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Venk Murthy MD PhD Profile picture
Venk Murthy MD PhD
@venkmurthy
#cardiometabolic #prevention; Multimodality #cvimaging; Posts may be my opinions & are not medical advice; RT≠endorse
3 subscribers
Jan 4, 2023 • 8 tweets • 2 min read
I am hearing from primary care colleagues that parents are concerned their kids are playing competitive sports without EKG/echos.

More valuable than that would be to mandate no games/practice without AED + CPR trained coach, trainer, and/or official present.

Here is why 👇

1/ Screening for underlying issues in fit teens and young adults is low value. The findings are almost always normal and even when they appear abnormal they are usually false positives.

2/
Jan 3, 2023 • 8 tweets • 2 min read
To be honest, this is even more complex than the factors in my initial thread. Been rounding so couldn't give it enough detail, but here are few more...

1/ A baseball will deposit that energy in a smaller surface area than a human head generally will. The concentration of that energy is required because if parts of it are not over the heart they won't cause a cardiac problem

2/
Jan 3, 2023 • 7 tweets • 2 min read
Generally trauma to the chest from person-person deposits only a small amount of energy into the heart compared to small hard objects like a baseball or motor vehicle collisions.

The amount of energy is proportional to the square of the velocity of the impact.

1/ There is a huge difference in the square of 90+ MPH fastball (9025 mph-squared) version a 10 MPH person (100 mph-squared) - nearly 100x!

Mass also matters, but the effective mass is not necessarily entire mass of person impacting but unsupported mass, depending on geometry.

2/
Jun 27, 2021 • 7 tweets • 1 min read
This is a *really* bad take. Why is this a bad take:

1) The self-limited troponemia referred to is not a diagnosis. The diagnosis is myocarditis, post-COVID vaccine

2) The relative awfulness of these diseases is not the only issue. Their relative frequency is not the only issue.
May 14, 2021 • 13 tweets • 3 min read
Excellent summary of the status of COVID heart & how it's mostly not a thing

Cardiologists who loudly hyped this should be explaining why they got it wrong & how they will do better

Here are a few tips in mini-thread 👇

Read excellent article first:

statnews.com/2021/05/14/set… #1 Number one reason seems to be fear

#2 Is that few MRI experts were asked before/during hype. Sports cardiologists & celebrity docs dominated the scene with weak understanding of what these tests were showing & what they showed in normal people.

Selective credentialism sucks.
Dec 2, 2020 • 39 tweets • 13 min read
What does it mean to have a healthy metabolism?

How does it relate to CVD?

These are questions @RaviShah_MD & I explored in our latest paper!

Here's a tweetorial on methods & results, which take a bit of a different approach than many prior studies.

ahajournals.org/doi/full/10.11… We started by applying metabolomics to ~2400 people from the CARDIA study

CARDIA is a study of young adults (age 18-30) recruited ~35 yrs ago to watch the development of CVD risk factors & events.

cardia.dopm.uab.edu
Oct 18, 2020 • 12 tweets • 2 min read
Want to tell a story about masks. This takes place in Ann Arbor, a very educated and left leaning place at a University hospital.

All patients admitted to the hospital have had a COVID PCR. So, I'm the cardiology consult attdg. I see tons of pts each day with all manner of cardiac issues that happen to be on other services like surgery, obstetrics, etc.
Sep 24, 2020 • 20 tweets • 4 min read
Now @AmerAcadPeds has released guidance on return to sports for kids after COVID:

Lots of thoughts below

h/t @drjohnm

medscape.com/viewarticle/93… Physical activity and sports participation can have many health benefits which is recognized in the guidance:

services.aap.org/en/pages/2019-…
Sep 20, 2020 • 6 tweets • 2 min read
Science is quickly devolving into teams.

People who are fans of a technology, methodology or approach serve as cheerleaders even for flawed papers/preprints because they give result that fits desired narrative.

"Congratulations on an excellent job"

"Spectacular work"

🧵🧵 This leads those who are less savvy to believe that the paper/preprint is indeed excellent.
Sep 13, 2020 • 15 tweets • 2 min read
I was reminded today that with all of the discussion about cardiac MRI, many folks may get the wrong idea about the test and when it is useful.

Let's do a mini thread on this! Cardiac MRI (CMR) is an excellent and cost effective test when used appropriately. It can be among the lowest cost cardiac imaging tests and it delivers high quality images with very good record of accuracy and safety.
Sep 12, 2020 • 4 tweets • 1 min read
Given how subtle the findings are on the OSU athlete COVID CMR paper, should all future COVID CMR papers include thumbnails of *all* cases, including orthogonal views? The supplement to the ORBITA trial did this for angiograms.

pubmed.ncbi.nlm.nih.gov/29103656/
Sep 11, 2020 • 29 tweets • 5 min read
This study adds very, very little to the literature.

In addition to the anomaly listed below wherein LVEF of 33 is described as normal there are a few other things that caught my eye. First, the pericardial effusions do not seem to be clearly more than physiologic.

Unlike Puntmann, there is no pericardial LGE identified.
Sep 5, 2020 • 4 tweets • 2 min read
Big news! Prominent non-COVID related cardiac MRI paper retracted.

sciencedirect.com/science/articl… H/t @mugander @PezelT

Sep 4, 2020 • 11 tweets • 3 min read
Dear all, after a week or two of serious illness a respiratory illness can leave residual lung abnormalities (permanent or slowly resolving), loss of skeletal muscle (from lying in bed mostly, rarely from viral myositis), and in rare cases heart dysfunction. Cardiac MRI is *not* the way to tease these apart.

Far more helpful could be exercise testing. This will help confirm the degree of limitation and whether there is an arrhythmic risk at high exercise levels.
Sep 3, 2020 • 4 tweets • 4 min read
@LehrerSteve @dennisdoddcbs @bigten @MJAckermanMDPhD Saw it. No information on the study but it appears to have no controls and unclear diagnostic criteria.

There is also zero consideration of what absolute risk increase a true case of myocarditis might have. @LehrerSteve @dennisdoddcbs @bigten @MJAckermanMDPhD No consideration of whether student athletes will comply with detraining instructins.

No science behind what level of detraining would make sense.
Aug 30, 2020 • 4 tweets • 2 min read
Wow. We need clones of @ProfDFrancis @drgrahamcole and @mshunshin.

Read this thread As @ADAlthousePhD points out baseline differences in RCTs really are not a thing to worry about.

In this case, @ProfDFrancis isn't using them to look at "randomization failure" but to suggest blinding may have been violated.
Aug 14, 2020 • 17 tweets • 4 min read
The Big 10 report on COVID relies heavily on this paper which found rampant abnormalities among normal controls and had many statistic that make no sense.

Time to retract or correct this paper. TBH I'm not a football guy so whether they put off a year doesn't really affect me, but the Big 10 is a majorly respected organization and many Americans get their news from @espn.

Unfortunately much of the messaging centers around a flawed paper.
Aug 5, 2020 • 4 tweets • 2 min read
Did you read that article in Lancet about predicting future Afib from a sinus rhythm ECG?

Here is the letter @bnallamo and I wrote in response to it.

Thanks to the authors for sharing info about age/sex in their appendix to response letter!

thelancet.com/journals/lance… Image Authors' response:

thelancet.com/journals/lance…
Jul 23, 2020 • 14 tweets • 4 min read
Cool paper from @DavidLBrownMD and Conor Williams in @Heart_BMJ exploring what would happen if we deferred PCI in diabetics with SIHD!

Mini-thread below

heart.bmj.com/cgi/content/fu… First, this is an example of data reuse from RCTs (in this case BARI-2D). Data are made available by @nih_nhlbi through BioLINCC repository. Some paperwork is required to ensure patient privacy, etc but process is usually straightforward & quick:

biolincc.nhlbi.nih.gov/studies/bari2d/
Jul 17, 2020 • 12 tweets • 3 min read
Major updates to NY Times COVID evidence tracker in first 24 hours.

But still lots of concerns.

**Thread**

nytimes.com/interactive/20… ImageImage They have eliminated strong evidence category.

Ventilation & proning now called "Widely Used"

Dexamethasone & remdesivir are now the only 2 w/ "Promising Evidence"

Anticoag (previously strong evidence) moved to mixed evidence (two grades down) along with most everything else.
Jun 28, 2020 • 6 tweets • 1 min read
COVID19 is serious. We need to take it seriously.

*Nobody* manages MI in anyone on outpt basis. It's malpractice.

Vast majority of 40yo w/ COVID aren't sick enough to get admitted

Many not sick enough for ED visit

Wrong to compare sickest sliver vs entire spectrum We admit people with MI to the hospital who aren't in that high risk of dying because we have specific hospital based therapies (anticoagulation, angiography) that can reduce mortality and morbidity.