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
1/ Cardiac Stress Testing
@CardioNerds
🔶Indications
🔶Types - Exercise vs. Pharmacological
🔶Compare & Contrast Modalities
Thanks to
@SimratKaurMD
,
@AmitGoyalMD
,
@jholtzman3
for feedback on this infographic!
Follow🧵for a breakdown of the graphic⤵️
Currently on Nephrology consult and realized I didn't have an approach to renal infarction, so schema it is...
#MedTwitter
and
@CPSolvers
fam - feedback appreciated!
I matched!
#IMProud
#internalmedicine
Couldn't have gotten to this point without the support of my family, friends, and mentors! So so grateful. Here's to soon becoming the first doctor in my family.
I first learned about the NEJM Clinical Problem-Solving cases during 3rd yr of med school from
@rabihmgeha
&
@DxRxEdu
on
@CPSolvers
VMR!
Grateful to have had the opportunity to author this CPS case, now out in
@NEJM
🫀
🔗
A 75-year-old man with a history of atrial tachyarrhythmias, tricuspid regurgitation, and pericarditis presented with worsening dyspnea, leg swelling, and abdominal bloating after recent catheter ablation. Read about the case:
Essentials of Stable Ischemic Heart Disease
♦️Plaque Characteristics & Progression
♦️Choosing From Imaging Toolbox
♦️Perils of Polypharmacy
♦️Who & When To Revascularize
♦️Overview of Guidelines
🧵on this great
@ACCinTouch
session from today
#ACC21
#ACCMedStudent
Made a schema for hemoptysis after
@CPSolvers
Student VMR66. Great case presented by
@AndreaAnampaG
. Fantastic discussion by
@dereckwpaul
and Brianna!
Please give feedback!
16/ Also check out the following infographic comparing and contrasting CAC score and CCTA
Thanks to the
@cardionerds
team for guidance and feedback, especially
@EvelynSongMD
&
@karanpdesai
Finished first week of intern yr on Cards nights!
Cardiology is 🤩🤩
My co-interns are amazing - so kind, smart, & down to earth
Senior residents = role models
Excellent teachers, always supportive, & so calm in times of emergencies
Grateful to be a part of
@BrighamMedRes
Great night float episode by
@UnremarkableLab
yesterday. We discussed Mobitz type 2 block, so here's what I came across for causes.
#MedTwitter
, feedback appreciated!
Reasoning out loud with
@CPSolvers
is an experience like none other! Post-VMR cognitive autopsy helped me identify some knowledge gaps on pulm HTN. Thank you
@ABRezMed
for this interesting case and
@ArsalanMedEd
,
@Sharminzi
,
@nsrosenberg
for guiding me throughout the discussion!
6/ ⁉️ When to use CAC ⁉️
Most evidence to help risk-stratify and aid in statin therapy decision
✅w/o DM & with LDL-C ≥70-189
✅10-yr ASCVD risk of 5%-20% (borderline-intermediate risk group)
NOT useful for pts with low risk (ASCVD <5%) or high risk (ASCVD >20%)
1/ Learned a lot by working on this review on "The Changing Epidemiology of the Cardiac Intensive Care Unit" with
@ddbergMD
!
🔗
🧵summarizing some key points ⤵️
Learned a lot by working on this review article with my mentors at Albany Med in collaboration with
@EugeniaGianos
⤵️Challenges in Optimizing Lipid Management in Women
🔗
4/ In the ️patient above, CAC score is useful to assess role for 1⁰ prevention meds like statins
CAC is an active process:
🦴propagated by inflammation & mediators of oxidative stress
🦴affected by HLD & glucose
CAC is an anatomic measure of calcific plaque burden
The ACC Resident Leadership Group is excited to welcome this new cohort of Resident Leaders for the 2023-2024 year. We are inspired by their journeys, leadership, and passion for our shared love of cardiology, and we look forward to supporting their new initiatives and efforts!
Excited to share our recent review article on the role of Ivabradine in heart failure, stable ischemic heart disease, and inappropriate sinus tachycardia!
#ACCMedStudent
#CardioTwitter
1/ Strategies for medical management of obesity, presentation by
@BevTchangMD
#ASPC2023
Currently 5 meds FDA-approved for long term management of obesity ⤵️
First recording for the
@CardioNerds
series on GLP-1 agonists!
A true masterclass on mechanisms of action w/ Dr. Dennis Bruemmer
So much fun hanging out w/
@CFAndersenMD
&
@RichardAFerraro
Stay tuned for new episodes of the Prevention series, in collaboration w/
@ASPCardio
!
1/ When to measure Lp(a) & what to do about it
#ASPC2023
@HeartDocSadiya
ACC/AHA guidelines: measure if intermediate risk
ESC guidelines: family hx of premature CVD or reclassification in those borderline between moderate & high-risk. Also consider at least once in lifetime
1/ Understanding obesity as a chronic condition
#ASPC2023
@CardioNerds
Great talk by Dr. Donna Ryans
⭐️ Cut points for BMI to define obesity are different in Asians
1/ Case discussion
#ASPC2023
CardioOb - severe hypertriglyceridemia in pregnancy
For the case below, what would you recommend as 1st line therapy?
➡️statin? fibrate? low-fat diet? plasmapheresis?
1/ Cardiac Stress Testing
@CardioNerds
🔶Indications
🔶Types - Exercise vs. Pharmacological
🔶Compare & Contrast Modalities
Thanks to
@SimratKaurMD
,
@AmitGoyalMD
,
@jholtzman3
for feedback on this infographic!
Follow🧵for a breakdown of the graphic⤵️
7/ CAC comes back as 0🎉
Power of Zero➡️defer statin! But what's the "warranty period"
Powerful negative risk predictor, guidelines recommend rescan ~5-10 yrs
More nuanced: 3-7 yr warranty w/ CAC = 0 in MESA study. Timing may be based on risk/comorbidities (age&diabetes)
1/ Great case by
@AnnKumfer
at
@CPSolvers
Student VMR today
Alpha-gal syndrome
🔸IgE antibody to galactose-α-1,3-galactose
🔸Delayed reaction (3-8 hrs) to red meat
🔸Associated w/ tick bites
So much fun co-facilitating w/
@jackpenner
& great discussion by
@nilayansarkar
& Ravi
1/ Lipoprotein(a) therapeutics in development, by
@RonBlankstein
#ASPC2023
🔺Currently, no available therapies that provide a large reduction in Lp(a)
🔺No clinical trial data that lowering Lp(a) leads to⬇️in CV events
Listen to the latest episode of
@CardioNerds
for a great discussion w/
@MKIttlesonMD
on her book Mastering the Art of Patient Care
Led by CardioNerds Academy Interns!
And filled with pearls of wisdom
#kittlesonrules
🎙️
12/ Let’s Summarize:
CAC➡️highly specific feature of coronary atherosclerosis, use for borderline-intermediate risk pts
CAC=0➡️very strong⛔️predictive value for future CV events
CAC score ≥1,000➡️very aggressive LDL-C lowering
⚡️Limitations: can miss high risk features⚡️
An honor to have
@tony_breu
share his expert tips & tricks on creating Tweetorials with the
@CardioNerds
!
Such an insightful discussion during this Academy Bootcamp session & we even got a sneak preview on his upcoming tweetorial topic...
#MedTwitter
stay tuned!🫀
5/ How is CAC score calculated?
Agatston CAC Score is based on a weighted density score – we measure volume of plaque and multiply by a density factor
E.g: Lesion is 15 mm2 and 450 HU (Factor of 4), score is 60. All plaques are summed up to give a total score!
The
@NYSCACC
Young Investigators Poster Session and Shark Tank Competition tonight at Coney Island Aquarium was so much fun!
Had a great time presenting my
#CardioObstetrics
research project
So so grateful for the
@CPSolvers
family! I have grown so much over the past year thanks to
@CPSolvers
and VMR. Excited to officially be a part of this amazing team! 😊
Hey
#MedTwitter
, we have wonderful news!
We are so excited to welcome
@Gurleen_Kaur96
to our CPSolvers family <3
You can learn more about Gurleen here:
It’s been such a great experience working with
@SinghSwaiman
’s team at 5 Rivers Heart Association this week!
Their work focuses on not just healthcare but also education and environmental initiatives across Punjab
Very proud to see
@Gurleen_Kaur96
working with the 5 heart team on the ground in India. Her presence and talks will inspire and motivate many young girls.
#womenincardiology
1/ Recent study led by
@SalmanZahid
in
@JACCJournals
investigated racial & socioeconomic disparities in CV outcomes of preeclampsia hospitalizations🤰🫀
🔗
And great editorial by
@GarovicVesna
&
@agkattah
🧵on summary of findings
8/ ☠️What about the opposite: CAC comes back as >1,000?☠️
CAC consortium study: 5x risk CVD, 2.8x risk all-cause mortality
Current guidelines have high risk as CAC >300-400, but CAC >1,000 may be distinct group w/ risk similar/📈 than traditional secondary prevention pts
Are you a medical student interested in Cardiology? 💕
@ACCinTouch
is currently accepting applications for the
#ACCMedStudent
Leadership Group
Great way to collaborate with a diverse group and implement new ideas and projects!
Apply here:
Such an amazing
@CardioNerds
Nerding Out session with
@SinghSwaiman
!
Thank you for sharing your journey & global health work with us - your passion & purpose are inspiring!
So grateful for the opportunity to join the amazing
@cardionerds
team as an Academy Intern and learn from these brilliant people! So excited for this perfect combo of all things Cardiology and
#MedEd
!
#ACCMedStudent
Chronic inflammatory diseases - risk marker or risk factor? Great talk by
@garshick
at
#ASPC2023
⬆️ risk of CV outcomes in pts with RA, psoriasis, and SLE
Observational data show that treatment of psoriasis reduces CV risk but RCTs of biologic therapy are inconclusive
1/ Understanding Lp(a) Measurement by
@hsbhatia
#ASPC2023
Lp(a) is made of apoB & apolipoprotein(a)
ApoA is made of subunits of proteins that can have different # of repeats & therefore lead to heterogeneity in size of Lp(a)
Assays that are isoform sensitive➡️affected by size
11/ What if pt is on statin? Does CAC have prognostic utility?
2018 AHA/ACC guidelines: no clinical utility
But CAC consortium retrospective analysis:
⬆️CAC w/ statins remains predictive of CVD mortality, though⬇️prognostic significance
Statins may impact CAC density
Starting off
#ACC23
/
#WCCCardio
with a session on Decoding the ABCs of the Cardiac ICU
Diagnostic Tools in the CICU by
@SarasVallabhMD
What is fluid responsiveness?
15% ⬆️ in stroke volume in response to a 500cc bolus of IV fluid
#CardioNerds
“Tout moun se moun - Every person is a person”
Just finished reading this inspiring book by
@AaronLBerkowitz
! Thank you for sharing your honest reflections and reminding us to always advocate for each and every one of our patients.
10/ Numerical CAC score can miss high-risk features
Ex: spotty calcification ⬆️ in pts w/ ACS when plaques also show +tive remodeling & low-attenuation
Some features can be assessed further by CT, OCT, IVUS
⬆️risk if >25% of the total score is in the left main coronary
Podcasts
🌟Easily accessible & well-suited for time-constrained adult learners
🌟Can range from fundamental concepts to nuanced knowledge
🌟Vary in breadth & design, from clinical reasoning to interviews to primary literature to narratives
🌟Connection within larger community
In this
@CCCTNetwork
analysis in
@ESC_Journals
, we assessed prognostic significance of hemodynamic parameters in pts w/ cardiogenic shock
⬇️systemic arterial tone & RV dysfunction were associated with mortality & systemic hypoperfusion
@ddbergMD
🔗
Loved learning from
@jackpenner
&
@Sharminzi
on today's
@CPSolvers
VMR!
A short🧵on the diagnosis from the case I presented of a returning traveler from Panama
What is myiasis❓
➡️infection of fly larva in human tissue
➡️most common species is Dermatobia hominis (human botfly)
#ACCMedStudent
, it's Day 2 of
#ACC21
! Benefits of virtual meeting⏪old sessions available onDemand.
Great
@ACCinTouch
session yesterday on Advanced Heart Failure Therapies, ending w/ debate on Transplant vs. LVAD!
#ACCHFT
🧵on some take-home points from the 6 presentations