Cardiology

How often do you check for Primary Aldosteronism (PA)?

Chances are, NOT nearly often enough!

VA study reveals widespread undertesting...can we do better?

https://www.acpjournals.org/doi/10.7326/M20-4873

If you've seen 10 pt's with HTN ➡️ you've probably seen PA!

Let's review in this #medtweetorial

1/15
Why is torsemide my preferred loop diuretic when treating heart failure?

As a follow-up to a recent tweetorial on furosemide and gut edema, let me offer a 3-part ode to torsemide.

1/17
[Why] is furosemide susceptible to malabsorption from "gut edema"?

When a patient with heart failure is hospitalized with congestion I often hear "let's use IV furosemide; they're probably not absorbing the PO."

It's a comment unique to furosemide.

But is it accurate?

In our @JAMA_current editorial, we tackle a timely question in #CardioTwitter: should we recommend #apixaban or #rivaroxaban as first-line anticoagulant for #Afib?The two #DOACs are not interchangeable for bleeding or stroke. Let's review all RCTs & RWE🧵
https://jamanetwork.com/journals/jama/article-abstract/2787339

ICU stories: Middle-aged pt w/o significant PMHx presented to the ED on a Friday afternoon w SOB/cough x 2 wks. Vaxed x2 but tested C19(+). BP 120/90, Sat 98% on 2 l/m. ECG: new-onset Afib/HR 140/QTc 500. CXR attached; read as RLL infiltrate. Labs: Na 125, BNP 800 (nl<100),

Last week a 50 y/o man is admitted to my service with alcohol withdrawal. No cardiopulmonary symptoms. Would you listen to his heart as part of your initial evaluation?

🚨New work from our team in @JAMAInternalMed 🚨

18% of adults with #hypertension report using medications (💊) that may raise blood pressure.

Use of these 💊 associated with:
⬇️ odds of achieving BP control
⬆️ # of antihypertensives used

https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2786014

Thread
/1

1/ #tweetorial

💠 Aggresive Nitroglycerin Usage in Acute Decompensated Heart Failure (ADHF)

➡️ Diuretics should not be considered first-line therapy in the ED treatment of patients with ADHF.

https://manualofmedicine.com/topics/cardiology/aggresive-nitroglycerin-usage-in-acute-decompensated-heart-failure-adhf/

#medtwitter #meded #foamed #cardioed #CardioTwitter

1) Welcome to a #tweetorial where we’ll explore how changing the formulation of #aspirin & where it's absorbed in the GI tract can ⬇️the risk of acute GI injury, but still maintain predictable absorption. This program is accredited for 0.50h CE/#CME. I am @CMichaelGibson. #FOAMed

Don’t miss a new accredited #tweetorial launching TOMORROW here on @cardiomet_ce. #Emergencymedicine researcher and devotee of deep understanding of drug mechanism of action @md_pollack will be considering why being #nonsteroidal means better #MRA. Don't miss it! @GoggleDocs

1/15
Why are statins administered at night?

In this tweetorial I'll discuss the mechanistic and historical reasons for the frequently used QHS dosing schedule. And why it's often unnecessary.

But before we get there, I'm curious: when do you prescribe/order/take statins?

70M presents with SOB. You're asked examine the cardiovascular system.

As you auscultate the heart you hear a murmur. What would you do next?

Open this thread and I'll share my approach.

#MedEd #Tweetorial
#MedTwitter #MedStudentTwitter
@grepmeded @AndreMansoor @medrants

70F presents with SOB. You're asked examine the cardiovascular system.

You look at the legs and detect peripheral oedema. What would you do next?

Open this thread and I'll share my approach.

#MedEd #Tweetorial
#MedTwitter #MedStudentTwitter
@thecurbsiders @CPSolvers @grepmeded

Time for a #tweetorial!
In my medical training, I have seen several patients without cardiac history who have EKGs with prominent R waves in lead V1. Check out this 🧵for a differential diagnosis framework on categories and causes of large R waves in V1! #meded @CardioNerds

1/ 🧵

Time for a #tweetorial on simple #ECG interpretation

When I learned to read ECGs, my biggest fear was to miss an important finding!
To avoid that: Be systematic❗️

My simple approach to ECGs with 8 steps 🪜👇

#medicalstudent #education #cardiotwitter #medtwitter #EPeeps

1/
#Tweetorial on IAMI trial

💔💉 Does influenza vaccination improve prognosis in patients who have had an acute myocardial infarction?

@FrobertOle et al. Investigated this in a well executed trial!

https://bit.ly/2YHycZe

@CircAHA @MedTweetorials #medtwitter #cardiotwitter

1/18 Chest pain is a frequently seen reason for admission. Here's my take on when to consider ACS in patients with chest pain!
#MedTwitter #CardioTwitter #MedEd #FOAMed #MedTweetorial @MedTweetorials

1/🧵
Why does Wenckebach AV nodal block (aka Mobitz type 1) present with progressive prolongation of the PR interval and eventually a non-conducted P wave? 

What causes this unique EKG pattern to arise?

#medtwitter #tweetorial

1/
If you're expecting to see this👇every time you think dissection, you'll be missing a lot of dissections (>40%). Everyone talks re widened mediastinum but its absence does NOT exclude it. Let’s chat about pitfalls of dissection.
#MedTwitter #FOAMed @MedTweetorials @RosenelliEM

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

Why we #pocus , a thread:

35 year old male with severely uncontrolled diabetes presents to the hospital with fevers and cough. Chest x-ray shown here:

1/8 A patient with compensated HFrEF (EF 35%) has positive orthostatics. He is not hypovolemic. What medication is reasonable to prescribe?
#MedTwitter #MedEd #FOAMed #NeuroTwitter #GeriTwitter

Join here tomorrow for the launch of a new accredited tweetorial on DAPT in patients with stable CAD+diabetes who have not (yet!) had an MI or stroke! Earn 0.5 CE/CME credits: physicians, nurses, pharmacists! Expert faculty @gabrielsteg. #medtwitter @academiccme #CardioTwitter

My 1st try with a tweetorial on an approach to device interrogation. I'd like to share my routine – no matter if it’s a PM, ICD or CRT or manufacturer.
Hope you'll share some thoughts on this! A 🧵

New heart failure presentation and a BP like this 114/33?

👇

😯🚨

#FOAMed #FOAMcc

The #TTM2trial was published today in the @NEJM
https://www.nejm.org/doi/full/10.1056/NEJMoa2100591?query=featured_home
Here’s a summary of what we did, what I think the trial means, and what next.
@ttm2trial @nielsen_niklas @CritCareReviews @NEJM

1) Welcome to our accredited tweetorial on #antiplatelet therapy in a #STEMI patient with #Gastroparesis! I am @md_pollack. Earn 0.5h CME/CE credit by following this thread. #cardiotwitter @MedTweetorials @SCAI @AHAScience @ACCinTouch #interventionalcardiology #FOAMed

This was an MI of the RV + inferior LV, with complete heart block, caused by a thrombotic occlusion of the proximal RCA.

Thanks all for commenting. 🧵 below has some basic stuff + nerdy stuff, hopefully something helpful for everyone.

1/ https://twitter.com/sargsyanz/status/1394646332116189185

1/10
Inspired by @ChrisZhouDO to create my first #tweetorial. I am by no means an expert ~ just someone who enjoyed learning about ekgs in med school. Hope it can help some med students who are as confused as I initially was!

#MedEd #MedTwitter #MedStudentTwitter

1/ 10 The most recognized form of Non-Cardiogenic pulmonary edema(NCPE) is ARDS, however the scope of NCPE is much broader with many causes. One particular cause of NCPE we encountered was due to opoid use which is explored in this #medtweetorial
#MedTwitter #MedStudentTwitter

Another one for the AKI Consult series 🧵:

👵 w group 4 Pulmonary Hypertension. Recently 🏥 w severe congestion and AKI 2/2 cardiorenal syndrome with a Cr of 3.5 mg/dl. (Baseline Cr 0.5 mg/dl)

After ultrafiltration and IV diuretics the pt was decongested and AKI resolved.. 1/11

#CMD #Tweetorial

⚡ Coronary Microvascular Dysfunction ⚡

1/19

📌 What Is #CMD❓
📌 Why Is #CMD Important❓

Based on my #ACC21 #ACCImaging presentation

1/ Ready for a #Tweetorial on coronary artery calcium (CAC) score?

Keep reading to:
☢️Understand the pathophysiology of coronary artery calcium
☢ Identify the utility of the CAC score
☢️Recognize the limitations of CAC scoring

Stop KILLING Your Patients with Fluid! Learn how to avoid Fluid Overload with Venous Congestion Evaluation using #POCUS

New BLOG POST on the #VExUS Protocol! Step By Step Guide, Downloadable PDF Pocket Guide, & Calculator
👉🔗https://pocus101.com/vexus

#medtweetorial👇(1/10)

🚨How do you get a STEMI without atherosclerotic coronary artery disease?? 📟

✏️ Drawing a blank? 📃

Join me to learn more about the world of non-atherosclerotic coronary artery disease and coronary artery vasculitis!

Would you care for a pragmatic understanding of cost-effectiveness for new #cardiovascular drugs?💊💵
In our new @Heart_BMJ article, we use 3 case studies to clarify key concepts like cost-effectiveness & affordability: #tafamidis, #PCSK9i & #DOAC.
🧵
https://tinyurl.com/BMJcea

ICU stories: Middle age pt was admitted with delayed presentation (probably 4 days' old) inferior wall MI

🚨How do you get a STEMI without atherosclerotic coronary artery disease?? 📟

✏️ Drawing a blank? 📃

Join me to learn more about the world of non-atherosclerotic coronary artery disease and coronary artery vasculitis!

1/
If you're expecting to see this👇every time you think dissection, you'll be missing a lot of dissections (>40%). Everyone talks re widened mediastinum but its absence does NOT exclude it. Let’s chat about pitfalls of dissection.
#MedTwitter #FOAMed @MedTweetorials @RosenelliEM

1) Welcome to our new accredited tweetorial - a case presentation/discussion on initiating new anti-thrombotic therapy into the treatment regimen of a patient with #PAD.