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Arjun Khadilkar, MD

@akhadilkarMD

Feb 6

One of the most important diagnostic tests in Cardiology to interpret is the EKG.

Here are my thoughts and notes. Will continue to this thread. Let me know what you think!

Thread #4: ECG Segments

#arjuncardiology #medtwitter #CardioTwitter #MedEd #IMG

General Principles:
- Positive deflection: wave of depolarization towards positive pole of that lead
- Negative deflection: wave of depolarization towards negative pole of that lead
- Biphasic deflection: wave of depolarization is perpendicular to a lead

Normal Sinus P-wave:
- Atrial depolarization that marks spontaneous depolarization of pacemakers cells in the right atrium
- Should be negative P-wave in aVR and upright in lead II
- Can communicate 'sinus rhythm with 1:1 AV conduction'

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Arjun Khadilkar, MD

@akhadilkarMD

Feb 5

One of the most important diagnostic tests in Cardiology to interpret is the EKG.

Here are my thoughts and notes. Will continue to this thread. Let me know what you think!

Thread #3: ECG Leads

#arjuncardiology #medtwitter #CardioTwitter #MedEd #IMG

ECG Leads:
- Body act as a conductor of electricity; the recording electrodes in the arms, legs, and chest wall show the differences in voltage (potential) among electrodes
- Different views of the same event leads to different ECG patterns

ECG Limb Leads:
- 6 Limb leads (extremity leads) and 6 chest (precordial)
- 3 bipolar limb leads: I, II, III
- 3 augmented unipolar: aVR, aVL, and aVF
- 6 precordial leads: V1-V6

Read 7 tweets

Arjun Khadilkar, MD

@akhadilkarMD

Jan 26

One of the most important diagnostic tests in Cardiology to interpret is the EKG.

Here are my thoughts and notes. Will continue to this thread. Let me know what you think!

#arjuncardiology #medtwitter #CardioTwitter #MedEd #IMG

Conduction System:
- SA node (pacemaker cells) have specialized conduction tissue
- SA node is located in the RA near the opening of the SVC
- Stimulation occurs from right atrium to left atrium
- Simultaneous atrial contractions allows for blood filling into LV and RV

Conduction:
- AV Junction: Located at the base of the inter-atrial septum and extends into the inter-ventricular septum; the proximal portion is the AV node and distal portion is bundle of His
- Left & Right Bundle branches depolarize the myocardium via Purkinje fibers

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Arjun Khadilkar, MD

@akhadilkarMD

Jan 8

As a Cardiology fellow, we get a lot of consults for hypertensive urgency/emergency.

Part 4: Clinical Consequences of Hypertensive Urgency/Emergency

-thread 🧵-

#arjuncardiology #MedTwitter #Cardiotwitter #IMG #MedEd

1) Hypertensive Encephalopathy
- Cerebral edema is induced by markedly elevated blood pressures
- Dysregulation of auto-regulatory capabilities of the brain
- Characterized by headache, irritability, and altered mental status
- Treatment of choice: Nitroprusside/Labetalol

2) Reversible Posterior Leukoencephalopathy Syndrome (PRES)
- MRI may reveal white matter edema in the parito-occipital regions

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Arjun Khadilkar, MD

@akhadilkarMD

Jan 3

As a Cardiology fellow, we get a lot of consults for hypertensive urgency/emergency.

Part 3B: Therapy

-thread 🧵-

#arjuncardiology #MedTwitter #Cardiotwitter #IMG #MedEd

Fenoldopam:
- Used mainly by anesthesiologists to control BP intra-operatively
- Selective peripheral dopamine-1 receptor agonist approved for the management of severe HTN
- Arterial vasodilator w/ relatively short half-life
- Contraindicated w/ glaucoma b/c can raise ICP

Nicardipine:
- Dihydropyridine calcium channel blocker that inhibits vascular smooth muscle contraction
- Little to no activity on the AV or sinus node
- Does not raise ICP and reduces cerebral ischemia
- Contraindicated w/ advanced HF, acute MI, and renal failure

Read 8 tweets

Arjun Khadilkar, MD

@akhadilkarMD

Jan 3

As a Cardiology fellow, we get a lot of consults for hypertensive urgency/emergency.

Part 3A: Therapy

-thread 🧵-

#arjuncardiology #MedTwitter #Cardiotwitter #IMG #MedEd

Therapy:
- The presence of acute/rapidly progressive end-organ damage and not the absolute BP determines whether the situation is an emergency
- Goals should be based on mean arterial pressure (MAP) with close monitoring in ICU setting with arterial line

Therapy:
- In general, should reduce no more than 25% of MAP in the first 24 hours; after this time will be more gradual and allow auto-regulatory mechanisms to reset
- Exceptions: more aggressive BP reduction in aortic dissection, post-operative bleeding, and pulmonary edema

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