Aakash Tuli
@AakashTuliMD
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🫀 Cardiology fellow @ahn_cvi | Alum @IMMWHC @kmc_manipal | Tech enthusiast | Proficient in dad jokes | RTs are not endorsements.
Pittsburgh, PA
Joined April 2011
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Middle aged male with history of chest pain 2-3 weeks ago and now presenting with progressive dyspnea. Echo shown below. What’s the diagnosis?
#echofirst
@ACCinTouch
#CardioTwitter
#CardioEd
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Still find a lot of early learners confused between posterior MI and inferior MI. Do you know what the difference is?
@ACCinTouch
#CardioEd
#CardioTwitter
#MedEd
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🫀Posterior vs inferior STEMI - Let’s break it down!
@ACCinTouch
@AHN_CVI
#CardioEd
#CardioTwitter
Check out this thread and 💾 it for reference
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Thrilled to dive into the Mayo Clinic Cardiovascular Board Review Course! Grateful for the scholarship from
@MayoClinicCV
and Dr. Rick Nishimura.
#CardioTwitter
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It’s almost the end of July! As new residents and fellows are getting comfortable in their new roles, this is the perfect time to go over some day-to-day scenarios and landmark trials that have shaped modern cardiology.
#MedEd
#MedTwitter
#CardioTwitter
@AHNtoday
@AHNIMres
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Had a fantastic time at
#ACC24
. Couldn’t have asked for a better group of people by my side!
@AHN_CVI
@AHNtoday
@ritikagad
@KhandelwalMD
. And to top it off, meeting
@AlexPapolos
was the icing on the cake.
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Landmark trials that shaped modern cardiology: Ep 02 - OAT (Occluded Artery Trial).
#FOAMed
#MedEd
#MedTwitter
#CardioTwitter
@AHN_CVI
@AHNIMres
@AHNtoday
1/ 🤔This trial aimed to answer the question: Should we revascularize stable patients with late presenting acute MI?
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Probably the most I’ve learned in any two days since med school at
#CCES2024
. Excited for the future of critical care cardiology! Sincere thanks to
@AndreaElliottUM
and the organizing team
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What a transformative experience at the 2024
@MayoClinicCV
Board Review Course! Grateful to course directors
@mwcullen
,
@jeffreygeske
,
@DrAmyPollak
for their excellent guidance, and an absolute honor to have met Dr. Nishimura! Thankful for this opportunity to learn and grow.
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@DrRajeshG1
Reflections of mitral inflow corresponding to E and A wave noted in the LVOT in diastole - perhaps due to stiff LV?
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AGH cardiology fellows representation at Western Pennsylvania Cardiogenic Shock Initiative Symposium
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#AirIndia
You don't deserve to be running flights if you can't work a website and mobile apps. Kindly step down to bullock carts. Money debited and PNR not issued, web chat, call center, website, everything is down.
#DigitialIndia
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@ECFMG_J1
Thank you so much for helping us out! Is it possible to temporarily waive SONS altogether and require candidates to submit them within a few weeks of joining? Even with ECFMG accepting eSONs, it's very difficult for IMGs to complete the MOH required paperwork during lockdown.
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Match day celebration cake by mom! (late celebration all thanks to covid). Excited to start residency!
#medtwitter
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Truly phenomenal place to train!
Now accepting applications for the
#Match2025
! Join our team in Cardiology, Advanced Heart Failure & Transplant, or Interventional Cardiology. We offer a collaborative learning environment under the guidance of highly experienced physicians. Apply in
#ERAS
now!
#CardioTwitter
🫀
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Ainsley was a shining star and brought endless energy to every rotation. She advocated tirelessly for her patients and her presence in the program will be sorely missed. Rest in peace 💔
We are heartbroken with the loss of our dear friend and beloved resident, Ainsley Pratt. We will remember her for her unwavering courage, vivacious energy and unbeatable wit. Our thoughts and prayers are with her family and friends.
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1/ ❤️Anatomy: Since LV is a 3D structure, anterior and inferior walls are located opposite one another. The basal segment of the inferior wall is an upward curve and called posterior or inferobasal wall
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Looking forward to it!!
T minus 21 days! Looking forward to welcoming all delegates to Minnesota!
@nhristakosdo
@OmarChehab1
@cebersbacher
@dpot29
@S3Cards
@KhaingKHtwe
@AlixB8
@drsharpdimitri
@amiemarie9121
@SZALI6791
@AmandaGarfinkel
@KatieVanchiere
@AakashTuliMD
@ambika_tejpal
@M14Sanders
@loriauxd
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Merry Christmas! 🎅
🎄The Christmas tree sign is revealed in aVL and aVF when turning the ECG counter-clockwise.
Bidirectional VT is a rare arrhythmia commonly associated with digitalis toxicity or catecholaminergic polymorphic VT!
#MerryChristmas
#FOAMed
#MedEd
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In addition some states require a two week quarantine. The visa appointment is a rate limiting step and will allow us to book flights to US in due time. Kindly consider this urgent request.
@USAndIndia
@StateDept
@ECFMG_IMG
@ECFMG_J1
@USAmbIndia
#visaforimgs
(2/2)
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@Senecatheolder
@DrRajeshG1
@ecgandrhythmRoe
@ECGEPSCADEVICE
@drahmedmohsen85
@DrRazi4
Never seen anything like it
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1/ Landmark trials that shaped modern cardiology: Ep 02 - OAT (Occluded Artery Trial).
#FOAMed
#MedEd
#MedTwitter
#CardioTwitter
@AHNtoday
@AHN_CVI
🤔This trial aimed to answer the question: Should we revascularize stable patients with late presenting acute MI?
@AHNIMres
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Kindly allow expedited visa appointments for physicians going to the USA at New Delhi ASAP! Many programs have their orientation as early as the first week of June.
@USAndIndia
@StateDept
@ECFMG_IMG
@ECFMG_J1
@USAmbIndia
#visaforimgs
(1/2)
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Excited to be joining Allegheny General Hospital and CVI for cardiology fellowship!!
#Cardiology
#Fellowshipmatch2022
@IMMWHC
@AHNtoday
Welcome to the incoming AGH General Cardiology Fellowship Class of 2026!
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@ECFMG_J1
Could you please urge the embassy at India to grant us expedited visa appointments as well?
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Walking amongst giants at
#THT2024
Thankful to
@manreetkanwar
for the opportunity and to
@AdnanKhalifMD
and Karthik Ranganathan for their constant mentorship. Excited for the future of cardiogenic shock!
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Hahahaha ok you got me guys. This
@blackmirror
episode is wayy too immersive. Can it end now?
#Corona
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🫀Posterior vs inferior STEMI - Let’s break it down!
@ACCinTouch
@AHN_CVI
#CardioEd
#CardioTwitter
Check out this thread and 💾 it for reference
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This is really natural selection at this point.
Hi, ER Doc here.
Do NOT inject or consume ANY disinfectants in an attempt to kill COVID19.
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2/ Posterior MI is usually seen as an extension of an inferior or lateral MI and implies a larger area of myocardial damage 💥 .
Isolated posterior infarcts are less common. However, lack of ST ⬆️ means that they are frequently missed!
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@HardeepSPuri
Any updates on tentative dates for resuming international flights or phase 3 of
#VandeBharathMission
?
#AskHardeepPuri
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8/ 📚 For more details, check out the full study:
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Yeah I feel bummed about this too. We worked so hard for this the past few years and things just aren't what we thought they'd be
Anyone else a little bummed that their intern orientation is mostly online? Obviously this is the right choice because of covid, but I’m sad that I have less time to meet my co-interns before our first day! 😭
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@healthefyheart
@ecgandrhythmRoe
@ECGEPSCADEVICE
@smithECGBlog
@EcgOxford
@ECGwithReid
@DrRazi4
Inferior MI with posterior involvement (Tall R in V2), culprit likely prox RCA
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Ep 01 - CARP trial
1/ 🚨 Pre-op risk stratification forms a huge chunk of consults. Contraindications to non-emergent high risk surgery include - active ACS, brady/tachy arrhythmia, severe valvular stenosis, severe PAH, decompensated heart failure
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Congratulations!
Finally published in Otolaryngology-Head and Neck Surgery(Q1 Scopus indexed journal)
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5/ What to do when you’re in🤨? Get posterior leads!
The degree of ST ⬆️ seen in V7-9 is typically modest – only 0.5 mm of ST elevation is required to make the diagnosis of posterior MI!
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Sooo proud of you!!
Internal medicine residency ✅
Onwards to Cardiology fellowship 🫀
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Legend
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@DGlaucomflecken
That's absolutely crazy! Hope you get well soon. Your wife is literally a life saver! You'll be hearing that a lot of times from now on 🤣
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4/❌ Who was excluded?: Patients with NYHA III or IV heart failure, shock, serum creatinine > 2.5 mg/dl, angiographically significant left main or 3-vessel CAD, angina at rest, and severe ischemia on stress testing (required if the infarct zone was not akinetic or dyskinetic)
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6/ Read more at .
Check out this interesting case of inferior MI with posterior injury + RV involvement by
@smithECGBlog
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3/ Posterior MI is suggested by the following changes in V1-3:
•Horizontal ST ⬇️
•Tall, broad R waves (>30ms)
•Upright T waves
•Dominant R wave (R/S ratio > 1) in V2
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@wifemomfuturemd
Your only competition is yourself. Strive to be better than you were yesterday instead of comparing yourself to others.
Just a lesson I think everyone should learn at an early age.
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@LGlaucomflecken
Cannot even imagine what must have gone though your mind! Sending best wishes your way!
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4/ 📊Participants were randomized into two groups: one received routine revascularization before surgery, and the other did not. Results showed no significant difference in long-term survival. However patients with LVEF <20% and significant left main disease were excluded.
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6/ 💡Context: CABG to improve survival is recommended for patients with significant (≥50% stenosis) LMCA stenosis. (Class Ib) | There is also a signal towards mortality benefit among patients with ICM with LVEF ≤35% with CABG as compared to OMT alone. (STITCH trial)
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@raghavchawla52
@ComedicMD
Probably will require candidates to take it later during intern year? It's easy for them to use clinical skill assessments from med schools for AMGs.
However IMGs will require a solution and I hope this difference doesn't put them at a disadvantage.
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7/ 📚For more details, check out the full study published in the New England Journal of Medicine: . What landmark trial should I cover next?
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@airindiain
Money debited via ICICI net banking but PNR not received! Please manually send the PNR as soon as possible. Transaction details : BIL/ONL/002002134239/National A/AIRINDIA
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Kindly expedite the process for issuing a duplicate DS2019 for the candidates affected by this! Also please consider applowing applicants to purchase a prepaid shipping label as they could before covid?
@ECFMG_IMG
Apparently, first class mail from ECFMG containing my visa petition hasn’t reached my residency program after a week & it’s so infuriating that I could barely sleep past few days.
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You are they ray of hope we need
This week’s good news: a 101-year-old woman survives coronavirus, a Japanese aquarium asks people to video chat its eels, and South Korea brings back baseball.
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3/ 🖊️ Enrollment: Patient were enrolled if coronary angiography performed showed TOTAL occlusion of the infarct-related artery with poor or absent flow (TIMI of 0 or 1) and high risk features mentioned above
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5/ 🤯Results: No clinical benefit with revascularization (All-cause mortality, nonfatal MI, or NYHA class IV HF) over medical treatment alone.
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6/❔ Why? By the time of intervention, myocardial damage might be irreversible, and the risks of the procedure might outweigh the benefits in stable asymptomatic patients.
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HCQ prolongs QT interval and may cause arrhythmia in patients at risk! Ideally an EKG should be done before starting the drug and is best avoided in people with QTc >420
#CoronaUpdates
Always consult a physician before taking
#hydroxychroloquine
drug. Never self administer the drug.
Know more about this drug from Dr. Ravi Gupta, Medical Superintendent, GMCH, Sector 32,
#Chandigarh
👇
@COVIDNewsByMIB
@PIB_India
@MoHFW_INDIA
@mygovindia
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Disappointed at this move but nevertheless, thank you
@SenSanders
for showing us what campaigning and politics should be all about! I hope other candidates can learn from your ideas and take them forward
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2/ ⌛️How late is 'late'? : Accepted period of myocardial salvage is accepted to be up to 72 hrs, this trial included 2166 stable patients who had total occlusion of the infarct-related artery 3 to 28 days after acute MI and high risk features (EF <50% or proximal occlusion)
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