Pre-Rounding Tips 3d: How to think about Troponin? (
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Pro-Tip: If you can print out a pre-rounding sheet with the labs auto-populated, that is always helpful.

Let's Dive in!
#arjuncardiology #medtwitter #cardiotwitterarjun-cardiology.ck.page/fec5d1458a One of the most common consults from the Emergency Room to Cardiology is 'elevated troponin.'

Yes, elevated troponin can be scary, but here is the framework that I use to analyze / consider troponin.

1. Patient Presentation?
2. Patient's risk factors and prior cardiac history?
3. What is the troponin trend?
4. What does the ECG look like?
5. What are some non-cardiac reasons troponin may be elevated?

When I was an intern, pre-rounding was one of the most stressful parts of the day. I would take too long and be inefficient. Part 1.

Now as a PGY7 (long-time, right?), here is 3 parts of my system that I use for new patients.

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On Twitter, I will provide a more condensed version for easier reading. In the email format, I will expand on my thoughts to provide more detailed insights. I will walk you through my thought process and make sure they are concise but helpful.

Future direction will be ECG/Echo/General Cardiology Topics!

#arjuncardiology #cardiotwitter #MedTwitter 1) Why is the patient here / chief concern?

- This seems like the most basic question that is often overlooked. What made the patient decide to leave his/her house to come to the hospital?

- When reading the overnight H&P, the abundance of clinical documentation can create confusion.

- Simplicity is key. What is the chief concern? Is it chest pain? Is it dyspnea on exertion? Knowing this information will help frame your thoughts.

As an intern, chart checking new patients was intimidating and time-consuming.

Even as a cardiology fellow, I continue to refine my system.

Here are 7 tips and tricks to help you out!

#arjuncardiology #MedTwitter #MedEd #Cardiotwitter #IMG

Studying for the IM Boards and Step 2 CK can be challenging.

Here are some of my notes that can help you.

Part #24: Ophthalmology : 5 High-yield facts!
#arjuncardiology #medtwitter #MedEd #IMG

During my Internal Medicine training, I wrote 100s of History and Physicals (H&Ps).

Now as a Cardiology fellow, I read every single H&P for a new consult.

Here are 7 tips and tricks for effective H&Ps. #arjuncardiology #MedTwitter #MedEd #Cardiotwitter #IMG

Studying for medical exams can be challenging.

Here are some of my notes I used to study for the IM Boards. Also high-yield for Step 2 CK!

Part #23: Dermatology: 5 High-yield facts! #arjuncardiology #medtwitter #MedEd #IMG

Studying for medical exams can be challenging.

Here are some of my notes I used to study for the IM Boards. Also high-yield for Step 2 CK!

Part #22: Dermatology: 5 High-yield facts! #arjuncardiology #medtwitter #MedEd #IMG

In order to become a sub-specialist, it is important to first be a good internist!

Here are some of my notes I used to study for the Internal Medicine Boards.

Part #1: 7 High-yield facts!
#arjuncardiology #medtwitter #MedEd #IMG

One of the most important diagnostic tests in Cardiology to interpret is the EKG. Here are my thoughts and notes. Let me know what you think!

Thread #19: Pericarditis

#arjuncardiology #medtwitter #CardioTwitter #MedEd #IMG Acute Pericarditis:
- Inflammation of the pericardium
- May be caused by number of factors: viral/bacterial infection, metastatic tumors, collagen vascular diseases, MI, cardiac surgery, and uremia

One of the most important diagnostic tests in Cardiology to interpret is the EKG. Here are my thoughts and notes.

Let me know what you think!

Thread #18: Electrolyte Abnormalities #arjuncardiology #medtwitter #CardioTwitter #MedEd #IMG Hyperkalemia:
- Distinctive sequence of ECG changes affecting both depolarization (QRS) and repolarization (ST-T)
- First change: Narrowing and peaking of T-waves ('tented' or 'pinched' shape) and can become tall

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 #13: Inferior, Posterior, RV Infarction

#arjuncardiology #medtwitter #CardioTwitter #MedEd #IMG Inferior Wall Infarction:
- Diaphragmatic portion of the LV
- Will see changes in leads II, III, and aVF
- May produce abnormal Q-waves in these leads
- Generally caused by occlusion of the RCA; less commonly can occur with a left circumflex coronary obstruction

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 #12: Q-waves

#arjuncardiology #medtwitter #CardioTwitter #MedEd #IMG Q-wave:
- Can occur in any lead; indicates that the electrical voltages are directed away from that particular lead
- With a transmural infarction, necrosis of heart muscle occurs in a localized area of the ventricle
- New Q-waves usually appear within first day of MI

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 #11: Myocardial Ischemia

#arjuncardiology #medtwitter #CardioTwitter #MedEd #IMG Myocardial Ischemia:
- One of the most important things to evaluate on EKG
- If severe narrowing/complete blockage of a coronary artery causes blood flow to become adequate, ischemia of the heart muscle develops
- Can be transient (angina pectoris) or more severe (necrosis & MI)

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 #10: Fascicular Blocks

#arjuncardiology #medtwitter #CardioTwitter #MedEd #IMG Fascicular Blocks:
- Left bundle branch system: sub-divided into an anterior & posterior fascicle.

- Hemi-block does not widen the QRS complex markedly (compared to a RBBB or LBBB)

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 #9: Left Bundle Branch Block (LBBB)

#arjuncardiology #medtwitter #CardioTwitter #MedEd #IMG LBBB:
- Similar to a RBBB, produces a wide QRS and affects the early phase of depolarization
- Septum will depolarize from (right to left; instead of normal left to right).
- Will see the loss of septal r-wave in V1 and septal q-wave in V6

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 #8: Right Bundle Branch Block (RBBB)

#arjuncardiology #medtwitter #CardioTwitter #MedEd #IMG Ventricular Conduction:
- Normal electrical stimulus reaches ventricles from the atria through the AV node & His-Purkinje systems
- First part of heart to be depolarized is the left-side of the septum; then spreads to RV and LV by right & left bundles
- Normal QRS < 0.10 sec

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 #7: Ventricular Hypertrophy

#arjuncardiology #medtwitter #CardioTwitter #MedEd #IMG Atrial and Ventricular Enlargement:
- Both dilation & hypertrophy usually result in chronic pressure and volume overload on the heart muscle

- Pathological hypertrophy & dilation are often accompanied by fibrosis (scarring); can lead to arrhythmias and heart failure.

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 #6: Atrial Abnormality

#arjuncardiology #medtwitter #CardioTwitter #MedEd #IMG Atrial and Ventricular Enlargement:
- Both dilation & hypertrophy usually result in chronic pressure and volume overload on the heart muscle

- Pathological hypertrophy & dilation are often accompanied by fibrosis (scarring); can lead to arrhythmias and heart failure.

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 #5: Axis Deviation

#arjuncardiology #medtwitter #CardioTwitter #MedEd #IMG QRS Axis:
- General direction in the frontal plane towards which the QRS complex is predominantly pointed

- General rule: Mean QRS points mid-way b/w any 2 leads that show tall R-wave of equal height

- If depolarization is perpendicular to any lead, will see biphasic complex

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

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