Cardiac Trials
@CardiacTrials
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Simplified landmark cardiology trials app 📱 by Justin Sharim MD. Mission: to spread evidence-based medicine worldwide 🌎
Joined March 2022
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Just a Sunday perusing the Cardiac Trials app📱😎 (sound on 🎶)
5
22
81
The NEW
#ESC
diabetes CV guidelines:
For the first time, metformin (first line therapy for years) steps aside for now first line GLP1 agonism and SGLT2 inhibition
8
317
841
~~ Fundamentals ~~
Echocardiographic segments and their coronary territories 📚👇
#CardioTwitter
#BackToBasics
1
217
688
~~ Fundamentals ~~
Echocardiographic segments and their coronary territories 📚👇
#CardioTwitter
#BackToBasics
3
181
579
Myocarditis, Diagnosis and Treatment: a nice summary. 📚 JAMA 2023 ♥️
#Cardiology
#CardioTwitter
2
165
564
VT vs SVT with aberrancy 🤜🤛, a
#FIT
review.
Spaced repetition – the key to learning 🧠👇
#CardioTwitter
2
196
556
HFrEF Quadruple therapy - in☝️tweet
#meded
1️⃣ Beta blockade (COPERNICUS, MERIT-HF, CIBIS II)
2️⃣ Renin-angiotensin inhibition (CONSENSUS, SOLVD, PARADIGM-HF)
3️⃣ Mineralocorticoid receptor antagonism (RALES, EPHESUS, EMPHASIS-HF)
4️⃣ SGLT-2 Inhibition (DAPA-HF, EMPEROR-Reduced)
3
152
533
The Echo right heart cath 🫀
Estimating chamber pressures via echocardiographic doppler parameters
3
134
499
Myocarditis, Diagnosis and Treatment: a nice summary. 📚 JAMA 2023 ♥️
4
170
479
“Not all that leaks troponin is an MI”
🔑 concept: troponin elevation, ischemic and nonischemic causes 📚
3
162
475
HFpEF vs HFmrEF management 🏥 via
#ESC2023
🔑 Clinical Trials:
🔹DELIVER (2022) and EMPEROR-Preserved (2021): SGLT2i in EF>40%
🔹PARAGON-HF (2019): ARNI vs ARB in EF>45%
🔹TOPCAT (2014): MRA in EF>45%
🔹CHARM-Preserved (2003): ARB in EF>40%
📱App link:
4
137
473
~~ Fundamentals ~~
Echocardiographic segments and their coronary territories 📚👇
#CardioTwitter
#BackToBasics
3
141
467
HFrEF Quadruple therapy - in☝️tweet
#meded
1️⃣ Beta blockade (COPERNICUS, MERIT-HF, CIBIS II)
2️⃣ Renin-angiotensin inhibition (CONSENSUS, SOLVD, PARADIGM-HF)
3️⃣ Mineralocorticoid receptor antagonism (RALES, EPHESUS, EMPHASIS-HF)
4️⃣ SGLT-2 Inhibition (DAPA-HF, EMPEROR-Reduced)
6
131
454
~~ Fundamentals ~~ Echocardiographic segments and their coronary territories 📚
Spaced repetition – the key to learning 🧠👇
#MedEd
#BackToBasics
1
130
433
SHOCK - helpful ddx diagram 📚
Distributive vs hypovolemic vs cardiogenic vs obstructive
2
111
415
SGLT2 inhibitors — once touted as simple glucosuric meds for diabetes — now with continuously unfolding clinical indications 👇
📚 Figure and paper courtesy of
@JavedButler1
#cardioX
#cardioed
2
136
407
Not all that leaks troponin is an MI
🔑 concept: troponin elevation, ischemic and nonischemic causes 📚
#JulySeries
#FIT
2
120
407
📚 HFpEF
🔹HFpEF ≠ diastolic dysfunction
1/3 of patients in PARAGON-HF did not have diastolic dysfunction on resting echo
🔹Use H2FPEF score to help diagnose HFpEF
🔹If suspicion remains high with neg H2FPEF, consider stress echo - E/e’ > 14 with stress suggests HFpEF
5
115
406
Cardiac medications in pregnancy and lactation 📝
What’s safe? What’s contraindicated? 👇
Cardiac-centered
#WomensHealth
4
128
391
2
109
373
#JulySeries
part 6 📚
Coronary anatomy – easier to understand when conceptualized in planes
🔹Atrio-ventricular plane: LCx and RCA
🔹Interventricular plane: LAD and PDA
0
84
371
Myocardial infarction – clopidogrel vs prasugrel vs ticagrelor 🤜🤛
♥️ PLATO Trial: clopidogrel vs ticagrelor
♥️ TRITON-TIMI 38: clopidogrel vs prasugrel
♥️ ISAR-REACT 5: ticagrelor vs prasugrel
#Cardiology
#cardioTwitter
2
115
363
Temporary mechanical circulatory support in cardiogenic shock 📚
Balloon pump, Impella, TandemHeart, & ECMO
2
78
359
Myocardial infarction - clopidogrel vs prasugrel vs ticagrelor 🤜🤛
♥️ PLATO Trial: clopidogrel vs ticagrelor
♥️ TRITON-TIMI 38: clopidogrel vs prasugrel
♥️ ISAR-REACT 5: ticagrelor vs prasugrel
0
120
336
VT vs SVT with aberrancy 🤜🤛, a newly-matched 🫀
#FIT
review.
Spaced repetition – the key to learning 🧠👇
#cardioTwitter
2
109
333
Cardioprotective effects of SGLT inhibition 🫀
Mechanisms of action 📚
0
116
338
VT vs SVT with aberrancy 🤜🤛
Yet to come across a better figure👇
1
131
321
Pericarditis management
Acute, recurrent, and constrictive 📚
JACC, 2020 ♥️
3
90
320
VT vs SVT with aberrancy 🤜🤛, a July
#FIT
review
Yet to come across a better figure👇
#CardioTwitter
2
105
317
~~ 🔑 Update: New 2023 Duke criteria for infective endocarditis ~~
Note changes (in bold): w/ new microbiology dx, imaging (CT and FDG PET), and inclusion of surgical inspection as a major clinical criterion 💥
#CardioTwitter
0
111
308
VT vs SVT with aberrancy 🤜🤛, a July 🫀
#FIT
review.
Spaced repetition – the key to learning 🧠👇
#cardiotwitter
1
75
310
HFpEF vs HFmrEF management 🏥 via
#ESC2023
🔑 Clinical Trials:
🔹DELIVER (2022) and EMPEROR-Preserved (2021): SGLT2i in EF>40%
🔹PARAGON-HF (2019): ARNI vs ARB in EF>45%
🔹TOPCAT (2014): MRA in EF>45%
🔹CHARM-Preserved (2003): ARB in EF>40%
📱App link:
3
93
305
New 2023 Duke criteria for infective endocarditis ~~
Note changes (in bold): with new microbiology dx, imaging (CT and FDG PET), and inclusion of surgical inspection as a major clinical criterion 💥
~~ Bridging
#cardiology
and
#ID
1
111
303
Lead aVR on EKG — the forgotten lead?
Don’t ignore lead aVR 📝👇
2
99
302
Myocardial infarction – clopidogrel vs prasugrel vs ticagrelor 🤜🤛
🔑
#CardiacTrials
♥️ PLATO (2009): clopidogrel vs ticagrelor
♥️ TRITON (2007): clopidogrel vs prasugrel
♥️ ISAR-REACT 5 (2019): ticagrelor vs prasugrel
1
101
294
HFpEF vs HFmrEF management 🏥 via
#ESC2023
🔑 Clinical Trials:
🔹DELIVER (2022) and EMPEROR-Preserved (2021): SGLT2i in EF>40%
🔹PARAGON-HF (2019): ARNI vs ARB in EF>45%
🔹TOPCAT (2014): MRA in EF>45%
🔹CHARM-Preserved (2003): ARB in EF>40%
📱App link:
1
90
295
SGLT2 inhibitors — once touted as simple glucosuric meds for diabetes — now with continuously unfolding clinical indications 👇
📚 Figure and paper courtesy of
@JavedButler1
#MedEd
2
83
286
M-mode echocardiography 📚
We can glean a surprising amount of information from the M-mode alone.. don’t ignore the M-mode 👇
Spaced-learning
#fundamentals
#echofirst
#CardioTwitter
2
94
276
When to suspect cardiac amyloidosis?
Echo features:
🔹Nondilated LV with thickened walls
🔹E/A > 2 and E/e’ > 14
🔹Biatrial enlargement
🔹Valvular thickening
🔹Apical sparing strain pattern
…and the following clinical features, 🖼️ via British Society of Echocardiography:
1
93
274
The Echo right heart cath 🫀
Estimating chamber pressures via echocardiographic doppler parameters
#cardiology
#meded
1
89
270
A classic: timeless JAMA illustration of aortic and mitral valve vegetations invading the his-purkinje system.
This valvular – conduction system anatomic proximity is why we get serial EKGs in patients hospitalized with infective endocarditis 🏥
3
92
256
~~ Pulmonary Vein Doppler 📕~~
We can glean a surprising amount of information from the pulmonary vein flow alone.. don’t ignore the pulmonary veins 👇
#echofirst
♥️
6
73
256
~~ The CVP waveform ~~
The waveform provides us with information beyond the average number alone. 👇 CVP physiology and color-coded pathologies, annotated
@CardiacTrials
style. 😎
Don’t ignore the CVP waveform 📚
0
79
250
M-mode echocardiography 📚
We can glean a surprising amount of information from the M-mode alone.. don’t ignore the M-mode 👇
#echofirst
#MedEd
4
85
249
The latest Atrial Fibrillation ACC Guidelines, published this past year
Key 🔑 figures 📚
#cardioX
2
74
242
Differential Diagnosis of Cardiac Masses
📚JACC Case report. 2020 Nov, 2 (14) 2240–2243
1
70
241
#BacktoBasics
Can we identify the cardiac valves on chest Xray?
Simple strategy of drawing an imaginary line from the LAA to the right costophrenic angle 📐👇
1
65
241
1
79
235
~~ 🔑 Update: New 2023 Duke criteria for infective endocarditis ~~
Note changes (in bold): w/ new microbiology dx, imaging (CT and FDG PET), and inclusion of surgical inspection as a major clinical criterion 💥
#MedEd
1
112
241
#BacktoBasics
review 📚
Coronary anatomy - conceptualized in planes
🔹Atrio-ventricular plane: LCx and RCA
🔹Interventricular plane: LAD and PDA
1
79
239
DOACs for atrial fibrillation?
🔹Apixaban - ARISTOTLE (2011)
🔹Dabigatran - RE-LY (2009)
🔹Edoxaban - ENGAGE AF-TIMI 48 (2013)
🔹Rivaroxaban - ROCKET AF (2011)
…all studied head-to-head against warfarin 🤜🤛
Sneakpeak into the Cardiac Trials app 📲👇
1
74
237
Myocardial infarction - clopidogrel vs prasugrel vs ticagrelor 🤜🤛
♥️ PLATO Trial: clopidogrel vs ticagrelor
♥️ TRITON-TIMI 38: clopidogrel vs prasugrel
♥️ ISAR-REACT 5: ticagrelor vs prasugrel
2
63
238
Cardiac medications in pregnancy 📚, distilled down 📝
What’s safe? What’s contraindicated? 👇
Cardiac-centered
#WomensHealth
1
82
224
Complex congenital heart disease - palliative shunts and interventions🫀
#cardiotwitter
#ACHD
1
71
221
Pulmonary Vein Doppler 📚📖
We can glean a surprising amount of information from the pulmonary vein flow alone.. don’t ignore the pulmonary veins 👇
#echofirst
♥️
2
69
225
Recalling HFrEF Quadruple therapy – in☝️post
1️⃣ Beta blockade (COPERNICUS, MERIT-HF, CIBIS II)
2️⃣ Renin-angiotensin inhibition (CONSENSUS, SOLVD, PARADIGM-HF)
3️⃣ Mineralocorticoid receptor antagonism (RALES, EPHESUS, EMPHASIS-HF)
4️⃣ SGLT2 Inhibition (DAPA-HF, EMPEROR-Reduced)
0
74
224
Can you tell the difference between constrictive pericarditis and restrictive cardiomyopathy?
Cath, imaging, and exam findings 📚👇Crucial, as end management is vastly different between the two: pericardiectomy vs consideration for heart transplant!
#MedEd
#echofirst
#yesCCT
3
66
226
#fundamentals
📚
Recall the Diamond-Forrester classification in heart failure, guiding both management and prognosis
1
76
220
M-mode echocardiography 📚
We can glean a surprising amount of information from the M-mode alone.. don’t ignore the M-mode 👇
#echofirst
#CardioTwitter
2
73
219
#JulySeries
part 4
~~ M-mode echocardiography 📚 ~~
We can glean a surprising amount of information from the M-mode alone.. don’t ignore the M-mode 👇
#ACCFIT
2
58
219
Is that wide complex tachycardia actually VT?
VT rule-in criteria ⚡️👇
A
#BacktoBasics
review 📚
2
63
207
Lead aVR on EKG — the forgotten lead?
Don’t ignore lead aVR 📝👇
2
70
206
Approach to genetic testing for cardiomyopathy 🧬👇
JACC HF, 2023 ♥️
#heartfailure
#cardiology
2
73
201
Revisiting a classic: 📚
Timeless JAMA illustration of aortic and mitral valve vegetations invading the his-purkinje system.
This valvular – conduction system anatomic proximity is why we get serial EKGs in patients hospitalized with infective endocarditis.
1
60
201
How to diagnose PAH (WHO Group 1 PH)?
#BackToBasics
🫀
1️⃣ Via finding pre-capillary PH on right heart cath
- mPAP > 20 mmHg
- PVR > 2 WU
- wedge < 15 mmHg
2️⃣ and ruling out other causes (PFTs, chest imaging, V/Q scan for CTEPH)
PAH is rare and a dx of exclusion☝️
2
68
198
First guidelines of
#2024
📚
ASE multimodality imaging guidelines for evaluation of prosthetic valves 👇
2
53
184
~~ Cardiology Fundamentals ~~
Constrictive pericarditis vs restrictive cardiomyopathy 📚👇
Crucial distinction, as end management is vastly different between the two: pericardiectomy vs consideration for heart transplant 🫀
#MedEd
#backtobasics
1
55
189
Complex congenital heart disease - palliative shunts and interventions 🫀
A summary 📚
#Cardiology
0
76
184
~~ CARDIAC MASSES ~~
Multimodality imaging key 🔑 characteristics to narrow our differential
📚Casado-Arroyo et al, JACC 2020 ♥️
#echofirst
#yesCCT
#CMR
0
77
181
Cardiac medications in pregnancy and lactation 📝
What’s safe? What’s contraindicated? 👇
Cardiac-centered
#WomensHealth
1
66
178
ASE Valvular Stenosis and Regurgitation Guidelines 📚
— summarized in just two infographics (for all 4 valves)
#cardiology
#echofirst
#cardioX
2
64
181
~~ Pulmonary Vein Doppler 📕~~
We can glean a surprising amount of information from the pulmonary vein flow alone.. don’t ignore the pulmonary veins 👇
#echofirst
♥️
1
61
174
SGLT2 inhibitors — once touted as simple glucosuric meds for diabetes — now with continuously unfolding clinical indications 👇
📚 Figure and paper courtesy of
@JavedButler1
#MedEd
3
56
167
Pulmonary Vein Doppler 📚
We can glean a surprising amount of information from the pulmonary vein flow alone.. don’t ignore the pulmonary veins 👇
#echofirst
♥️
1
63
172
🔑 concept: LDL-Years
Increasing evidence suggests that we can think of lifetime LDL exposure much the same as we can smoking, with pack-year history
Higher LDL x higher span of years —> increased risk
#cardiotwitter
#prevention
2
62
167