, 28 tweets, 14 min read Read on Twitter
1/ Running list of #ActionableKnowledgeItems (AKIs per @keaglemd) from the @ACCinTouch #BigSky19 Conference
2/ From Dr. Greg Hundley @VCUHealth

✔️Cardiac MRI for HF evaluation VERY useful
✔️LGE patterns suggestive for specific diagnoses
✔️T2 images find the "water" --> identify active inflammation/edema (acute injury, myocarditis)
3/ From @keaglemd @umichCVC

✔️Be vigilant for recurrent CV events after Takotsubo/stress CMP (common!)
✔️Might be a role for continued HF medical therapy after "recovery"
4/ From @MeneesMD at @umichCVC

✔️TAVR: new indications? -> studies in low risk, asymptomatic, new disease states
✔️TMVR: future may be combining techniques to address root causes
✔️Food for thought: How do we train future "structuralists" (both surgeons and cardiologists)?
5/ From Dr. Pat O'Gara @BrighamWomens

Primary MR:
✔️Still a surgical disease...when the risk level is not prohibitive and appropriate center/surgeon outcomes.

Secondary MR:
✔️MitraClip story is evolving. Image below gives a new way to look at patient selection.
6/ From Dr. Jim Froehlich at @umichCVC

Consider DOACs in APPROPRIATELY selected patients with:
✔️Need for extended VTE treatment
✔️CAD/PAD (though increased bleeding and not common practice)

*Not all DOACs are equal, so please refer to the individual studies
6.5/ Bonus: Great audience question ➡️ impromptu poll+lively discussion. #CardioMedEd at it’s best!

The question(some artistic license): Patient with stable CAD (>12mo from a stent, on ASA only). Develops new AF (C2V of 3). Low bleeding risk. What regimen would you recommend?
7/ From Drs. Estes, Vogel, Hundley

Syncope in young athletes:
✔️DURING exercise ➡️ NOT NORMAL ➡️ assume cardiac
✔️Cardiac MRI ➡️ info on coronary anatomy/anomalies, etiologies of RV/LV CMP, fibrosis
✔️AFTER exercise > consider BP/HR changes a/w abrupt activity cessation
8/ From Dr. Estes @PittCardiology

Atrial fibrillation + obesity:
✔️Weight loss is key
✔️Ideally >10% + sustained loss
✔️Detect and treat OSA
9/ From Dr. Mollie McDermott @UMneurosciences

Ischemic stroke tips for the cardiologist:
✔️Permissive hypertension
✔️Immediate ASA
✔️Defer AF anticoag for days ➡️ risk of hemorrhage >> recurrent stroke
✔️Stroke during an PCI? ➡️ STAT CT head + check ACT for bleeding risk
10/ From Dr. Vogel

Medical PAD management:
✔️Focus on smoking cessation + structured exercise
✔️Include anti platelets + statins
✔️Consider rivaroxaban, PCSK-9 inhibitors
✔️Be careful with BP goals! ➡️ too low or high = more PAD events (see below)
11/ Dr. Froehlich

Asymptomatic but significant carotid stenosis:
✔️Several treatment options ➡️ variation in practice (see image)
✔️Better to know risks/benefits of the options
✔️CEA ➡️ more MIs, better for older patients
✔️CAS ➡️ more stroke, better for young
12/ Dr. Vogel

Lipid management:
✔️Consider the MESA risk calculator ➡️ includes CCS, family hx, race/ethnicity
✔️Nice summary for non-LDL treatment options (see image)
13/ Dr. Froehlich

DOAC safety points:
✔️Don't bridge with heparin ➡️ just stop and restart if needed
✔️HASBLED score made for warfarin ➡️ not completely applicable for DOACs
✔️Apixaban used in ESRD and obesity ➡️ levels less predictable ➡️ watch for AEs
14/ Dr. Vogel

Diet and exercise recommendations. I can't say it better than this image!
15/ From Dr. Yancy @NMHheartdoc

HFmrEF: mid range EF (40-49%)
✔️Not quite HFrEF or HFpEF - we need to better understand
✔️Ex) post MI

✔️HFrEF with improved EF (>40%)
✔️Do not stop GDMT ➡️ high likelihood to relapse
✔️LV strain and genetic profiles predict outcomes
16/ From Dr. Hundley

Updates in cardio-oncology:
✔️See image for history/guideline overview (many opinions)
✔️Check point inhibitors ➡️ risk of myocarditis
✔️CAR-T ➡️ massive cytokine release ➡️ AFib and major hemodynamic changes
17/ From Dr. Yancy @NMHheartdoc

Cardiac amyloidosis:
✔️Under-diagnosed ➡️ consider in HFpEF and LF/LG AS
✔️Tafamidis for mutant/wild-type TTR ➡️ reduces mortality + improves function/QOL

Cardiac sarcoidosis:
✔️Steroid/immune therapy commonly used but evidence lacking
18/ From Dr. McCord @HenryFordNews

Outpatient uses of hs-troponin
✔️No standardization in assays btw centers ➡️ interpret with CAUTION
✔️Chronic elevation is bad ➡️ increased MACE ➡️ consider CV RF mod
✔️May provide prognostic info on AF stroke/bleeding risk (ESC class IIb)
19/ From @MeneesMD

Flow and CTO:
✔️iFR compared to FFR ➡️ non-inferior ➡️ faster, cheaper, less AEs (no adenosine needed)
✔️CTO ➡️ new techniques/technology/strategy + safer ➡️ consider to improve QOL/ischemia in SELECTED patients
✔️CTO on MACE still TBD
20/ From Dr. Estes

WCDs after MI with ⬇️EF:
✔️VEST trial did NOT show reduction in primary endpoint (SCD)
✔️VEST lingering Qs ➡️ why the mortality (and stroke) reduction ➡️ extra monitoring/care?
✔️Shared decision making is KEY as always! ➡️ "You guide, the patient decides"
21/ From @MeneesMD

AMI with cardiogenic shock:
✔️Culprit vessel >> multi vessel PCI (CULPRIT SHOCK)
✔️Timing, type, and benefit of temp MCS still unclear
22/ From Dr. McCord

What is an MI in 2019??
✔️Many will have detectable hs-trop ➡️ need corroborating evidence to be MI
✔️The DELTA is important ➡️ rise/fall in trops points to MI
✔️Use cutoff values with caution ➡️ 99% somewhat arbitrary + centers deviate from this (image)
23/ From @keaglemd

Risk stratification for non-cardiac surgery:
✔️Most important test still H&P ➡️ find ACTIVE CV disease
✔️No active CV disease ➡️ most can go to surgery w/o further testing
✔️Testing for few patients ➡️ high risk surgery + high risk patient + poor function
24/ From Dr. McDermott

PFO closure:
✔️PFOs very common ➡️ ~25% population ➡️ closure selection should be multi disciplinary
✔️Consider in true cryptogenic CVA + large shunt/ASA
✔️TIA only without brain imaging findings ➡️ unclear benefit
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 Marty Tam
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!

Follow Us on Twitter!

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 ($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!