Discover and read the best of Twitter Threads about #radialfirst

Most recents (9)

#RadialFirst #ldtra

Radial Access Sleeve Instructions. Easiest Left radial setup around !!!

Optimize sterility for patients and Optimize ergonomics for operators!
1. Have pt raise arm 45 degrees off armboard
2. Place sterile gown or half sheet over armboard
3. Place RAS on pts arm
4. Remove transparent plastic from sleeve fenestration
5. Prep access site
6. Remove tab from back of flap & expose adhesive
7. Approximate flap fenestration 2 access site and seal off by pressing down on all sides
8. Expose adhesive on back of RAS & attach to body drape to create a seamless sterile field
9. Obtain access
10. Adduct arm so sheath hub sits approximately at midline of pt & clamp⬇️RAS
Read 9 tweets
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
2/6

💥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
Read 6 tweets
Kicking off @CRT_meeting #CardiogenicShock sessions: Pathophysiology by @drmortkern...
Don’t forget the RV: by #DrJamesGoldstein...
Trials and evidence (presence and absence) in #Shock treatment: by @thiele_holger...
Read 25 tweets
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 :)
“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 The ESC guidelines continue to promote an outdated paradigm for the evaluation of suspected ischemia that focuses on the focal epicardial stenosis.”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
Read 7 tweets
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
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 ...
Read 6 tweets
#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
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
Read 32 tweets
I had a balloon-uncrossable lesion the other day and wanted to share a potential new tip that I hadn't heard described before (though it's not rocket science). It was a mid-LAD CTO. I was #RadialFirst, 7F EBU 3.75 guide, 6F guidelines as far as it would go.1/x
I could get a 1.2 x 20 mm balloon to cross the lesion and inflated it to 20 atm, but nothing larger would get across, and all the gear kept backing out. I had excellent wire purchase. I suspected there was one spot that was providing the resistance, possibly a spicule of Ca. 2/x
I had asked the crew in the lab to start setting up for rota, but I tried one more thing as they were prepping. I took a 1.5 x 20 mm Rx balloon and pushed it gently as far as it would go. Maintaining gentle force with my L hand, I clockwise turned the balloon with my R hand. 3/x
Read 8 tweets
1/10 “To PCI, or Not to PCI, That is the Question” Will Shakespeare, MD
#FITSurvivalGuide
*Per many contentious #cardiotwitter discussions I realize this is loaded topic but I’m going to attempt an early stage #ACCFIT overview while recognizing there is a lot of nuance.
2/10 Why not “See lesion Fix lesion”?
Poor correlation between est'd visual stenosis & quantitative stenosis. And, without noninvasive ischemic data, coronary angio has limited accuracy w/ regard to identifying significance of many stenoses
*STEMI PCI already done @KhandelwalMD
3/10 COURAGE trial (OMT vs OMT and PCI of visually-estimated significant stenoses): No difference death/MI between OMT & OMT/PCI. PCI demonstrated clinical benefit only when treating relevant myocardial ischemia determined by noninvasive testing.
Read 14 tweets
1/10 #STEMI from ruptured plaque, less plaque erosion. @BraunwaldEugene pic demonstrates LDL oxidized, glycated➡️cytokines release express adhesion molecules➡️monocytes roll, diapedesis➡️ingest LDL, become foam cell➡️SMC migrate, proliferate➡️some apoptosis➡️plaque
2/10 Why #STEMI on #ECG
1. Diastolic current of injury: current away from relatively depolarized injury➡️TQ depression➡️normalized on ECG➡️ST elevation
2. Systolic current of injury: current towards injury due to early repol➡️ST elevation
Read 19 tweets

Related hashtags

Did Thread Reader help you today?

Support us! We are indie developers!


This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3.00/month or $30.00/year) and get exclusive features!

Become Premium

Too expensive? Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal Become our Patreon

Thank you for your support!