Sarah Hudson Profile picture
May 5 11 tweets 7 min read Twitter logo Read on Twitter
Top Ten slides from day 1 of the @BSHeartFailure meeting @JubileeHospital conference centre in Glasgow. A 🧵for all in the #HF MDT

1) Hypotension with HF meds- less than you might think- mean SBP⬇️ at 6m 1-2mmHg with eplerenone & 2mmHg with SGLT2i

Slide shown by @_antocannata Image
2) Summary slide of drugs that may be used in shock plotted on a scale of inotropy and vasoconstriction.

Slide shown as part of a case discussion by Daniel Doherty #HF Image
3) A reminder that the absence of crackles and a normal CXR do not exclude ⬆️ PCWP

Slide shown by @drpmcampbell #HF Image
4) Summary of sensitivity and specificity of various signs and symptoms for congestion

Slide shown by Ross Campbell #HF Image
5) Reminder of the gains to be made by OMT in #HF - 5 yrs of life gained vs no therapy

Slide shown by @TheresaMcDonag3 Image
6) Comprehensive summary table of effects of different #HF drugs on HR/BP/egfr/K

Slide shown by @_antocannata Image
7) How sensitive & specific is ferritin as a surrogate for iron deficiency?

Slide shown by @JJCuthbert Image
8) Has the #HF world taken a wrong turn? Should we be more focused on TSAT?

Slide shown by @JJCuthbert Image
9) Strengths and weaknesses of ADVOR

Shown by Ross Campbell Image
10) Could CRT be useful for HFpEF? Still theoretical at present but interesting concept

Slide shown by Zaheer Yousef Image
Finally an honorary mention to @markcpetrie20 and @ProfDConnelly for a fabulous interactive case discussion & including a tribute to May 4th

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More from @sarahhudsonuk

Oct 16, 2022
💚Top Ten Slides from day 1 of #BSEcho2022 💚

A thread for all those who echo

1) Should we use the highest beat/signal in AF? Slide shown by Sanjeev Bhattacharyya

1/n
2) Peripartum cardiomyopathy - don't miss it and remember need to counsel/risk stratisfy if considering future pregnancies. Slide shown by @BSE_President Claire Colebourn at #BSEcho2022

2/n
3) The adult ACHD population is larger than the paediatric one, and 86% have biventricular anatomies. Interesting UK data shown by Liam Corbett at #BSEcho2022

3/n
Read 12 tweets
Aug 29, 2022
💥My top 10 learning points from the #ESCCongress 2022💥

A thread for cardiologists/general physicians

1) Addition of IV acetazolamide to IV furosemide in AHF results in 46% higher incidence of successful decongestion after 3 days

EVIDENCE: ADVOR nejm.org/doi/full/10.10… ImageImageImageImage
2) Revascularization with PCI does not improve event-free survival in pts with severe LVSD over OMT alone
(HF cohort, not acute ACS pts or significant angina)

Evidence: REVIVED
nejm.org/doi/full/10.10…

#ESCCongress ImageImageImageImage
3) In pts with rheumatic heart disease and AF, RCT evidence supports VKA use over rivaroxaban, with decreased composite of CV events and death with VKA and no increase in bleeding.

Evidence: INVICTUS nejm.org/doi/full/10.10…

#ESCCongress ImageImageImageImage
Read 11 tweets
Aug 29, 2022
We have GDMT and CRT for HFrEF, we will soon also have BAT (Baroreflex Activation Therapy)?

See 🧵below to learn more about this treatment that has significantly improved QoL, exercised capacity and NTproBNP in a RCT...

#ESCCongress
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The #ESCCongress session started with @FudimMarat discussing how it worked – explaining how pts with HF have poor baroreflex sensitivity, that baroreflex down-regulation is related to worse HF symptoms & barostim provided chronic improvement in muscle sym nerve activity

2/n
Next William Abraham talked about what has been learnt from clinical trials, focusing on BeAT-HF which was an RCT that showed BAT significantly improved exercise capacity, QoL, NYHA class and NTproBNP, and was safe

Paper: jacc.org/doi/10.1016/j.…

#ESCCongress

3/n
Read 7 tweets
Nov 17, 2021
💥The new NICE valve guidelines are out! 💥

When do they recommend intervention in severe non-symptomatic valve disease? And how does this compare to the ESC 2021 valve guidelines?

A thread...

References:
nice.org.uk/guidance/ng208…
escardio.org/Guidelines/Cli…

1/n Image
Indications for referral for surgery for severe asymptomatic AS:

❤️Some match ESC guidelines (Vmax >5m/s, LVEF <55%, symptoms on exercise testing)
❤️lower cut off for raised BNP (2x ULN compared to ESC’s 3x ULN)
❤️include valve area <0.6cm2 (not mentioned by ESC)

2/n Image
The NICE guidelines for referral for surgery for severe asymptomatic AS do NOT include a couple of criteria mentioned by the ESC guidelines:

▪️ progression ≥ 0.3m/s/yr not included
▪️ Sustained fall in BP >20mmHg on exercise testing not included

3/n
Read 11 tweets
Aug 30, 2021
💥My top 10 learning points from the #ESCCongress 2021💥

A thread for cardiologists/general physicians

1) There is a treatment for HFpEF!

Empagliflozin significantly ⬇️composite of HF hospitalisation & CV death by 21%

Evidence: EMPEROR-Preserved nejm.org/doi/full/10.10…

1/n Image
2) A more aggressive BP target (110 to 130 Vs 130 to 150) in elderly patients resulted in lower rates of cardiovascular events

Evidence: STEP study -nejm.org/doi/full/10.10…

2/n #ESCCongress ImageImageImageImage
3) Using a salt substitute ⬇️risk of stroke, major CV events and total mortality.

Evidence: SSaSS study - nejm.org/doi/full/10.10…

3/n #ESCCongress ImageImageImageImage
Read 10 tweets
Aug 28, 2021
Have there been changes in when to intervene with the new 2021 ESC/EACTS guidelines for the management of valvular heart disease?

Yes, and in general the bar for intervention is now lower

Thread follows...

#ESCCongress

1/n Image
1)The indications for surgery in severe asym AR have changed

- LVEDD has disappeared from the summary table& diagram
- but LVEDD>65mm is mentioned in the text as a possible indicator for surgery (less than previous >70mm) if there is progressive LV size⬆️/⬇️EF

#ESCCongress

2/n Image
Surgery in asymp severe AR with LVESD>50mm or indexed >25mm/m2 has been upgraded from IIa to I

A new IIb recommendation has appeared for indexed LVESD >20mm/m2 or LVEF≤ 55% if surgery low risk

Valve repair for AR has been downgraded from I to IIb

#ESCCongress

3/n Image
Read 6 tweets

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