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Venk Murthy MD PhD Profile picture
@venkmurthy
Jun 28, 2020 • 6 tweets • 1 min read • Read on X
COVID19 is serious. We need to take it seriously.

*Nobody* manages MI in anyone on outpt basis. It's malpractice.

Vast majority of 40yo w/ COVID aren't sick enough to get admitted

Many not sick enough for ED visit

Wrong to compare sickest sliver vs entire spectrum
We admit people with MI to the hospital who aren't in that high risk of dying because we have specific hospital based therapies (anticoagulation, angiography) that can reduce mortality and morbidity.
We also do it because the sickest sliver of MI pts are sick as stink and we can't always tell 100% up front which are which.
If a trial tomorrow showed a 48 hour admission for remdesivir improved outcomes compared to outpatient management in non-O2 requiring mold COVID19 pts, you would find the average mortality of COVID19 inpts drops overnight.
A better comparison would be to hospitalized patients with pneumonia from non-COVID causes, but comparing it to heart attack certainly gets people to sit up!
Two tweets back should have said mild COVID and not mold COVID19!

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More from @venkmurthy

Venk Murthy MD PhD Profile picture
Jan 4, 2023
I am hearing from primary care colleagues that parents are concerned their kids are playing competitive sports without EKG/echos.

More valuable than that would be to mandate no games/practice without AED + CPR trained coach, trainer, and/or official present.

Here is why 👇

1/
Screening for underlying issues in fit teens and young adults is low value. The findings are almost always normal and even when they appear abnormal they are usually false positives.

2/
These kids will end up having lots of expensive & potentially invasive testing which will either lead nowhere or lead to an incorrect recommendation not to exercise at a high level. This is tragic and wasteful.

Imagine incorrectly being told you can't play a sport you love!

3/
Read 8 tweets
Venk Murthy MD PhD Profile picture
Jan 3, 2023
To be honest, this is even more complex than the factors in my initial thread. Been rounding so couldn't give it enough detail, but here are few more...

1/
A baseball will deposit that energy in a smaller surface area than a human head generally will. The concentration of that energy is required because if parts of it are not over the heart they won't cause a cardiac problem

2/
The deformation issue is also more complex.

Not only does deformation reduce the energy transferred, it spreads out the time over which the energy is transferred making it more likely part of the energy is deposited outside the vulnerable period.

3/
Read 8 tweets
Venk Murthy MD PhD Profile picture
Jan 3, 2023
Generally trauma to the chest from person-person deposits only a small amount of energy into the heart compared to small hard objects like a baseball or motor vehicle collisions.

The amount of energy is proportional to the square of the velocity of the impact.

1/
There is a huge difference in the square of 90+ MPH fastball (9025 mph-squared) version a 10 MPH person (100 mph-squared) - nearly 100x!

Mass also matters, but the effective mass is not necessarily entire mass of person impacting but unsupported mass, depending on geometry.

2/
Also, some energy can be lost to deformation. This is how padding works - it deforms, dissipating energy.

Humans are also somewhat deformable due to motion of joints, soft tissue, etc.

3/
Read 7 tweets
Venk Murthy MD PhD Profile picture
Jun 27, 2021
This is a *really* bad take.
Why is this a bad take:

1) The self-limited troponemia referred to is not a diagnosis. The diagnosis is myocarditis, post-COVID vaccine

2) The relative awfulness of these diseases is not the only issue. Their relative frequency is not the only issue.
3) Myocarditis is a spectrum. Can range from rapidly progressive to death to mild chest pain with no further consequence. Like most diseases, the mild forms are much more common than the severe.
Read 7 tweets
Venk Murthy MD PhD Profile picture
May 14, 2021
Excellent summary of the status of COVID heart & how it's mostly not a thing

Cardiologists who loudly hyped this should be explaining why they got it wrong & how they will do better

Here are a few tips in mini-thread 👇

Read excellent article first:

statnews.com/2021/05/14/set…
#1 Number one reason seems to be fear

#2 Is that few MRI experts were asked before/during hype. Sports cardiologists & celebrity docs dominated the scene with weak understanding of what these tests were showing & what they showed in normal people.

Selective credentialism sucks.
#3 Early closing of the Overton window is not science. But in this fact checking culture we are quick to determine what is truth and terminate further discussion.

In this case the estimated rate of CMR findings due to COVID was probably off by 100x or more at first.
Read 13 tweets
Venk Murthy MD PhD Profile picture
Dec 2, 2020
What does it mean to have a healthy metabolism?

How does it relate to CVD?

These are questions @RaviShah_MD & I explored in our latest paper!

Here's a tweetorial on methods & results, which take a bit of a different approach than many prior studies.

ahajournals.org/doi/full/10.11…
We started by applying metabolomics to ~2400 people from the CARDIA study

CARDIA is a study of young adults (age 18-30) recruited ~35 yrs ago to watch the development of CVD risk factors & events.

cardia.dopm.uab.edu
We obtained plasma samples from the year 7 exam from ~2400 individuals with good representation of Black & white races, men & women.
Read 39 tweets

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