukesCV
There is a flow reversal indeed. However, in this case the hepatic flow reversal is pre-systolic due to powerful atrial contraction in the setting of stiff RV. TR here is not severe. This is similar to a large Ar wave in pulmonary veins doppler in patients with stiff LV.
Read 3 tweets
1/ I could go into the specifics of GLS (and perhaps I will later),but this pertains to imaging in general, not only GLS. Very few #echofirst measures have been evaluated as part of a treatment strategy, newer technology mainly in observational prognostic studies.
2/ But when treatment strategy is evaluated, we turn to the oldest measures, because that's where we have basic prognostic data. In valvular disease, we have pressures and stenosis areas, where intervention cut offs have been transferred from invasive to Doppler data
3/ But for ventricular function, even newer studies return to EF!! So EF have been evaluated as treatment guide for CABG, CRT, ACEI. And even in the present days, EF is the inclusion criterion for an ongoing post MI study of beta blocker treatment (EF>40).
Read 4 tweets
#ASEchoJC #Tweetorial on #WASE
Societies of Echocardiography
Normal Values Study

#Echofirst most widely used imaging modality BUT

WHAT IS NORMAL for ❤️ size & function? @JournalASEcho
2/ Prior ❤️measurement studies:
❤️used VARIOUS methods- M mode, M mode & simpsons, 2D
❤️No standard analysis or core lab
❤️Only single race or country/region
❤️?? State of the art machines or techniques

❤️Need for a prospective international observational study #WASE was born
@ASE360 @escardio #EACVI recommended normal values used all over the 🌎 but only represent normal Caucasian people from USA & Europe #ASEchoJC
Read 10 tweets
Comprehensive talk by Dr. @JoaoLCavalcante who who patiently walked us through #WhyCMR in Mitral Regurgitation.
First: different etiologies of MR where #WhyCMR may be applicable:
🧲Primary MR
🧲Arrhythmogenic MVP phenotype (including MAD)
🧲Secondary MR (work in progress)
Limitations of #echofirst:
🧲overestimation of MR by PISA, underestimation of eccentric MR.
🧲poor reproducibility if MR severity (inter- and intra-observer)
🧲Alas, there is no accuracy without reproducibility 👎🏻
#WhyCMR for Primary MR➡️
🧲CIRC ‘17➡️CMR severe-TTE moderate MR outcomes similar to CMR severe-TTE-severe MR.
🧲JACC ‘15➡️👎🏻correlation of MR estimates by #whycmr & #echofirst in pts referred to MV Sx.
🧲💪🏻 correlation b/w post-op LV remodeling & baseline MR severity by CMR
Read 11 tweets
#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
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

...& now the science! In random order (depending on which I could find in my twitter thread most easily!)

No 1. #Covid and the HEART

HTN, Lipids, Diabetes, CAD, heart failure, ALL associated with worse prognosis (critical events & deaths)

Women have it less severely

Read 16 tweets
Excellent session on #Aortopathy by @michelenahector


📌 Aortic root up to STJ
📌 Dilatation per Body size & Pathology
>45mm significant dilatation
📌 Use nomograms to define dilation
📌 Describe Dilatation/segment/accurate measurement in the 📰
Excellent session on #Aortopathy by

📌 Look for RF in Bicuspid Aortopathy Sx cut off 50-54mm
📌 Bicuspid Aortopathy without RF Sx cut off 55mm
📌 Some example of Fusiform AA dilatation VS Root dilatation
#Aortopathy by @michelenahector

Dilatation Phenotypes
🎈Most common:AA dilatation in HTN, BAV
🎈 Marfanoid in Marfan, LDS, BAV root phenotype
Read 5 tweets
Understanding #VExUS from scratch:
A mini #tweetorial on normal hepatic vein waveform genesis 👇 #MedEd #echofirst

1/ Understanding color and direction
2/ What is S wave? #POCUS
3/ V wave #POCUS
Read 8 tweets
#EchoBoardPrep #ACCFIT #echofirst #CardioEd @HMHCardioFellow


"Motion mode"

💡Stand-alone M-mode: 2000 fps
💡2D guided M-mode: 1000 fps
💡2D: 100 fps

#EchoBoardPrep #ACCFIT #echofirst #CardioEd

💡EPSS > 1 cm = Abnormal (not valid if MS or AI present)
💡B-bump = LVEDP likely > 20 mm Hg
💡MV closure before electrical depolarization = Severe AI


#EchoBoardPrep #ACCFIT #echofirst #CardioEd

💡SAM-septal contact in HCM
💡MV prolapse = systolic bowing of the leaflet tips >2 mm below C-D line
💡Reduced EF slope = mitral stenosis


Read 6 tweets

In our hospital, we have seen 2 patients over the past 3 years that presented with acute heart failure and who had severe AR on echo with large, characteristic masses on the AV. This week's poll is simply... what do you think these masses are? (1)
Patient 1 - Female, early 60s, no major PMHx, admitted with 2 weeks worsening SOB and palpitations. No fever. In heart failure, BP 110mmHg systolic. AR murmur. Normal white cell count & near normal CRP on bloods. TTE below...zoomed PLAX view of AV (2)
Here is a TOE view...(3)
Read 12 tweets
(1/22) Acute PE treatment. An ever evolving landscape.

How about a #tweetorial on acute pulmonary embolism (#PE) and how to use mechanical #thombectomy with @InariMedical #FlowTriever?? Lets goooooo!

#InariFellowsEdition #IRad #IC #cardiotwitter
Pic credit @Jonathan_PaulMD Image
2/ From @CDCgov data one American dies of a blood clot every....? #VTE #PE @PERTConsortium #InariFellowsForum
3/ Acute #PE stats

📊100,000–180,000 PE-related deaths annually in US

📊PE is the most preventable cause of death among hospitalized patients

📊3rd leading cardiovascular cause of death after coronary disease and stroke

⏱ 1 American dies of a blood clot every 6 seconds Image
Read 25 tweets


I'm on holiday (staycation 😫) so I'll keep it brief! No poll. Experienced scanners will know this, but could hopefully be of use to physiologists and Fellows in training.

This case focuses on the concept of physiological MR...(1)
Patient having an echo for a different reason (i.e. not murmur) had this AP4Ch view in 2014...

This was reported as "mild MR" and a repeat echo was advised in 2 years...(2)
So the patient returns in 2016 for an echo...

Again reported as "mild MR" and again follow-up advised in 2 years' time...(3)
Read 10 tweets
🔵Right-Sided Infected Endocarditis 2020: Challenges & Updates in Diagnosis and Treatment #CardioEd via @JAHA_AHA
✅Compared w/Left-Sided ⬇️information📚features & management
✅Right-Sided 5-10% of all IE cases
✅Link ⬆️ IV drugs use, intracardiac devices, CVC
(2/7) The modified 2015 duke criteria by @ESC_Journals difficult to apply in these 👥 because of lower sensitivity. Modifications proposed
✅local signs of infection
✅pulmonary embolism
@MediCasos @Drainternista @MrDoctorOficial @ZavalaGerard @AmbrizMau @IsaMathiasMD @cpgale3 Image
✅Staph aureus most prevalent🦠60-90%
#echofirst TTE limited sens detecting veggie attached pacemaker leads. TEE 👍 areas close to or within sup vena cava (70-90% vs 20-30%)
✅Dont forget 🔍embryonic remnants
✅Help w/ 18-PET/TC or radiolabeled white blood cells SPECT ImageImageImage
Read 9 tweets
#EchoBoardPrep #Echofirst #ACCFIT #AHAFIT

Pulmonary Vein Doppler
⚡️TTE: Find on A4C

⚡️TEE: Right veins at 45 and left veins at 120 (Watch: )

⚡️Flow components: S1, S2, D, A

PV flow patterns #EchoBoardPrep
⚡️Healthy: S>D
⚡️Diastolic dysfunction, normal filling pressure: S>D
⚡️High LV filling pressure: D>S

A: Grade 1 diastolic dysfunction, B: Pseudonormal pattern, C: Restrictive filling

PV flow patterns #EchoBoardPrep
⚡️A: Restrictive cardiomyopathy: No resp variation
⚡️B: Constriction: Resp variation+

Read 6 tweets
C’est l’heure du #POCUS du jour !

H, 30a, consulte pour douleurs au bras gauche suite à une rixe avec plaie par tournevis il y a 1 mois.

Cliniquement : masse indurée en regard du biceps.
Conclu comme hématome du biceps par son médecin traitant.

Il consulte devant la persistance de douleurs aux Urgences.

Vous me connaissez, it’s #POCUS time 😉
Je découvre à la pose de la sonde d’échographie un muscle remanié, avec des plages hypoéchogènes non spécifiques à l’intérieur faisant penser à du sang remanié.

Je me suis dis que c’était un hématome vieilli en voie de résorption, jusqu’à ce que je monte la sonde un peu...
Read 7 tweets
🚨 Multi-part case #Tweetorial
24y man no PMH. 3-4 days myalgias, freq diarrhea. 2L saline given on med floor -> hypox/tachypnea. COVID pend.
A 👍
B RR30-34, SpO2 92% 5L NC
❤️ MAP 90, HR 110s ->150s over 12 hrs
D Avpu
E Anxious
L CRP 58 (ULN 0.9), Cr 1.4 (no baseline), Lact 4.8 Image
WOB is moderately elevated.

What diagnostic manuever do you think is most important at this point?
Unlike most MC questions, you also get to choose a therapeutic maneuver while dx is happening. What's your first choice?

More case details to follow tomorrow!
Read 25 tweets
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

Each week I'll post an interesting and, hopefully, educational case related to heart valves.

This week...early systolic MR. We see late MR in prolapse, what about early systolic MR? See spectral Doppler, colour M-mode & movie clip from TOE/TEE...1/2
What's the mechanism of MR? If unsure, what views / images would you use to investigate further?

@BSEcho @ASE360 @echocardiac @doconmoney @TheBJCA @BJCA_Women_LTFT @WessexSpRs @BrHeartValveSoc @DrDanAugustine #echofirst
@hannahzr @hannahcvimaging
So...I thought the jet was pretty central. Lots of comments about possible post leaflet restriction, but what about the timing? Confined to 1st 1/2 of systole? I'll explain what I thought. Below is TOE AV long axis view, 2D and in next message with colour...(1)
Read 7 tweets
On behalf of @ACC Imaging Section Leadership Council & @JACCJournals Imaging, I’d like to invite you to join us for this webinar:

Multimodality CV Imaging in #COVID19 Era: Ramping up safely to a New Normal

Friday, June 19th at Noon ET Image
Safe reopening of #CVImaging labs

What modality?
What patient?

Great @ACCinTouch @JACCJournals #JACCImaging webinar by @WilliamZoghbi @RonBlankstein @salernomdphd @VTaqMD @RigolinVera @mdicarli

1/2 #EchoFirst & #CVNuc ImageImageImageImage
Read 4 tweets
#POCUS #echofirst The correct answer is dilated coronary sinus [48% got it right (of 229 votes)]. From #IMPOCUS standpoint, 2 main causes: persistent left superior vena cava and pulmonary HTN. This pt had the former. Normal anatomy of the coronary sinus (Read #thread)👇 #MedEd
More anatomy: 3D CT angio
We need to understand the anatomy first to understand #pocus orientation
Original image shows the typical location of CS in PLAX view. Don't confuse with descending aorta. You can also see CS from the apical window. From apical 4C, tilt the transducer posterior (in the opposite direction as you would for the 5-chamber view) #POCUS
Read 7 tweets

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