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Gurleen Kaur, MD Profile picture
@Gurleen_Kaur96
Jul 24, 2021 • 12 tweets • 10 min read • Read on X
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1/ Great #ASPC2021 session by @dramitkhera on ACS in Patients with COVID-19

Follow this🧵on pts w/ COVID
🔷Prevention of ACS events
🔷Identification of ACS
🔷Management of ACS

@ASPCardio @CardioNerds
2/ 8 fold📈in AMI w/ COVID even in pts with no ASCVD/FH

Absolute risk for AMI📈in pts with ASCVD. Even higher for FH +ASCVD bit.ly/3eJ2csW

Based on NHANES, 75% of US pop has risk factors (CKD, obesity, smoking, T2DM) for severe COVID
bit.ly/3xYxpQn

#ASPC2021
3/ 🌟Prevention of ACS🌟

🗝️Address barriers to medication adherence and access
🗝️Team-based approach
🗝️Regular physical activity and nutrition
🗝️Cardiac rehab
🗝️Utilize telehealth
🗝️Counsel on promptly reporting new symptoms

#ASPC2021
4/ During 1st wave, decline in ED visits for heart attack (23%) & stroke (20%)➡️delayed/deferred care➡️ repercussions including chronic & debilitating CVD

Study from NC, re-opening phase showed rebound in AMI & ADHF in urban & rural areas
bit.ly/3zoseJM

#ASPC2021
5/🌟 Identification of ACS 🌟

Challenging due to overlapping symptoms & ST changes/troponin elevation also seen in COVID

1/3 of COVID pts had positive troponin from study at Mt. Sinai from earlier in pandemic bit.ly/3rrS4tH
Troponin ➡️ prognostic marker

#ASPC2021
6/ Causes of Troponin Elevation related to COVID-19

♦️ACS
♦️Myocarditis
♦️Arrhythmias
♦️HF
♦️Thromboembolic complications

Also consider other non-direct CV causes leading to📈myocardial demand:
♦️Hypoxia (ARDS)
♦️Sepsis
bit.ly/3kPWk4O

#ASPC2021
7/ Aside on vaccine associated myocarditis…rare

Case series showed:
🔸Usually young males
🔸mRNA vaccines
🔸3-7 day range
🔸Chest pain
🔸Markedly elevated troponin
🔸CMR – late gadolinium enhancement

#ASPC2021
8/ Pathophysiology of ACS
🔹⬆️ thrombosis
🔹Endothelial injury
🔹Cytokine storm
🔹⬆️catecholamines
🔹Microvascular dysfunction

Outcomes of ACS in pts with COVID ➡️delay to admission & door to balloon time, higher cardiogenic shock & mortality
bit.ly/3i1dACB

#ASPC2021
9/ NSTE-ACS & very high risk patient➡️cath
Guidelines: bit.ly/3hWYCxk

Risk stratification tool: POCUS
LV - Myocarditis, ACS, shock
RV - PE, cardiomyopathy
Other: Tamponade, valve disease

CCTA=⬆️neg predictive value in NSTEMI pts (VERDICT trial)

#ASPC2021
10/ Consider ACS risk features & COVID severity

Intermediate/Low risk➡️non-invasive tests (CCTA, CMR)
Poor prognosis➡️conserv. approach

No diff in thrombotic events/death w/ therapeutic AC vs. prophylactic in pts w/ high d-dimer (ACTION trial)
bit.ly/3eDTL27
#ASPC2021
11/ Summary for ACS in COVID

🗝️Prevent ACS w/ aggressive risk factor management, encourage timely care, & VACCINATE!

🗝️ACS can be challenging diagnosis in this population: use POCUS early (think of alternate causes)

#ASPC2021
12/ More on cardiovascular implications of COVID-19 on @CardioNerds website: cardionerds.com/covid19/

#ASPC2021

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More from @Gurleen_Kaur96

Gurleen Kaur, MD Profile picture
Jul 23, 2023
1/ Strategies for medical management of obesity, presentation by @BevTchangMD #ASPC2023

Currently 5 meds FDA-approved for long term management of obesity ⤵️ Image
2/ Who is eligible for anti-obesity medication❓

🫀 BMI >= 30, BMI>=27 with weight related comorbidity
🫀For Asians, BMI>=25-27, BMI>=25 with weight-related comorbidity

#ASPC2023 Image
3/ Efficacy‼️

Expectation of response rate: >5% weight loss over 1 year

Phen/top: 10% weight loss, 70% response rate

Semaglutide: 15% weight loss, 86% response rate

Tirzepatide: 20% weight loss, 90% response rate

#ASPC2023 Image
Read 6 tweets
Gurleen Kaur, MD Profile picture
Jan 19, 2023
1/ Cardiac Stress Testing @CardioNerds
🔶Indications
🔶Types - Exercise vs. Pharmacological
🔶Compare & Contrast Modalities

Thanks to @SimratKaurMD, @AmitGoyalMD, @jholtzman3 for feedback on this infographic!

Follow🧵for a breakdown of the graphic⤵️
2/ Indications

Evaluate:
🔺Stable chest pain in pts w/ intermediate-high risk of CAD
🔺New onset symptoms in pt w/ known CAD
🔺Valvular heart disease & provocative testing in HCM
🔺Microvascular disease & CAV in transplant pts
🔺Hibernating myocardium in pts w/ known CAD
3/ Types❓Exercise vs. Pharmacological

🏃‍♀️Exercise
What➡️Treadmill
Who➡️ Anyone who can exercise (achieve 4 METs) and get to 85% of max predicted HR (220-age)

When evaluating report, look for:
🌟Duration of exercise
🌟METs achieved
🌟% max HR
🌟HR/BP response
Read 12 tweets
Gurleen Kaur, MD Profile picture
Nov 16, 2022
1/ In Episode 234, @PaChapterACC & @CardioNerds featured a Narratives in Cardiology discussion on Structural Heart Disease & LatinX Representation in Cardiology w/ @MayraGuerreroMD, @TDonisan, @AdrianaCMares

Follow this #CardsNarratives 🧵 on Valvular Heart Disease in Women Image
2/ We’ll cover these 2 questions:

❓What are the disparities in valvular heart disease in women?
❓What changes need to be implemented to improve the care of women with valvular heart disease?
3/ I feel comfortable openly discussing or asking others about factors that make them different from myself like race, religion, ethnicity, gender, sexual orientation, immigration status, etc
Read 12 tweets
Gurleen Kaur, MD Profile picture
Aug 30, 2021
1/ In the🥉@PaChapterACC & @CardioNerds Narratives in Cardiology episode @mirmerrill, @scfuentesr, and @NatashaCuk talk w/ @KTamirisaMD

Follow this #CardsNarratives🧵on the discussion about gender equity & women in Cardiology/Electrophysiology (EP)
2/ We'll cover these 3 questions:

🔸Why should we promote gender diversity in Cardiology/EP?
🔸How do we address barriers for women in Cardiology/EP?
🔸What are some opportunities for EP in private practice?
3/ I feel comfortable openly discussing or asking others about factors that make them different from myself like race, religion, ethnicity, gender, sexual orientation, immigration status, etc
Read 20 tweets
Gurleen Kaur, MD Profile picture
Jul 25, 2021
1/ Day 3 & last session of #ASPC2021 on special populations

Talk on MI & HF among people with HIV by Dr. Markella Zanni

Follow this🧵on:
🔹MI risk in people w/ HIV
🔹HF in PWH
🔹CVD preventive approaches tailored to people w/ HIV

@ASPCardio @CardioNerds
2/ Patients with HIV are now living longer ➡️increased risk of CVD

Global burden of atherosclerotic CVD in people living with HIV has tripled over past 2 decades

Relative risk of MI is 1.5-2 in high-income countries

pubmed.ncbi.nlm.nih.gov/23459863/

#ASPC2021
3/ From US Partners database study – adjusted relative risk for MI was around 3 for women & 1.5 for men – regionally specific

Type 1 vs. type 2 MI: both ~50%
Women – more type 2 MI

pubmed.ncbi.nlm.nih.gov/17456578/

#ASPC2021
Read 18 tweets
Gurleen Kaur, MD Profile picture
Jul 24, 2021
1/ #ASPC2021 talk for Honorary Fellowship Award by @NMHheartdoc on New Kind of Prevention – Reducing CV Health Disparities at Community and Individual Level

🧵from session

@ASPCardio @CardioNerds
2/ #ASPC2021
Covid-19 deaths by race and ethnicity in the US:
1 in 555 Black Americans has died

Populations w/ highest disease burden➡️ lowest vaccination rates
3/ Any discussion of prevention shouldn’t start at hypertension, dyslipidemia, but at the root cause of those inequities.

Need to address policy. All policy is health policy.

Stolen breaths nejm.org/doi/full/10.10…

#ASPC2021
Read 10 tweets

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