Often times in healthcare, we focus on providing medical advice and guidance to patients.

I have realized that patients also enjoy talking about their life OUTSIDE the clinical setting.

Here are few of my reflections: -🧵-

#MedTwitter #MedEd #Cardiotwitter #IMG #Match2023
Make time to learn about your patients outside their diagnosis. It will create a sense of a rapport!

Here are some questions that can stimulate interesting conversations:

1) What kind of work do you do (or did you do)?

2) Have you lived in this city for a while?
3) Do you have a good family / friend support system in the area? Do you have anyone I can call while I am here?

4) Do you enjoy playing any sports? What kind of hobbies do you enjoy? (Can be good in Cardiology to determine METS and baseline functional status)
5) I like to ask questions based on their TV channel they may be watching in the hospital (particularly if a sports fan).

6) If patients are wearing a shirt from their recent travel/vacation, can ask how their trip was.

7) How are your kids/ parents doing?
In the outpatient setting, it can be helpful to create a separate section for 'patient notes' w/ personal details (work, kids and names, sports hobbies).

These can remind you of previous conversations and personal information. Patients appreciate the attention to detail!
This idea was influenced by my wife @salonijairdn. In medicine, sometimes we see patients as a diagnosis (patient w/ HF, COPD, etc)

The better we know and connect with our patients outside of their medical diagnosis, I believe the better care we can provide! Comment 👇

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More from @akhadilkarMD

Nov 28
As a Cardiology fellow, we get a lot of consults for NSTEMI.

Here is my approach/work-up for this consult (Part 1).

*Not to use as medical advice, just tips, and always discuss with your fellow/attending*

-thread 🧵-

#MedTwitter #MedEd #Cardiotwitter #IMG
What is an NSTEMI?

- Part of acute coronary syndrome (ACS)
- Acute plaque rupture that causes partial occlusion to the vessel that results in injury & infarct to the sub-endocardial myocardium.
- Can have non-specific ST-T changes, commonly TWI and elevated troponins Image
Presentation:
- Chest pain (heaviness/pressure) usually > 20 minutes with minimal exertion, new-onset / increase in severity, better with sublingual NTG
- Patients tend to be older, higher comorbid (DM, HTN, HLD) and high likelihood of prior MI, PCI, or CABG
Read 9 tweets
Nov 26
Medical Management for Heart Failure with a Reduced Ejection Fraction.

Here is my approach/work-up for this consult (Part 4).

*Not to use as medical advice, just tips, and always discuss with your fellow/attending*

-thread 🧵-

#MedTwitter #MedEd #Cardiotwitter #IMG
Remember:
- Acute heart failure remain to be the most common indication for hospital admission in adults > 65 years!

- 90-day and 1-year post-discharge mortality is high; studies reported ~14% and ~37%, respectively.

- Management: symptoms, decongestion, & hemodynamics
See if there are precipitating/treatable factors for decompensation!

- Medication non-compliance
- Acute myocardial ischemia
- Arrhythmias
- PE
- Infections (pneumonia, UTI, endocarditis)
- Alcohol/drug use
- Uncontrolled HTN
- BB in decompensated state
- Valvular Pathology
Read 15 tweets
Nov 25
As a Cardiology fellow, we get a lot of consults for systolic heart failure.

Here is my approach/work-up for this consult (Part 3).

*Not to use as medical advice, just tips, and always discuss with your fellow/attending*

-thread 🧵-

#MedTwitter #MedEd #Cardiotwitter #IMG
Presentation:
- Dyspnea: earliest and most common
- Orthopnea: more with advanced disease (90% sensitive and specific), can develop PND and Cheyne-Stokes
- Fatigue/exercise intolerance
- Anorexia, abdominal pain, bloating with advanced right-sided heart failure
Physical Examination:
- Well-compensated: no symptoms
- Volume overloaded: weight gain, elevated JVP, +Hepatojugular reflex (>4 cm)
- Pedal edema (can be non-specific if venous insufficiency, nephrotic syndrome, hepatic dysfunction, use of Ca2+ blocker, or TZD)
Read 9 tweets
Nov 24
As a Cardiology fellow, we get a lot of consults for systolic heart failure.

Here is my approach/work-up for this consult (Part 2).

*Not to use as medical advice, just tips, and always discuss with your fellow/attending*

-thread 🧵-

#MedTwitter #MedEd #Cardiotwitter #IMG
Etiology:

- If the LHC is negative for obstructive epicardial disease, you have to play detective and determine the cause for non-ischemic cardiomyopathy

- Remember ~50% of cases will be non-ischemic cardiomyopathy. It may be challenging to determine the exact cause!
Differentials (Laundry List):
1) Idiopathic
2) Familial
3) Hypertrophic
4) Restrictive
5) Arrhythmia
6) Valvular Heart Disease
7) Hypertension
8) Amyloidosis
9) Sarcoidosis
10) Infectious (Chagas, Lyme, HIV, Adenovirus)
11) Toxins (alcohol, cocaine)
Read 10 tweets
Nov 23
As a Cardiology fellow, we get a lot of consults for systolic heart failure.

Here is my approach/work-up for this consult (Part 1).

*Not to use as medical advice, just tips, and always discuss with your fellow/attending*

-thread 🧵-

#MedTwitter #MedEd #Cardiotwitter #IMG
What is Systolic Heart Failure?

- It is an impaired myocardial performance & progressive maladaptive neurohormonal activation of the cardiovascular + renal systems

- This leads to circulatory insufficiency & congestion

- Most common indication for hospitalization > 65 years
Definition:
- LVEF < 40% with chamber dilation and decreased stroke volume

- Different modalities can vary in measuring EF (can use TTE, TEE, LV gram during LHC, MRI)

- Cardiac remodeling with myocyte hypertrophy, fibrosis, apoptosis, necrosis
Read 10 tweets
Nov 22
As healthcare workers, our responsibility is to improve the well-being of our patients.

In order to take care of others, at the highest level, we need to prioritize our health & wellness.

Here are 4 areas I try to focus on:

-thread 🧵-

#MedTwitter #MedEd #Cardiotwitter #IMG
1) Healthy Eating
2) Sleeping
3) Physical Activity
4) Stress Management

The limiting resources during residency, fellowship, & even attending life are time and energy. As a fellow, I am working on trying to improve these 4 aspects.

Lets dive in:
1) Healthy Eating:

- This is critical because in the healthcare setting, we are expected to do physical work (walk around and see patients) & mental work (medical analysis, clinical decision-making)

- As we know, the brain consumes around 20% glucose and requires energy
Read 11 tweets

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