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Angry Cardiologist Profile picture
@AngryCardio
Sep 25, 2020 • 5 tweets • 3 min read • Read on X
According to ET’s piece in Science, “diffuse inflammation of the heart… that can extend throughout the three layers of the human heart to the pericardium… is a typical finding at autopsy after SARS-CoV-2 infections.”

Can anyone verify this—through literature or experience? Image
Thanks to @fitterhappierAJ, who tweeted this European autopsy series: academic.oup.com/eurheartj/adva…
Bottom line summary: lymphocytic myocarditis is rare, and there are many forms of heart injury. ImageImage
Some more details from the European autopsy series: ImageImageImageImage
The last highlighted line suggests EMB or CMR as an adjunct to troponin bumps and/or dysfunction to diagnose “myocarditis”.

I leave it as an exercise for the reader to determine the value of CMR in this clinical scenario to make a positive diagnosis of myocarditis.

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More from @AngryCardio

Angry Cardiologist Profile picture
Feb 19, 2022
Here is a recent RCT of ivermectin in COVID, published in @JAMAInternalMed: jamanetwork.com/journals/jamai…
I have screenshotted why I think are key elements: ImageImage
Abstract ImageImageImageImage
Read 8 tweets
Angry Cardiologist Profile picture
Sep 12, 2021
Working as a scientist in industry, it took me a long time to understand the differences between the research I do now & the research I did as an academic.

A good framework is the differences between pharma & academic research is “Finite & Infinite Games” en.m.wikipedia.org/wiki/Finite_an…
What do I mean?

Briefly, pharma research is directed at answering specific questions to move a drug development program forward—or kill it.

Academic research is directed at answering questions—sure. But the productive questions are those that lead to more interesting questions.
In this sense, pharma research is a “finite game”, with winners & losers.

Academic research is an “infinite game”, where the goal is to keep playing.

This is relevant to the discussion around COVID mRNA vaccine-associated myocarditis.
Read 8 tweets
Angry Cardiologist Profile picture
Sep 12, 2021
Now it’s time for me to weigh in on the “COVID vaccine-associated myocarditis” preprint.
I have tweeted on many occasions that VAERS ought not to be used for analysis, but rather for signal detection.

My view on that remains the same.
I think what is useful from this preprint is as follows:

1) myocarditis/pericarditis seems to be an AE being observed with enough frequency to merit further, systematic attention.

2) Young men & boys are likely at substantially higher risk than older men & women/girls.
Read 10 tweets
Angry Cardiologist Profile picture
Aug 21, 2021
Too many of my colleagues, facing the reality of vaccine-associated myocarditis, are either burying their heads in the sand or throwing up their hands.

In an effort to promote vaccination, they are making what I believe are misguided actions.
I believe vaccination for COVID is our best way back to a normal life. And we need to be honest with people about what we know.

We also need to acknowledge that there is a great deal we can do to minimize the harms of our interventions.
Regarding what we know—we need to be honest about who is affected, and how frequently. We shouldn’t try to make marginally valid comparisons to COVID. The folks you want to persuade won’t believe you anyway. Most people think differently about an active interventions & disease.
Read 5 tweets
Angry Cardiologist Profile picture
Mar 14, 2021
Let’s be clear: 2 months of safety data for a new drug or vaccine is at best marginally better than 1 month for identifying acute AEs. And it has almost no power in identifying chronic/long term AEs.
A 2-month cutoff is not a routine cutoff for evaluating AEs in drug or vaccine development.

Of course, all cutoffs are arbitrary to some degree, but there are typical timeframes that are routinely used: eg 1 month, 1 year.
In the setting of a pandemic, we have to weigh potential risks with benefits. Every day we wait to accumulate more data is a day we are not immunizing.
Read 9 tweets
Angry Cardiologist Profile picture
Oct 8, 2020
Time for another takedown.

Today, it’s the editors of @NEJM for today’s editorial.
nejm.org/doi/full/10.10…
I will start with the references: 2 database queries, and 2 newspaper articles.

Definitely typical for an editorial in arguably the world’s top medical journal.
Regarding the arguments forwarded by the editors, we should first compare COVID rates of cherry-picked countries.

Should Canadians complain that their death rate is ~1000x that of Vietnam?
Read 11 tweets

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