Cardiology

What should you call that elevated troponin?

This is NOT taught well and impacts more than you think.

Understand it in 2 minutes:

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🤔Why does heart failure with preserved ejection fraction (HFpEF) lead to sodium retention?

With reduced ejection fraction (HFrEF), decreased cardiac output (CO) leads to neurohormonal activation and sodium avidity.

If CO is preserved in HFpEF, what's the inciting event?

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Why would adenosine, a purine nucleoside, be able to treat supraventricular tachycardias (SVT)?

And why are its effects so short lived (e.g. <2 seconds)?

The answers will change the way you think about this drug.

#tweetorial #medtwitter

🧵 1/7 Ever wondered why the Osborn wave looks the way it does? Stay with me during my newest #tweetorial. A thread 🧵1/7
#cardiotwitter #EPeeps #CardioEd #MedTwitter @TRassafMD @YoungDgk @DGK_org @YoungDZHK @AaronGoodman33 @Steph_Achenbach @fuzzymittens @AvrahamCooperMD

Young pt ➡️ 🏥 worsening shortness of breath

PMH: ESRD. Only 1 HD session/week. However, residual urine volume has now decreased substantially

On exam: BP 134/94, 2L O2,🧠✅, elevated JVP, decreased 🫁 sounds at bases, No murmurs, very mild edema. Functional left BC AVF

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🤔Why does subarachnoid hemorrhage lead to deep/inverted "cerebral T-waves"?

This ECG finding is so dramatic. But as we will see, these patients often have normal hearts.

Why does an issue in the brain manifest on a test of the heart?

Here is the thread containg all master classes by @Lpa_Doc

ICU stories: Eldelry pt w CAD s/p multi-vessel PCI / DM2 / HTN presented to the ED w epigastric "burning". Symptoms much worse with laying down & while eating. No relief w iv famotidine; got relief with morphine. Troponin I elevated and peaked at 1,000 (nl <15). ECG:

There are ~350,000 sudden cardiac deaths (SCD) each year in the US (almost 1000 per day).

Most SCD occurs in older people with known coronary disease, but, sadly a minority of sudden deaths occur in the young.

Roughly 1500 people under 25 die of SCD each year in the US.

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‘VT’ versus ‘SVT with aberrancy’.

The long list of VT "suggestive" ECG features is difficult to recall and apply in real time.

How can we simplify things?

Here is my ABCDE approach – five simple Qs to ask:
🧵👇

You see a patient on the ward with an exacerbation of heart failure.

The team has inserted a urinary catheter for fluid monitoring. What would you do?

Open this thread and I'll share my approach.

#MedEd #Tweetorials
@MedTweetorials @SocietyHospMed
@tony_breu @AndreMansoor

1/13
🤔 Why do patients with acute myocardial infarction often present with diaphoresis (sweating)?

And, is there any significance when this symptom is present?

🎟️Let's have a look.

1) Welcome to a new #accredited #tweetorial, Prevention and Management of Heart Failure in T2 Diabetes: The Diabetologist’s Perspective! Our expert author is Melanie J Davies CBE FMedSci @profmjdavies, Prof of Diabetes Medicine, U Leicester, Leicester Diabetes Unit @LDC_Tweets

Should you give albumin with loop diuretics to augment diuresis?

I've been asked this three different times today so a quick🧵of my thoughts

#nephtwitter #MedTwitter @MedTweetorials

Yesterday, I discussed a pt who had subacute chest pain and dyspnea w/a group of learners

A pivot point in the case gave me some insight into the process of teaching reasoning

I'd love to share my experience #medtwitter #teachdx 1/

1/ You see a 56 y.o man with a h/o HTN, DM2 & HLD in your clinic. He’s been out of care for a while and you’re concerned about his ASCVD risk. You order a lipid panel, but wonder, “should I also add an ApoB level?”

Keep reading this @CardioNerds #tweetorial to learn more…!

1/10. Wat is the most important driver of worsening renal function in #HeartFailure ?

Look at #Tweetorial on central hemodynamic derangements in heart failure

#Cardiotwitter #Cardiology #FOAMed #Cardiorenal #MedEd #MedTwitter #Nephrology #ADVOR

Here’s a situation many of us have seen in the ICU or ED: “It looked like there was ST elevation on the monitor but when I took a 12 lead it was gone?!”

A STEMI went MIA? Here’s a #tweetorial all about why ST segments look different on monitors.

#FOAMed #FOAMcc
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MINOCA :
MINOCA terminology came when has been recongnozed that angiograpghy may identified no signficant ( < 50% ) diseases artery in pts with MI

It’s 5-10% of all MI
Incidence 50000-100000 / year US

ICU stories: Middle-aged pt w remote hx of seizures had grand-mal sz at home & in the ambulance. Intubated for airway protection in ED; transferred to ICU. Placed on propofol. Overnight received 5 l NS & norepi gtt @ 0.1 & (ABx + steroids) for septic shock due to aspiration PNA.

🚨STAT 📟 I received recently in the @mghmedres CCU: “balloon pump helium leak alarm, blood in driveline.” In other words, the balloon had RUPRTURED. What do you do?

Here’s a quick primer on intra-aortic balloon pumps for your next rotation in the CCU! #CardioTwitter

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📢📢📢CALLING ALL #firstyearmedics!! 🥁🥁

Struggling with ECGs⁉️ 🤔

Not for long!! @MedicsAcademy brings to you a brand new ECG #tweetorial that will fix all your ECG problems 🥳🥳🥳

@MedTweetorials @MedEd
#MedTwitter #ECG #medicine #sdocs

What's going on with the intra-aortic balloon pump (IABP)?

Here's a practical🧵 for all residents and fellows during their time on rotation in the cardiac ICU.

Learning objectives
🎈 basics of the IABP
🎈 IABP alarms
🎈 ways to fix them

#CardioTwitter #Medtwitter #tweetorial

Awesome diagnostic schema from @rav7ks i will be sharing some additional teaching points from today’s @CPSolvers session in this tweet.🧵 @RosenelliEM

@deboracloureiro @seymss15 https://twitter.com/rav7ks/status/1490398423555653634

LV thrombi (LVT)

👉Are associated with systolic dysfunction.
👉Can occur in both ischemic & non-ischemic cardiomyopathy.
👉Carry a significant risk of systemic thromboembolism.

Management is mainly anticoagulation, but would you choose WARFARIN or a DOAC?? A #tweetorial 🧵

Here's something we only do rarely--joint posting of an #accredited #tweetorial on @cardiomet_ce and @ckd_ce at the same time. What's the 🗝️ this time? Anderson-#Fabry disease, which affects both the #cardiovascular and #renal organ systems. Figure from 🔓https://link.springer.com/article/10.1007/s40265-021-01486-1

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

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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.

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[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

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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

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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

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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

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#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