Discover and read the best of Twitter Threads about #echofirst

Most recents (24)

After yesterday's #POCUS quiz, it's time to reshare these cardiac tamponade infographics.
Courtesy of @ACEP_EUS
Set of 3
See 🧵for the rest
#Nephpearls #MedEd #FOAMcc
Pulsus paradoxus #echofirst
Hepatic vein waveform changes
Read 5 tweets
A 58-year-old woman with no known comorbidities presents with progressive fatigue and shortness of breath x several months. Noted to have bilateral pedal edema; BNP 2,473 pg/mL.
#echofirst 👇❓
Answer and 🔗 to source in thread.
Left atrial myxoma -> pulmonary hypertension (RVSP 93 mmHg) -> RV dysfunction (Note obvious RV enlargement ☝️…
PLAX (same case)
Read 4 tweets
Another set of cardiac #POCUS #anatomy illustrations. 🧵
#Nephpearls #FOAMed
1⃣ Parasternal long axis
2⃣ Parasternal short axis aortic valve level
3⃣ Apical 4-chamber view #POCUS
Read 7 tweets
ICU stories (a brief one): One hour before the end of the am shift, u walk around in the ICU to make sure thinks look OK before u type your sign-out note. You spot the resp therapist & the nurse bagging the pt in Rm 306. From the hallway, u see the monitor: HR 160, RR/45, Sat 70%
This is a 30 yo pt w hx of a catastrophic brain bleed, s/p trach & PEG, admitted 2 wks ago w MDR Klebsiella UTI. Doing well, on trach mask 28%, until the episode of acute/unexpected desaturation
When u examine the pt, s/he is in extremis (accessory muscle use-tachycardic-tachypneic-diaphoretic). BP: 105/55. You grab the stethoscope that the resp therapist wears around his neck & you hear breath sounds in both sides (pt is skinny...)
Read 24 tweets
#MedEd image of the day. What's wrong with the 🫀?
Clinical: A woman in 40s with h/o severe mitral stenosis secondary to rheumatic heart disease & Afib presented with worsening dyspnea, orthopnea, & chest pain x 7 months
See thread for #echofirst images and source/answer.
#POCUS Image
Apical 4-chamber view showing severe right atrial enlargement and annular dilatation of the tricuspid valve during systole.
Severe TR as expected.
Read 5 tweets
Afectación cardiaca en enfermedad de Fabry en 🧔🏻‍♂️de 52 años. EKG con PR corto + HVI. @VazyurVasquez @MDBeni @CuitlhuacArroy1 @ImagenCardiaca @LiliPosadaM @ASE360 @smexcardiologia @Cardiotweets83 @SISIACOficial @Enrique_Berrios #echofirst #Cardiology #Cardiotwitter
La enfermedad de Fabry es un desorden lisosomal de transmisión ligada al cromosoma X debido al déficit de la enzima alfa galactosidasa A, con acumulación multisistémica de globotriaosilceramida (GB3).
La afectación cardiovascular suele manifestarse en forma de HVI, fibrosis miocárdica, ICC y arritmias, que limitan la calidad de vida y constituyen las causas más frecuentes de muerte. En la imagen se observa los estadios de la afección cardiaca
Read 6 tweets
ICU stories: 70 yo pt without medical hx but tobacco use (2 ppd x 40 y) was admitted w shortness of breath a wk ago. CXR/chest CT without PE/infiltrate. Was in afib/RVR on admission; placed on heparin & dilt/b-blocker (w some hypotension). Remained dyspneic, at times restless,
“requiring” multiple sedatives, & eventually was brought to the ICU. Intubated for "resp distress" & mental status changes. "Formal" echo, the day of ICU transfer, showed “LVEF 20% w global LV dysfunction”. On the vent 50% - peep 10. BP 110-130/60-70. Lactate < 2.0
Cards follow for "well compensated heart failure". A look w POCUS upon ICU admission:
Read 20 tweets
💥Question 10 #ASEchoJC

What are the #EchoFirst criteria to determine suitability for PBMV (aka PMBV or PMBC)? After PBMV, how do we define success, and do we identify severe MR?

@SLittleMD @senguptasp @pattypellikka @iamritu @ash71us @JournalASEcho @ASE360 Image
🔺PBMV if symptomatic severe MS, pliable valve, <2+ MR & no LAA thrombus
🔺Consider in asymptomatic severe MS & PASP>50 mmHg
🔺Wilkins score <=8
🔺Importance of careful #iEcho guidance, watch for severe acute MR Image
#ASEchoJC Wilkins score for assessing suitability for PBMV. Can consider >8 in very selected cases based on specific morphologic features. Image
Read 4 tweets
💥Question 3 #ASEchoJC

What are the pitfalls and potential sources of error in assessing rheumatic MS severity by direct planimetry or CWD spectral display of mitral inflow (mean gradient, VTI, PHT)?

@SLittleMD @senguptasp @pattypellikka @iamritu @ash71us @JournalASEcho Image
🔺MG influenced by HR (ok only between 60-80 bpm), cardiac output, mixed valve disease
🔺Always report rhythm and heart rate
🔺PHT >150 ~ MVA <1.5 cm2 in RHD, assuming normal LV & LA compliance (unreliable in calcific MS)
🔺Trace mid-diastolic slope
🔺Avoid after PMBV
🔺2D planimetry should transect leaflet tips perpendicular to LV axis
🔺Overestimation is common; look at the shape of LV in SAX (⭕️vs🥚)
🔺Caution with gain settings
🔺Consider biplane imaging & 3D #EchoFirst
Read 3 tweets
Presión Venosa Yugular: sabes cómo examinarla e interpretarla?
Aquí te lo cuento🧵⬇️
Actualmente, es fácil depender tanto de la tecnología que no tenemos en cuenta el valor de los signos físicos a pie de cama. Sus ventajas son claras:
🔸Sin coste
En posición semisupina, el sistema venoso está parcialmente lleno de sangre y colapsándose por encima de este nivel
Read 20 tweets
55 yo active F with BAV, severe AR and 9 cm aneurysm of ascending aorta! Minimal shortness of breath. My echo tech was panicking when reporting to me. I panicked too. #echofirst #cardiotwitter #CVimaging
55 yo active F with BAV, severe AR and 9 cm aneurysm of ascending aorta! Minimal shortness of breath. My echo tech was panicking when reporting to me. I panicked too. #echofirst #cardiotwitter #CVimaging
55 yo active F with BAV, severe AR and 9 cm aneurysm of ascending aorta! Minimal shortness of breath. My echo tech was panicking when reporting to me. I panicked too. #echofirst #cardiotwitter #CVimaging
Read 3 tweets
1) Welcome to a new #accredited #tweetorial on #hypertrophic #cardiomyopathy #HCM. Our expert author is Ahmad Masri MD @MasriAhmadMD of @OHSUCardio where he leads the Hypertrophic Cardiomyopathy Ctr. See a previous program from him, on #Fabry disease, at…. Image
2a) This program is intended for #healthcare providers and is supported by an educational grant from Bristol-Myers Squibb. Statement of accreditation and faculty disclosures at FOLLOW US for the most timely expert education in #cardiometabolic care!
2b) #Physicians #Nurses #PhysicianAssociates #NursePractitioners #Pharmacists earn a full 1⃣ hour of 🆓CE/#CME credit from following this 🧵. For educational purposes, Twitter still works!! 😁
Read 93 tweets
#echofirst approach to eccentric MR
TEE always need for diagnostic purpose?
@eromerodorta @HenrykDreger @SKelle_Berlin
#echofirst TTE for sure first line of defense in diagnostic workup as we look for dimension, volumes and function to follow GL for decision making
but once #echofirst made clear that there is significant pathology with consecutive enlargement of LV and LA we must hunt down the jet, here we see 2 jets. Now call for TEE or can we proceed with TTE?
Read 8 tweets
ICU stories (a boring one…): If you work in a general ICU of a community hospital in United States, one of the common admissions you will get is the unfortunate resident of a nursing home or rehabilitation center that lives there for several decades & at some point becomes
febrile/“altered” & is sent to the ED for “evaluation”. The course is so predictable that we usually consider these admissions “boring”. This is the case of a middle-aged pt w cerebral palsy/mental retardation/seizures (on valproic)/PEG-chronic Foley in place who was sent to
the ED for fever+hypotension+tachycadia. Labs: WBC 15k, lactate 4.0. UA -as usually- suggestive of UTI (WBC>50, +bacteria, +nitrite, +esterase). CXR “clear” & pt w sat 99% on room air. Received ivf, Abx (pip/tazo + vanco) but due to persistent ⬇️BP, norepinephrine gtt was ordered
Read 25 tweets
#EchoFirst case of the month
🧓86yo with inflammatory syndrome
Poll & 2D images in next tweet 👇👇
Some (suboptimal) 2D images
See 3D in 1st post 👆 @NMerke @VerwerftJan @C_VanDeHeyning @HNSturkenboom
Read 4 tweets
It's December, already. The time of the year when I am trying to spend every last cent of the annual allowance given to us for continuing medical education (CME) by our employer. In essence, this is money that we have worked for and, since it won't carry over to next year, I hate
leaving it on the table. The problem is that if you buy a conference or a study course now, you have to watch everything - and submit proof of attendance/completion - before the end of the year. So, it's a very busy month dedicated to studying/reviewing educational material!
For example, I just finished watching the last one of the 93 lectures from The Hospitalist & Resuscitationist 2022 conference #HR2022. If you are an intensivist/internist/family medicine/EM physician, I have no doubt that u will find several pearls to bring back to your practice
Read 5 tweets
TOP 🔟 ECHOCARDIOGRAPHY CASES ➡️ November 2022 (personal opinion) #medtwitter #pocus #echofirst #cardioed #cardiotwitter #medicaleducation #ENARM #FOAMed
10. Subaortic membrane in the outflow tract of LV @Irina67790690
9. Septal rupture complicating acute myocardial infarction @CyntiaMachain
Read 12 tweets
#POCUS #tamponade #MedEd
Short axis view and 🔗to source in thread.
👆image shows parasternal long axis view with diastolic collapse of the right ventricle.
👇short axis view at the aortic valve level showing right atrial systolic collapse (arrowhead) and RV diastolic collapse (arrow).
#POCUS #echofirst #MedEd
Conventional physical exam!
Read 5 tweets
#AKIConsultSeries:👨w T2DM➡️🏥 for fever, dysuria and CVA tenderness. On arrival: ⬇️BP, ⬆️Glucose, ⬆️AGMA. Dx UTI + DKA. Tx: Abx + Insulin Pump + 4 L Crystalloid + NE

After resus, pt still oliguric, Cr 3.2. NE 0.7 ug/kg/min,🧠confused, BP 85/62, HR 123, 2L O2. CRT 4 sec

Given DKA, giving additional fluids is tempting. But before we do this, its easy to do a quick assessment of fluid tolerance #POCUS

#LUS shows some B-lines (bilat)
#IVC plethoric w no respiratory collapse
#VExUS shows very pulsatile portal vein 🚨🤔

Pulse pressure is low (23!): This suggest a low cardiac output state!

Also, there are signs of fluid intolerance!

#EchoFirst: Window is suboptimal, but we see a Hyper-dynamic LV w small cavity and a turbulent flow (green color). There was no systolic RV failure

Read 12 tweets
Basic cardiac #POCUS views image acquisition flash cards.
Courtesy of Philips Healthcare
#MedEd #Nephpearls #echofirst
Read 10 tweets
Head‑to‑toe #POCUS skills for intensivists in the general and neuro #intensivecareunit population: consensus and expert recommendations of the European Society of Intensive Care Medicine.
Summary of the recommendations
#POCUS #Brain
Thorax #POCUS
Read 6 tweets
Critical care echo lecture #4 @HarvardPulm @MGH_PCCM @PCCSM_BIDMC:
Key slides ⤵️ and brief pearls/takeaways 🧵... (1/8)
#Medtwitter #echofirst #PCCMTwitter ImageImageImageImage
1⃣ Speak to your PH specialists about RVSP role and utility in PH diagnosis and management. That is not its role for the intensivist.
2⃣ Acutely, RVSP can help determine if there is a chronic component to elevated PA pressures (>60 usually not acute!), but does not rule out acute on chronic, nor pseudonormalization in severe RV failure
Read 9 tweets
MAPSE in #IntensiveCare (with examples)🧵#FOAMcc #FOAMed #MedTwitter #Hemodynamic #POCUS #EchoFirst #CriticalCare
Take homes:
1⃣ Redefining "the hyperdynamic heart" with #MAPSE
2⃣ MAPSE is better than EF in the #ICU
3⃣ Linking MAPSE with supply/demand-ischemia
1⃣ Can MAPSE redefine "the hyperdynamic heart?
The term "hyperdynamic LV" - EF > 55% - is misleading. It has no relation to a hyperdyanmic circulation; SV/CO. Someone bleeding to death has a hyperdynamic heart, but the circulation is life-threatening hypodynamic.
MAPSE is cardiac motion, and defining the hyperDYNAMIC heart as good cardiac motion makes perfect sense. Recent geometrical analysis of cardiac pumping shows that MAPSE is the main determinant of SV. Fig from @mugander:
Read 17 tweets
A case of low ScvO2 (60%), high PvaCO2 (8.2 mmHg), fluid intolerance (CVP 11) and fluid responsiveness (PPV 17). What's the physiology and what to do?
#FOAMcc #Hemodynamics #ThePeoplesVentricle #FOAMed #Fluidtolerance #Cardiotwitter #CriticalCare
Post-cardiac surgery. MAP 70, HR 95, low dose pressor. High CVP (11 mmHg) with pathologic waveform of x < y-descent. PPV > 17 despite low Vt (< 6 mL/kg). Normal blood gasses, normal lactate.
#EchoFirst #POCUS #TEE: Mildly reduced LV function; #MAPSE 5.75 mm. EF visually 45-50%. Small EDV.
Read 11 tweets

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