Great news for cardiologists and
#echofirst
boarded physicians:
#NBE
will no longer administer recertification exams and is transitioning to maintenance of certification in echo (MOCE) in 2024. Here is a quick summary 🧵of the new MOCE rules.
@ASE360
#cardioTwitter
#MOC
@argulian
This is “fan-shaped artifact” from the interference of U/S waves from another U/S source (intrapulmonary EKOS thrombolysis system used in massive/submissive PE given the associated McConnel’s sign).
#echofirst
#CardioTwitter
A🧵on Starling curves, Force-tension curve & pressure volume loops. I made these notes back when I was an IM resident. I refer to them when I’m in the CCU, my clinic and imaging lab, and when I have a coming exam. I hope you find them helpful
#CardioTwitter
#Cardiology
1/n:
I had to miss
#ACC22
including representing TN Jeopardy team to welcome our lovely son, Hadi Alkhatib, to this world. Mama and baby are safe and we so happy to have him. I love this nerdy onesie from my wife
#CardioTwitter
#MedTwitter
@ACCinTouch
@TNChapterACC
What a beautiful day& journey! I’m honored to receive both the teaching fellow award & outstanding performance award. Huge thanks to my lovely wife, family, mentors, and colleagues!
✅ Graduated from cardiology fellowship at
@uthsc
⏭️
#ACCimaging
at
@Yale
#CardioTwitter
Hi
#Cardiotwitter
,
#echofirst
,
@ACCinTouch
#ACCFIT
:
I had my echo boards recently, and it took me so long time and many resources to get things together. I will be giving a series of lectures on U/S physics on Zoom. Join my first session (Mon 9/26 @ 7 AM Central time) Link👇
@AkhilNarangMD
1. MR jet 2. Late peaking systolic jet (likely mid-ventricular dynamic obstruction) 3. MV inflow.
I wonder why jet 1 is not that wide (giant V wave of acute MR or just because of the overlapping jet 2🤔). Thank you
@AkhilNarangMD
for sharing!
#echofirst
A short 🧵on figure of 8️⃣ artifact.
▶️Different types of percutaneous disc occluders present as a figure-of-eight artifact on
#echofirst
(eg. Amplatzer LAA closure Device (Amulet))
▶️Mechanism: Interaction of device mesh and U/S waves.
#CardioTwitter
#MedTwitter
A nice case of bicuspid AV (RCC & NCC) on
#whyCMR
by
@DrTonyPastor
🌱Due to right and noncoronary cusps fusion, the jet is directed toward the aortic arch➡️ Arch dilation with involvement of tubular ascending aorta & relative sparing of aortic root
#CardioTwitter
@KemalogluOz
According to the ASE 2015 guidelines, aortic annulus should be measured inner-inner edge (at mid-systole) and all other measurements (including SV, STJ & AscAo) should be measured leading-leading edge at end-diastole.
#echofirst
@ASE360
3/3 🧵
The take 🏡 point:
🌟L wave (with high velocity >40 cm/s) is indicative of significant diastolic dysfunction, but can be seen in normal🫀 with bradycardia (L velocity <40 cm/s)
#echofirst
Thank U so much my
#CardioTwitter
friends! 2022 was a wonderful year with ✨ milestones ➡️I became a father➡️I passed my
#echofirst
& nuclear boards
@ASE360
@MyASNC
➡️I was appointed the Academic Chief Fellow
@uthsc
➡️I’ll be going to
@Yale
for advanced cardiac imaging fellowship
@argulian
Overlapping MR and LVOT jets in HOCM.
✳️MR jet: ▶️starts earlier ▶️has high velocity during the ejection period ▶️and has higher velocity than LVOT jet. ✳️LVOT jet starts later in systole and peaks near end ejection.
@nat_echo
MVP with specific signs suggestive of
arrhythmic MVP (higher risk of SCD in
MVP): 1️⃣ MAD (abnormal
lengthening of distance between mitral
annulus and edge of LV posterior wall) 2️⃣
Pickelhaube sign (high velocity systolic
signal on TDI).
#echofirst
#CardioTwitter
@leilii
Sinus of valsalva aneurysm rupture. On color Doppler you will see continuous flow (both systole and diastole). It can be mistaken for a VSD. Color Doppler and 3D are helpful.
#EchoFirst
#CardioTwitter
@DavidTLinker
Late systolic MR jet due to MVP (since the jet is very late, it’s likely mild MVP). In MVP, regurgitant volume is more important than ERO in assessing the severity of MR (RegVol =>60 mL ➡️ severe).
#echofirst
@argulian
MVP (systolic bowing of the posterior leaflet below the C-D line). Looking at the duration of the prolapse, it appears to be significant.
#echofirst
#CardioTwitter
Thank you
@argulian
for sharing
1/3 🧵
▶️L wave is present when mid-diastolic forward flow velocity >20 cm/s.
▶️It represents continuous PV flow ➡️ LA ➡️ LV across MV after early rapid filling (E wave).
@argulian
Merged E&A➡️ AV is too long
Absent A wave➡️ AV is too short
✅To optimize CRT/PPM: aim for a satisfactory AV delay by having a SEPARATED E & A waves
✅Start w a long AV delay ➡️ decrease AV interval by 20 ms to achieve normal or grade 1 DD on MV inflow
#EchoFirst
#CardioTwitter
Hi
#Cardiotwitter
,
#echofirst
,
@ACCinTouch
#ACCFIT
:
I had my echo boards recently, and it took me so long time and many resources to get things together. I will be giving a series of lectures on U/S physics on Zoom. Join my first session (Mon 9/26 @ 7 AM Central time) Link👇
@argulian
Dynamic LVOTO likely from low implanted TAVR. Would also look for other signs of low implantation including: paravalvular AR, MV disruption, and high-degree AV block (typically in the acute settings).
#echofirst
#CardioTwitter
#YesCCT
showing a bileaflet mechanical aortic valve with a stuck leaflet & mobile lesion in the LVOT (likely thrombus vs vegetation). Dynamic assessment on
#echofirst
showed prosthetic valve stenosis (Vmax 3.5 m/sec, mean gradient 26 and DVI 0.26)
#CardioTwitter
2/3 🧵
DDx of L wave (velocity can help differentiating):
1️⃣ DD grade II or III (L wave velocity >40 cm/s)
2️⃣ Normal 🫀 with bradycardia (L wave velocity <40 cm/s)
🌟Also look for other parameters for assessing diastolic function including e’, E/e’ ratio, LAVi, and TR velocity
@DrRajeshG1
@DrRajeshG1
From the timing, it looks like “MID” systolic AV closure (due to dynamic LVOT obstruction that can be seen in HCM) followed by leaflets oscillation (from turbulent LVOT flow). Vs. “Early” systolic AV closure (due to sub-valvular stenosis)
#echofirst
#CardioTwitter
37 yo Jehovah witness woman w/ PMH of preeclampsia (14 years ago; had subsequent uncomplicated pregnancies) pw chest pain. Initial ECG showed nonspecific changes before it progressed to full blown STEMI. HS-troponin 41>930>1050
See ECG and cath below 👇
@ShariqShamimMD
I will go through Edelman U/S Physics Chapter (which you need to master for your echo boards). I ❤️ physics and math, and I guarantee you that you will ❤️ that too! I look forward to our 1st lecture tomorrow
#echofirst
#Cardiotwitter
The Zoom Link:
@argulian
A ➡️ Late systolic gradient suggestive of LVOT gradient
B ➡️ E wave
C ➡️ L wave (DDx: elevated LVEDP especially if =>40 vs bradycardia if velocity <20)
D ➡️ A wave
#echofirst
#CardioTwitter
So thrilled to share that I have matched into Internal Medicine residency in the United States!!
تم قبولي في برنامج الاختصاص في الطب الباطني في الولايات المتحدة الأمريكية! 🇺🇸🇺🇸
This one’s for you, dad and Sahar!Alhamdulillah!!👩🏻⚕️🌟🌟
#IMatched
#Match2024
#InternalMedicine
@argulian
@argulian
1/n: Side-lobe artifact (violation of the assumption that echo images are generated exclusively from reflectors located within the main U/S beam)
#echofirst
3/n: For those who became board (re-) certified in 2014-2023, enrollment in MOCE in NOT necessary until 10 years lapse since passing their last exam.
#echofirst
#cardioTwitter
@argulian
Holosystolic MR suggestive of severe PRIMARY (aka, organic) MR. Color M mode helps to differentiate biphasic MR (seen in FUNCTIONAL aka secondary MR) from early or late systolic MR (seen in mild MVP) from holosystolic MR
#echofirst
#CardioTwitter
1/n: "Diplomates must enroll in the longitudinal learning assessment, attest to holding an active medical license, confirm the number of echocardiograms read, and participate in continuing medical education credits."
#echofirst
#cardioTwitter
Saline-agitated (bubble) study showing PFO with significant shunting (>25 bubbles ➡️ grade 3). This can be concerning for paradoxical embolism and worsening hypoxemia; however, there is a theoretical benefit from off-loading RV into LV.
@ASE360
@VLSorrellImages
@22tabbah_randa
Mirror image artifact due to 2 violations of US assumptions: 1️⃣ US moves in a LINEAR path 2️⃣ US returns to the transducer in a SINGLE trip. It appears as a replica of the true reflector & always more distal than the true reflector.
#echofirst
#Cardiotwitter
I’m so grateful for my lovely wife, amazing family, great mentors, and supportive
#CardioTwitter
friends. I’m looking forward to
#NewYear2023
to learn more & continue growing. I wish you all a
#HappyNewYear
🎊🎉
Happy New Academic Year! Best of luck to all new interns, residents, fellows, and new attendings! It will be a wonderful journey, enjoy it!
#CardioTwitter
#MedTwitter
#echofirst
@BhaskarEchoVA
@ASE360
@echocardiac
Note the “B bump” on MV M-mode = ⬆️ LVEDP and restrictive filling profile. In B bump you may expect a “diastolic” MR caused by a temporary higher LV diastolic pressure than LAP causing reversal of flow from LV to LA and that’s why you will see B bump
#echofirst
#CardioTwitter
@MondaEmanuele
Apical sparing suggestive of cardiac amyloidosis. However, I’d like to know more about the pt and see more images (RA&LA size, etc). Also look for any discrepancy between LV wall thickness and QRS voltage on 12-lead ECG.
▶️The morphology of figure of 8️⃣ artifact appears different on TEE vs TTE (depends on the depth; smaller probe to device distance➡️asymmetric figure of 8️⃣ on TEE vs symmetric 8️⃣ on TTE)
▶️Best seen on 3D TEE (~100%) and 5-ch 2D TTE (~90%); never on 2-ch TTE
#echofirst
@SalemASalemMD
Is it stitch artifact. Causes include: respiratory motion, patient motion, and irregular rhythm. Typically the stitch artifact results in a VERTICAL line across the image. Haven’t seen a horizontal one.