Gurleen Kaur, MD Profile picture
Nov 16, 2022 12 tweets 7 min read Read on X
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
4/ Awareness about CV disease in women is suboptimal

From survey data, 📉 in awareness about heart disease as a leading cause of death among women from 2009-2019, particularly among Hispanic & Black women
bit.ly/3TQaG3A

Valvular heart disease awareness is low Image
5/ Women have⬆️mortality than men during surgical aortic or mitral interventions

🚩Older age
🚩More frail
🚩More comorbidities

⬇️rates of aortic valve replacement in women than men

Among those referred for AVR, ⬆️TAVR vs SAVR among women than men

bit.ly/3DunZBl Image
6/ How to address?
🔷Identify referral biases for AVR
🔷Need ⬆️ enrollment of women in clinical trials
bit.ly/3VYfFkD

To address disparities in valve disease for women, also need ⬆️ women cardiologists & interventional cardiologists

‼️<4% of TAVR operators are women‼️ Image
7/ 58.7% annualized increase in TAVR operators from 2014-2018, but female operators only📈from 2.5% to 3.9%

⬇️proportion of women interventional cardiology operators compared with women cardiac surgeons

ahajournals.org/doi/10.1161/CI… Image
8/ To⬆️diversity in IC:
🌟Mentorship at every level
🌟⬇️unconscious bias
🌟Improve workplace conditions & promote inclusive culture
🌟Women/URiM in leadership
🌟FDA, industry, societies responsible for ensuring representation in clinical trial leadership
bit.ly/3zc8gEu Image
9/ Summary
✨ Inadequate awareness of valvular disease among women
✨Need to⬆️representation of women in clinical trials to address sex disparities in valvular heart disease
✨Very few women operators for structural heart disease - needs to be addressed at all levels to📈 WIC
10/ 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
11/ After reading this #CardsNarratives Tweetorial, I have a greater appreciation for diversity in cardiology.
12/ Listen to full discussion: cardionerds.com/234-narratives…

Please consider replying with a personal experience or reflection in relation to anything discussed

Thanks to @AmitGoyalMD, @Dr_DanMD, @ThomasMDas for guidance on #CardsNarratives Tweetorials Image

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More from @Gurleen_Kaur96

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
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
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
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
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
Jul 24, 2021
1/ Great #ASPC2021 session by @RonBlankstein on Chest Pain and Imaging

Follow this🧵for some takeaways on
🟣Stress Testing vs. Anatomical Testing
🟣Coronary CTA
🟣Guidelines

@ASPCardio @CardioNerds Image
2/ ‼️ Imaging tests alone do NOT change pt outcomes but how we act on them might

‼️ No one test is always the best test

‼️ Test selection influenced by multiple factors: local availability, prior training, guidelines, evidence

🔜AHA/ACC New Chest Pain Guidelines

#ASPC2021
3/ Stress testing vs. Anatomical

ETT: exercise capacity, not as great for ischemia

SPECT MPI: reversible perfusion deficits, underestimates extent of disease esp if multi-vessel

PET MPI: measure absolute blood flow, calculate myocardial blood flow reserve

#ASPC2021 ImageImage
Read 10 tweets

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