Profile picture
Daniel Ambinder, MD @Dr_DanMD
, 12 tweets, 20 min read Read on Twitter
#FITSurvivalGuide #ACCFIT

1/10: Stroke🧠 prevention in afib. #warfarin, #noacs, & LAA occlusion devices.

◽️shared decision making is key 🔑
◽️CHADS-Vasc to stratify risk
◽️factor 💸and CrCl 🚽
◽️DAPT+AC= ↑↑bleeding



2/10
For a quick review on coagulation physiology as it pertains to AC see 📽below.

@dr_chirumamilla @Pooh_Velagapudi @bcostelloMD @majazayeri @fawazalenezi55 @SanChris999 @GuruKowlgi @Nidhi_Madan9 @sabeedak1 @noshreza
@SaggerMawri @nsivcd @DrManiCardio @khandelwalMD @drjohnm
3/10
Warfarin 🐀☣️
◽️interferes with normal post translational gamma-carboxylation of vitamin K dependent clotting factors 2️⃣7️⃣9️⃣🔟

◽️doesn’t inactivate functional clotting factors
◽️prothrombin half life: 72h
◽️Ergo INR effect 24-36 hr
🛑 teratogenic
4/10
For "Valvular afib": Warfarin & LMWH
◽️rheumatic MS
◽️mechanical or mitral valve
◽️mitral valve repair

🛑Class3️⃣: no NOACs for valvular afib. RE-ALIGN

@heartdoc45 @zainasadEP  @docaward @yogitar @KevinShahMD
@sairasamani @sarahhudsonuk @avolgman @rahatheart1
5/10
Data for NOACs vs warfarin in AFib

◽️Dabigatran- RELY
◽️Rivaroxaban- ROCKET AF 🚀
◽️Apixaban- ARISTOTLE, AVERROES
◽️Edoxaban- ENGAGE AF TIMI48

@sunnyvmd @monsangh @feelingthepulse @achoiheart
@akshitsharmaMD @adcaTicTocDoc @rezaemaminia @MartyTamMD @true_EP
6/10
In NOACS: Pay attention⚠️
◽️To CrCl 🚽
◽️💊 interactions
◽️BMI ⚖️
◽️ pharmacokinetic profiles vary 👇

Reversal ◀️
◽️Idarucizumab ◀️dabigatran
◽️Andexanet Alfa◀️Xa Inhibitors *news*🥂

@onco_cardiology @sheelakrishmd @skilicmd @ekgpdx @chadialraies
7/10
NOAC advantages:
◽️lower bleeding risk
◽️no lab monitoring 💉
◽️not dependent on vit K

Warfarin advantages:
◽️cost
◽️ok in renal impairment
◽️easily reversable

@mirvatalasnag @venkmurthy @fischman_david @DrToniyaSingh @DrMarthaGulati @VietHeartPA @Regadenoson
8/10
LA appendage: source of embolization and thrombus formation due to:
◽️intense fibrosis and inflammation
◽️pectinate muscle

Consider for:
◽️↓plts, coagulopathy
◽️recurrent bleeding
◽️intolerance of AC
◽️high risk or prior falls

@cardiojaydoc02 @mark_kaeppler
9/10
Various ways to exclude the LAA👇

◽️LARIAT
◽️WATCHMAN (preferred @HopkinsMedicine)
◽️AMPLATZER Cardiac Plug
◽️Surgical removal

@mmamas1973 @CMichaelGibson @DocSavageTJU @rajivxgulati @SVRaoMD @MinnowWalsh @DrKevinCampbell @krishmd @cardiodee @DrLaxmiMehta @ash71us
10/10
That's a wrap for today! Hopefully with the right strategy we can save 🧠and keep 🧡 happy😍!

Your pharmacist is your friend🤝! Thanks to @johnplinds, Jess Chasler, @kdane_pharmd !

Definitely recommend this #acc app
itunes.apple.com/us/app/acc-gui…
Missing some Tweet in this thread?
You can try to force a refresh.

Like this thread? Get email updates or save it to PDF!

Subscribe to Daniel Ambinder, MD
Profile picture

Get real-time email alerts when new unrolls are available from this author!

This content may be removed anytime!

Twitter may remove this content at anytime, convert it as a PDF, save and print for later use!

Try unrolling a thread yourself!

how to unroll video

1) Follow Thread Reader App on Twitter so you can easily mention us!

2) Go to a Twitter thread (series of Tweets by the same owner) and mention us with a keyword "unroll" @threadreaderapp unroll

You can practice here first or read more on our help page!

Related hashtags

#FITSurvivalGuide #ACCFIT #warfarin #noacs #acc

Related threads

Profile picture
#FITSurvivalGuide: CV disease in Pregnancy #CardioObstetrics

#Tweetorial for new #CardiologyFIT by @MonSangh and @JennLewey @Penn

1⃣CV Physiology
2⃣Peripartum CM
3⃣SCAD
4⃣Valve Dz
5⃣Aortopathy
6⃣Arrhythmias
7⃣HTN Disorders of 🤰
8⃣🤰& Future CV Risk
9⃣Drug Safety
1⃣CV Physiology

**Major changes occur to meet metabolic & circulatory needs of 🚼.

🔸Hemodynamic: ⬇️SVR/BP ⬆️HR/CO ⬆️Plasma ↔️Filling pressure
🔸Structural: ⬆️Chamber/LV mass ⬆️Aortic Compliance
🔸Cardiometabolic: ⬆️Insulin resistance ⬆️Lipid/Trig
2⃣Peripartum Cardiomyopathy

🔸Epi: Blacks>>White
🔸Cause: Double-hit hypothesis
🔸Dx: Idiopathic, EF < 45%, ~ 1 m prior or 5 m after delivery
🔸Rx: HF tx; metoprolol/enalapril safe for lactation; ?bromocriptine, ?lactation
🔸LVEF recovery 👍 future risk
🔸Anticoagulation
Read 12 tweets
Profile picture
#FITSurvivalGuide - Right Heart Catheterizations
1⃣&2⃣ - Applications
3⃣ , 4⃣ , 5⃣ & 6⃣ - Data: Pressures, PCWP Waveform, CO & Shunts
7⃣ - Complications
Take home: RHC = useful diagnostic tool. Safe & effective use depends on thoughtful placement and data intepretation
#FITSurvivalGuide - Right Heart Catheterizations
1⃣ - Applications
Accurate assessment of hemodynamics and etiology of shock
Assessment and management of severe HF e.g. "tailored therapy"
Evaluations of intracardiac shunts, valvular lesions
Perioperative management of severe HF
#FITSurvivalGuide - Right Heart Catheterizations
2⃣ - Applications
Risk stratification for patients considered for ❤️ Xplant
Establishing dx of PAH vs. secondary PH
Ddx: ❤️ vs non-❤️ cause of pulm edema (*caveat: RHC not indicated for routine mgmt of pulm edema or CHF)
Read 9 tweets
Profile picture
Evaluation of Cardiac Masses:
A Tweetorial for #FITSurvivalGuide 🚨 #ACCImaging @ASE360 @SCMR @journalofCMR @ACCinTouch
Dedicated:@dr_chirumamilla & all #ACCFIT in #CardioTwitter
Main Ref: link.springer.com/article/10.100… Palaskas, et al. Curr Treat Options Cardio Med (2018) 20: 29.
Usually, it all starts with an abnormal finding in an echo suggestive of intracavitary mass. How can we tell one from the other? It can be confusing.
For artifacts, I did a Tweetorial already that describes the most common ones. Basic understanding of ultrasound physics is needed to be able to explain them: twitter.com/i/moments/1030…
Read 24 tweets
Profile picture
A #tweetorial on Perioperative risk assessment for Non-cardiac surgeries for #FITsurvivalguide

⚠️NOT "clearance"!

Purpose of consult
-Evaluate pt`s medical status
-Risk assessment
-Management recs
-Treat modifiable risk factors
-"Team" approach for shared decision making
2/ Triggers for perioperative myocardial injury
-Inflammatory state
-Hypercoagulable state
-Stress state
-Hypoxic state

All predispose to ischemia and coronary thrombosis.
3/ Think about- 🤔
-Should pt have surgery? Emergent or not?
-Type of surgery and type of anesthesia?
-Functional status of the pt?
-Relevant medical hx and any ongoing cardiac sx?
-Review the meds.
-Prior cardiac w/u.

Focus on good history and PE, can save a lot of tests & 💸
Read 19 tweets
Profile picture
#FITSurvivalGuide #ACCFIT
Topic - Ventricular Tachycardia!

Agenda:
1- Approach to evaluating #VT
2- Management of #VT
3- Practice Cases

Please share your thoughts & input to this #tweetorial!

@ACCCardioEd @ACCinTouch #FOAMed @MichiganACC
#FITSurvivalGuide #ACCFIT
1/10 – Ventricular Tachycardia
Simplified approach to evaluate tachycardia:
Rule #1 – If HD unstable ➡️ shock!

If HD stable, sit down & think.
Step # 1 - QRS: wide or narrow?
Step # 2 - Rhythm: regular or irregular?

This will narrow DDx!
#FITSurvivalGuide #ACCFIT
2/10 - Wide complex tachycardia

Always consider clinical Scenario!
Look for history of MI and cardiomyopathy ➡️ strongly favor #VT!

* If structural heart disease is present, you will be correct 9/10 times with diagnosis of VT!
Read 26 tweets
Profile picture
#FITSurvivalGuide #ACCFIT
#InfectiveEndocarditis.
1/10 Not comprehensive. ⬇️⬇️some imp. points. Hx, exam, echo, micro data essential to diagnose & treat apporpriately. Suggested read : 2014 ACC/AHA valve guideline with 2017 Focused update.

cc: @dr_chirumamilla
2/10
Incidence varies. Native IE 10-15/100K/year, PVE ~30% of all IE.

Risk ⬆️>60 years, ♂️sex, IV drug use, HIV, hemodialysis, poor 🦷 with infection, Alcoholic cirrhosis, intravascular device, CIED, immunosuppression, Transplants, Rheumatic ❤️ dz...
3/10
-Vegetations - "On the lower pressure side of a cardiac chamber / structural lesion or at site of impact of high-velocity blood jets "

-Acute vs Subacute IE
-Right vs Left sided IE
-Early (<60 days) vs Late ( >60days) Prosthetic IE

⭐️Modified Duke's criteria⭐️
Read 12 tweets

Trending hashtags

#TOpoli #Diagnostics #VCmanagers #CardiologyFIT #OMT #CommunityWellness #Methodologies #EchoFirst #Tweetorial #YesSCCT #ThePowerofZero #FITSurvivalGuide #MAGA #ACCFIT #KPIs #reperfusion #SeniorPartners #PerformanceIndicators #Sensitivity #DetroitCSI #smartcitirs #yourewelcome #TricuspidRegurgitation #whyCMR #smarticites

Did Thread Reader help you today?

Support us! We are indie developers!

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

Become a Premium Member and get exclusive features!

Premium member ($3.00/month or $30.00/year)

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!