1/ What features PRIOR to intervention are suggestive of adverse prognosis in acute PE?

Which marker do you suggest is the highest risk of poor outcome DURING intervention?

#Cardiotwitter #VTE #pe 2/ This is the list. I would suggest that a very large RV/LV ratio (>2) and presence of severe PH (PASP>60) yields significant risk during intervention

I know @AntoniousAttall has touched on this, but I would warn most operators extreme caution in this patient subset.

We don’t have a true list to assess during intervention!

1/ It’s #July!! Welcome aboard new fellows! Over the next few days I’ll post things that will be helpful as you start your training!

To start- a #tweettutorial on CATH LAB VIEWS!

🔑 LAO- left/right
🔑 RAO- ant/post
🔑 Cranial- distal
🔑 Caudal- proximal

#Cardiotwitter 2/ 🔑 to success

It’s not going to come easy! It’s all about repartition and practice! Learn a good pattern to follow!

Use the RCIS techs to your benefit! They know more than you right now! Focus on the basics!

#CathLab @RadialFirstBot @BotPci #Cardiotwitter #FellowBootCamp

1/ Had a great time writing this @EPLabDigest article with @DrCJBradley

tinyurl.com/mryk3cwe

2️⃣ different perspectives (IC And EP) using different devices (watchman/ amulet) for LAAC in the community center.

Let’s take a dive into two different LAAC programs #Tweetorial 2/ #LAAC has come a long way over the past few years and now we have two main players in the space

🔸 @bostonsci #watchman
🔸 @AbbottNews #Amulet

Both are very effective and each has pros/cons

My center focuses on Watchman FLX while @DrCJBradley center focuses on Amulet… twitter.com/i/web/status/1…

1/ For the fellows and #ACCEarlyCareer!

It’s a coronary thrombus! When to consider thrombectomy? What do you do? Let’s walk through this…#Tweetorial

#Cardiotwitter #Cardiology #STEMI 2/ Middle age patient with hx of CAD and PCI to LAD presents with significant SOB and elevated Hs-Trop. No chest pain. No ECG changes. Echo with inferior hypokinesis.

Here’s the diagnostic with a JR4.

Notice the filling defect in the RCA. This is thrombus. How do we know?

1/ A tweetorial- Watchman Left Atrial Appendage Occlusion!

#LAAO #Watchman #StructuralHeartDisease #EPeeps #interventionalcardiology @EPeeps_Bot @RadialFirstBot @EchofirstB @BotPci @TAVRBot 2/ what is the left atrial appendage?

The LAA is derived from the left wall of the primary atrium (embryo). Its diff from the true LA and its suited to function as a decompression chamber during left ventricular systole and during other periods when left atrial pressure is high

1/ Atypical CLOT- a tweetorial

I recently saw a controversial tweet arguing against tx of chronic clot and restricting tx SOLEY to the CFV/iliac. While I agree (for the most part)- data is limited. At the end of the day we care about the pt, and not every pt is the same! Case➡️ 2/ Pathophysiology of chronic #clot formation.

It’s important to recognize the lesions that can form after a clot:

Spurs/Webs
Rokitansky/NIVL/fibrosis

Your pts CEAP >5 always consider for non thrombotic obstructions! Consider #IVUS if things don’t fit!

1/ #Tweetorial Part 2- Now its time to talk about….

CHRONIC

C-L-O-T

#VTE #DVT #Thrombectomy #Lytics #Cardiotwitter #IRAD #Medthread #Clot @CardioBot @RadialFirstBot @BotPci @EPeeps_Bot @TAVRBot @MedTweetorials @UjjwalRastogiMD @Umair2017 @Umair2017 @VenuVadlamudiMD 2/ How much time does it take for #ChronicClot to START to form? 

#Fellowstwitter #fellows #fellowtwitter #medtwitter #Clottwitter #VTE @MedTweetorials @CardioBot #Tweetorial #Meded @GAEscobarMD @ekgpdx @HeartOTXHeartMD @EM_RESUS @Pooh_Velagapudi @Vascupedia_com @Dr_Bowser

1/ pt presents with sudden onset CP at home. Takes Tylenol and goes back to sleep. Wakes up in the AM with mild CP. Goes to outside hospital with near res of pain. Trop 5 on arrival. No EKG changes. Diag cath 🔽

@HadyLichaaMD @agtruesdell @RajTayalMD @rajivxgulati @DrAmirKaki 2/ Outside hospital does not do PCI. What would you do next? #Cardiotwitter

@CardioBot @BotPci @BaoGTran @trivaxheartmd @LuaySayed @djc795 @evandrofilhobr @Uqayyum123 @iQ_cath @TheNarulaSeries @nyalborgesmd @ekgpdx @SamChitsaz @cardioPCImom @MarqPatton @mirvatalasnag @hect2701

1/ Welcome to the first part of a #Tweetorial series on #VenousDisease.

🩸To begin how about we talk about the main player in the game- C.L.O.T. (and why you should care about it)

#Cardiotwitter #Irad #fellows #fellowtwitter #medthread #clot #medtwitter #clottwitter 2/ But first a question- Is there a difference between arterial and venous clot??

#Clot #cardiology #DVT #irad #VenousDisease #medthread #tweetorial #fellows @HadyLichaaMD @VladLakhter @agtruesdell @AntoniousAttall @TheNarulaSeries @t_intheleadcoat @ShariqShamimMD

1/ NAME THAT #COMPRESSIONSYNDROME

Patient with left flank pain, pelvic pain, hematuria and gonadal varices

Your only imaging modality is vascular U/S....Lets find out!

A Mohan #Tweetorial

#RPVI #cardiotwitter #irad #vascular @HadyLichaaMD @t_intheleadcoat @TheNarulaSeries 2/ What’s going on here?? First name your structures #RPVI

SMA- superior mesenteric artery
AO- Descending Aorta
Lt renal VN- left renal vein

@CHICKVIR @Jonathan_PaulMD @iRadRock @keithppereira @Vascupedia_com @DrYanLiu

(1/)—🅰🆁🆃🅴🆁🅸🅾🆂🅰 🅻🆄🆂🅾🆁🅸🅰

➡️Arteria Lusoria or aberrant right subclavian artery (ARSA) is the most common congenital arch anomaly in which the right subclavian artery originates from the descending aorta, distal to the left subclavian at the ductus arteriosus. (2/)On its course towards the R arm, the aberrant vessel travels retrotracheal +retroesophageal. The prevalence of ARSA ranges from 0.6 to 1.4%. The prevalence of ARSA rises exponentially to 26–34% in individuals with Down syndrome and other chromosomal defects. Pic: @Tesslagra

(1/22) Acute PE treatment. An ever evolving landscape.

How about a #tweetorial on acute pulmonary embolism (#PE) and how to use mechanical #thombectomy with @InariMedical #FlowTriever?? Lets goooooo!

#InariFellowsEdition #IRad #IC #cardiotwitter
Pic credit @Jonathan_PaulMD 2/ From @CDCgov data one American dies of a blood clot every....? #VTE #PE @PERTConsortium #InariFellowsForum