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Abbott @AbbottCardio
, 12 tweets, 10 min read Read on Twitter
1/Welcome to our second OCTober #Tweetorial 🎃🤓. We’ll talk about diagnosing and treating calcific plaque with #OCTImaging. #imagefirst

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2/The absence of intravascular imaging may lead to underestimation of calcium and improper diagnosis, as seen in the chart below, courtesy of Richard Shlofmitz, MD. #OCTImaging #imagefirst

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3/Calcific plaque is characterized as having low attenuation (light penetrates deep, can see tissue) & clear, delineated edges (appear as “islands” or “rocks”). In this image, calcific plaque is observed from 12 o’clock to 3 o’clock.
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4/When diagnosing calcium, it’s important❗️ to differentiate between (A) deep, (B) superficial and (C) nodular calcium--as seen in these OCT images--to choose the right treatment strategy. #OCTImaging #imagefirst

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5/Let’s review how each calcium type appears on OCT.

Deep calcium appears furthest away from the lumen separated by a thick layer. #OCTImaging #imagefirst

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6/Superficial calcium appears close to the lumen. #OCTImaging #imagefirst

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7/Nodular calcium extends into the lumen. #OCTImaging #imagefirst

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8/ By accessing the degree of calcium burden, you can identify the right pretreatment strategy. Use this handy chart developed by Richard Shlofmitz,
MD. #OCTImaging #imagefirst

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9/During atherectomy, OCT helps visualize fractures in and the reduction of calcium to guide further treatment decisions. #OCTImaging #imagefirst

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10/ #OCTimaging helps you realize the thickness of the calcium as compared to IVUS. OCT is light-based, it penetrates and surrounds calcium; IVUS is sound-based, sound waves bounce off calcium & create a dark shadow, seen below.

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11/Measuring calcium depth w/ an OCT-based calcium score algorithm can help identify calcific lesions that would benefit from plaque modification before stent implantation, concluded in Fujino et al study: bit.ly/2pJ0LRh

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12/This algorithm looks at calcium thickness, calcium angle and calcium length. Lesions at risk of stent under-expansion have a calcium score of 4, based on this algorithm.

➡️ Thickness >0.5 mm
➡️ Angle >180
➡️ Length >5 mm

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1/Welcome to our third #OCTober #Tweetorial 🎃🤓. Here we’ll talk
about how #OCTImaging can help detect the mechanisms of in-stent
restenosis (ISR) to guide treatment. #imagefirst #imagelast

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2/ What causes ISR? Stent underexpansion and neointimal hyperplasia (NIH) are the two predominant mechanisms of stent failure, as cited in this expert consensus document of the European Association of PCI: bit.ly/2PdMGtt

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3/Here’s how stent underexpansion and NIH are seen on angiography and OCT respectively. To spot NIH, look for a large layer of growth on top of an already fully expanded stent.

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Read 7 tweets
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1/Welcome to our first OCT #Tweetorial! We'll cover a few key
concepts and share a step-by-step guide on the basics of image
interpretation 🤓 #imagefirst #OCTimaging

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2/First things first, what is OCT?

OCT stands for optical coherence tomography which is an imaging modality that uses near-infrared light to provide high definition images of the artery.

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3/What are the basic elements of an OCT image? Here's what you see in a radial cross-sectional view:

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Read 8 tweets

Related threads

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#Tweetorial on hypoxemic #respiratoryfailure. #FITSurvivalGuide #FOAMed
1️⃣ Shunt
2️⃣ V/Q mismatch
3️⃣ Low FiO2/low O2 tension
4️⃣ Alveolar hypoventilation
5️⃣ Diffusion limitation
6️⃣ Venous admixture
#CriticalCare
1️⃣Shunt - can be intra or extrapulmonary. No V, only Q. Does not respond to O2 - shunt fraction not exposed to o2. Inflamm alveolar dz (eg PNA) can p/w shunt (imp. vasoconstr.) Think abt PFO w R➡️L shunt in PE, ARDS (elevation in R sided pressures), check bubble study. Aa grad ⬆️
2️⃣V/Q mismatch. More Q than V but regions with low V not entirely excluded from gas exchange. Can improve w increasing FiO2. Probably 75-90% of hypoxemia cases. Wide Aa gradient.
Read 7 tweets
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What’s Your “Shear Stress”?

Want to Know More?

Relax & Read ⤵️ #Tweetorial by @CoronaryDoc + @arnavkumar

⚡️Coronary Wall Shear Stress in 12 Tweets ⚡️

1/12
Main Readings:
1) interventions.onlinejacc.org/content/early/…
2) ow.ly/XmD130mc9X8
3) link.springer.com/article/10.100…
#ACCImaging @ACCCardioEd
2/12
Wall shear stress (#WSS) is the frictional force of blood exerted tangential to endothelial surface of vessel wall & expressed in variety of units (1Pa=1N/m2=10 dynes/cm2)

It is derived from
• luminal geometry
• flow rate
• blood viscosity
• near wall velocity values
3/12
In vivo WSS calculations are derived from computational fluid dynamic (#CFD) simulations created from reconstructed 3D vessel geometries (from biplane angio/IVUS/OCT/CT/MR) combined with patient-specific pulsatile inlet/outlet velocity values (Doppler wire or other methods)
Read 12 tweets
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Antibiotic testing. Let's go.

Tentatively calling this #tweetorial "Antibiotic testing: why and how and huh?"

Important caveat: this is a HUGE topic. I’m mostly going to focus on 1) basic rationale and 2) laboratory methods. And 3) try not to say anything wrong/misleading!
Question #1: Why would a person want to know if bacteria A is resistant to antibiotic B?
And the answer is ...

All are legit answers! But it's very situation dependent and you'd have different reasons for each. Let’s go through them.
#tweetorial #pathtweet #asmclinmicro
Read 28 tweets
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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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1/
 As #ESCCongress nears, I thought I would do a #tweetorial on amyloidosis. Exciting times for the field and new data/treatments expected next week.

#FITSurvivalGuide #CardioTwitter @tony_breu @rodney_falk @marthagrogan1 @amyloidosisfdn @AmyloidosisSupp @Amyloidosis_ARC
2/
 What is amyloidosis?

A protein misfolding disorder in which one of thirty-five distinct proteins pathologically misfolds and aggregates extracellularly as insoluble amyloid fibrils, ultimately leading to organ dysfunction.
3/
 You can see that other diseases like Alzheimer’s involve amyloid deposition. We will focus on two types of amyloidosis that affect the heart and nervous system: immunoglobulin light chain (AL) and transthyretin (ATTR) amyloidosis.
Read 16 tweets
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#Important:
Yesterday late afternoon #Russia/n forces took 3 positions in Qusseyr and Juseh and established checkpoints. #Hezbollah, not informed of the Russian presence, came close to these forces and asked their immediate pull out+
Following the direct intervention of President Bashar al-Assad, the Russian force pulled out this morning and avoided any clash with #Hezbollah in the area.

hezbollah maantin and kept all positions. The #Russia/n move was not coordinated.+

#Hezbollah did not...I repeat, did not pull out one single element from the area.

I spoke to people on the ground: The Russian decision was unclear and considered unwelcome by the forces on the ground. Still, many elements of this move are unclear.

Read 6 tweets

Trending hashtags

#military #VoteThemAllOut #TWEETORIAL #Tweetorial #Pakistan #pathtweetorial #CardioMedEd #epimethodsclub #40weeksiege #papilloma #bushdid911 #landmark #RCTs #tweetorial #NoRNCinCLT #bias #top4of2018 #Ventaneando #STEMI #Iranians #enough #bush43 #SchoolShooting #backtobedside #PFEs

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