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Alexandra Ward, MD @DocAWard
, 10 tweets, 7 min read Read on Twitter
1/10 What is chest pain? #FITSurvivalGuide #Tweetorial
- "Pain anywhere in the chest" 🤦‍♀️
- Many things cause chest pain
- ❤️ vs ❌❤️
- ❤️ - ischemic vs non ischemic
- Life threatening vs not
2/10 - Common causes of chest pain (by system) #FITSurvivalGuide
- Cardiac
- Pulmonary
- GI
- MSK
- Infectious
- Psych
- Skin/ soft tissue
3/10 Chest pain- The History! #FITSurvivalGuide
- Going back to medical school 👩‍⚕️👨‍⚕️🥼😷
- The key to figuring out what type of chest pain the patient has!
- Quality, location, radiation, duration, associated symptoms, relieving factors!
4/10 ❤️ Chest pain #FITSurvivalGuide
- Typical vs atypical symptoms
- Again history is 🗝️
- Pain/pressure/tightness
- Some patients will deny chest pain, but endorse pressure
- If prior history of cardiac disease, ask if the symptoms are similar!
5/10 Risk Factors for ❤️ chest pain #FITSurvivalGuide
- ⬆️ age
- Male sex
- FH
- 🚬
- HTN
- HL
- Obesity
- DM
6/10 ❤️ Chest pain - Women #FITSurvivalGuide
- Often present with atypical symptoms
- Have a high index of suspicion
- Not just anxious!!
- Microvascular angina, MINOCA
7/10 ❤️ Non Ischemic #FITSurvivalGuide
- Pericarditis
- Myocarditis
- Heart Failure
- Stress CM
- MV Disease
8/10 Can't miss chest pain etiologies!! #FITSurvivalGuide
- Aortic Dissection
- PTX
- PE
- Tamponade
- Esophageal Rupture
9/10 ❌❤️ Chest Pain #FITSurvivalGuide
- Ask about duration/character of pain
- History is 🗝️🔑!!
- Focus on - duration, character, associated symptoms
- Not all chest pain is ❤️!
10/10 Chest pain work up! #FITSurvivalGuide
- EKG (of course!)
- CXR
- Biomarkers (only if indicated!)
- CTA (PE/dissection)
- ECHO (if indicated)
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#Tweetorial on #Diagnostics and #Screening interpretation.
An otherwise healthy 40 year old woman comes to you after reading on the internet about a terrible disease that one in a thousand women get, and a highly accurate test that can save her life.
The test is over 99% accurate in people with the disease. For those without disease, the test is only wrong 5% of the time.

You order this test and it comes back positive. The woman anxiously asks you, do I have the disease? What is the chance this woman has the disease?
Assuming they weren't immediately fooled by the "test is only wrong 5 % of the time," most I've asked correctly recognize the stats provided are Sensitivity = 99% and Specificity = 95%, and that the objective is to determine the Positive Predictive Value.
Read 21 tweets
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Another #FITSurvivalGuide tweetorial. This time on #intracoronary imaging w/ focus on IVUS and OCT
➡️ Rationale for use
➡️ Tech basics
➡️ Uses
➡️ Data
➡️ Images (high-yield)
➡️Comparison
@z_alirhayim @Almanfi_Cardio @AntoniousAttall @abashirMD @Babar_Basir
Why use them?
- Cor angio limited by: 2D view of 3D artery, diffuse dx, foreshortening, angulations, Ca++, eccentricity, vessel overlap, contrast streaming
- Angio alone ➡️ undetected edge complications, suboptimal stent exp in 15-20% ➡️ adverse events @cardiojaydoc02
IVUS tech: US reflected from vessel wall
➡️ 2 types: Rotational; Phased-array
➡️Rotational: 40-45 MHz, 3.2 Fr, 5 Fr guide, Rx, better near field resolution
➡️Phased-array: 20 MHz, 3.5 Fr, 5 Fr guide, Rx, more trackable
➡️Co-registration with angio now available
Read 13 tweets
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#FITSurvivalGuide #tweetorial Diagnosis of Heart failure: HF is a complex clinical syndrome related to structural or functional impairment of ventricular filling or contraction. HF can be classified into HFrEF and HFpEF based on assessment of LVEF.
Typical HF symptoms are dyspnea, fatigue, edema, orthopnea, PND. NYHA system used to indicate symptom severity. Essential to inquire about onset, duration & progression of symptoms, risk factors for HF (MI, HTN, DM), FH of HF, drug or alcohol abuse, radiation/chemotherapy.
HF is a largely clinical diagnosis. Physical exam must include careful assessment of vital signs, signs of volume overload (JVD, edema, S3, rales on lung exam) and assessment of perfusion (cyanosis, cool extremities).
Read 10 tweets
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My #FITSurvivalGuide Tweetorial on the Dx/Rx of wide complex tachycardia: SVT vs VT
@dr_chirumamilla @Pooh_Velagapudi @bcostelloMD @majazayeri @fawazalenezi55 @SanChris999 @GuruKowlgi @Nidhi_Madan9 @mmamas1973 @CMichaelGibson @DocSavageTJU @rajivxgulati @SVRaoMD @MinnowWalsh
Step 1 w WCT is to assess ABCs. If the pt is unstable or in shock, it doesn't matter what the rhythm is> just shock the patient #FITSurvivalGuide
@sabeedak1 @noshreza @chadialraies @mirvatalasnag @venkmurthy @fischman_david i @vietheartPA @DrKevinCampbell @krishmd @cardiodee
Step 2 for WCT is stop and think. Engage Kahneman's System 2 brain. Embrace Lord Bayes' concept of priors
What are the three reasons a tachy becomes wide?
#FITSurvivalGuide
@SaggerMawri @nsivcd @DrManiCardio @khandelwalMD @heartdoc45 @zainasadEP @docaward @yogitar @KevinShahMD
Read 18 tweets
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#FITSurvivalGuide: The Forgotten Valve-#TricuspidRegurgitation (#TR) #tweetorial for the new #ACCFIT!

1⃣ Anatomy
2⃣ Etiologies
3⃣ Classification
4⃣ Diagnosis
5⃣ Treatment

Resources: @ASE360 @JACCJournals @CircAHA @ACCCardioEd @UMNews @Medtronic

1/10
cc: @dr_chirumamilla
[2/10] Impt to understand #TricuspidValve 1⃣ Anatomy

3 leaflets ⬇️ + fibrous annulus + 2 papillary 💪🏽 + chordae tendinae + RA/RV ❤️

⬛️ Anterior 🍃 (largest)
◾️Posterior
▪️Septal (smallest)

(note: throughout #tweetorial, see image descriptions for more content) TV is largest and most apically displaced valve (normal TV area is between 7 and 9 cm^2). Tricuspid annulus = complex nonplanar 3D structure w/low posteroseptal portion (towards the RV apex) & high anterolateral portion.TV has 2 distinct pap muscles (ant & post) + 3rd variable septal pap muscle. Largest pap = typically anterior w/chordae supporting ant & post leaflets. Posterior pap supports post + septal leaflets. Septal pap is variable: absent in up to 20% of normal patients or small, or multiple.Note attachments of leaflets/chordae to papillary muscles, RV free wall, moderator band.
[3/10] 2⃣ Etiologies = Structural (1º) vs. Functional (FTR)

Keep chart ⬇️ DDx in mind when reading #EchoFirst

~80% of significant TR = FTR/2º to TA dilatation + leaflet tethering ⬅️ RV remodeling ⬅️ volume and/or pressure overload

Structural (1º) cause = less common
Read 12 tweets
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1/
Let’s continue with Day 7 of the cardiology #FITSurvivalGuide #tweetorial! Today we will talk about basics of stress testing for diagnosing CAD.

#ACCFIT #CardioMedEd #FOAMed @ACCinTouch @ACCCardioEd
2/
 Let’s start with a case: 55 y/o woman with CV risk factors presents to clinic with mild CP for 3 months. What is the next test if you want to diagnose significant CAD?
3/
 Not enough info. History/physical critical. Starting meds ok but get a diagnosis if case not clear cut. Exercise testing is better but not appropriate for every patient. Cath first if you believe unstable/high-risk disease or if symptomatic + high-pretest probability.
Read 13 tweets

Trending hashtags

#FITSurvivalGuide #whyCMR #ACCFIT #tweetorial #echoboards #TricuspidValve #teacher #pulmpath #Tweetorial #EchoFirst #flushot #surgery #AmJGastro #gipath #respiratoryfailure #EHR #knoworfail #AntibioticResistance #BSTPath #TWEETORIAL #Collagen #patientsbeforepaperwork #pathpoll #pain #SCAD

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