First talk from Prof Takkenberg, who needs no introduction to any of you. A very important talk in which she questioned the primacy of RCTs and spoke up on the importance of 'real world' registry data, often dismissed as poor quality
TAVI has revolutionised treatment of aortic stenosis; TMVI is further behind largely due to anaromical complexity of treating the MV compared to the AV - the AV valves are much more complex than the semilunar valves!
This is a 🧵 about physical examination, and what role it (still) plays in modern clinical practice. Decided to write this after seeing a post earlier this yr by @RichardLehman1 on this issue and some people replying that examination was much less relevant in the modern era
I'd like to share 3 case examples of why I don't believe that is true. POCUS is a valuable *adjunct* to the initial clinical assessment, which includes both history & exam (H&E). The H&E should direct which tests you want & what Q you're asking
1. MR case 2. AS case 3. HF case
Pt referred to @UHS_valveclinic with new murmur. Completely asymptomatic, very fit & active. Phys exam revealed a prominent systolic murmur, no other abN findings.
This is a tough one! This will separate the men from the boys, the women from the girls...are you Luke Skywalker or are you already the Obi-Wan Kenobi of valve disease?!
Mid 70s patient, known ischaemic cardiomyopathy & aortic stenosis.
Clinical signs suggest severe AS.
BP 90/50mmHg, HR 60bpm.
This is the resting ECG (hint - showing this for a reason - 😉)
What a busy day! Great session related to TAVI and discussion of low risk patients and insights from the 🇺🇸 TVT database containing results from over 330,000 patients! Read more below... warning, long but interesting (hopefully!) thread... @EACTS@SCTSUK
First presentation included 2yr outcomes from PARTNER 3 trial from Dr Vinod Thourani 👇
We were reminded of the 1year results presented last year at ACC
Significant difference in composite 1o EP at 1yr, endpoint was death / stroke / rehospitalization
OK, this starts off about valves...but then isn't really about valves...but it's the broader educational point (which is relevant to valves) that I want to make this week...no poll I'm afraid, but as always, comments encouraged! 😁
In my office doing Admin, lot to get through & a very busy morning ahead. Asked to r/v a TTE for helping determine AS severity. Pt admitted with heart failure, clinically severe AS is all I know at this point. Now, the golden rule in this situation is *review the whole study*...
Not just one or two images.
But I was super-busy, I BROKE MY OWN RULE and just looked at the relevant images. Here's the PW and CW Doppler tracings (Pt in AF)...
In our hospital, we have seen 2 patients over the past 3 years that presented with acute heart failure and who had severe AR on echo with large, characteristic masses on the AV. This week's poll is simply... what do you think these masses are? (1)
Patient 1 - Female, early 60s, no major PMHx, admitted with 2 weeks worsening SOB and palpitations. No fever. In heart failure, BP 110mmHg systolic. AR murmur. Normal white cell count & near normal CRP on bloods. TTE below...zoomed PLAX view of AV (2)
32yr old lady with moderate mitral stenosis tells you in clinic she is planning on trying for a baby...is that ok? Denies any symptoms, feels well. Echo - mean MVG 6mmHg. RVSP ~ 20mmHg. What would you say / do / advise?