James Januzzi Jr MD @jimjanuzzi.bsky.social
@JJheart_doc
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@jimjanuzzi.bsky.social Adolph Hutter Professor at Harvard and @MGHHeartHealth. Chief Scientific Officer and Gibson Chair @BaimInstitute. @RedSox team doc.
Boston MA
Joined January 2013
Dear valued surgery colleagues,. You do a lot, and we are grateful. However, cardiologists don't "clear" people for surgery. We provide an assessment of perioperative risk and make recommendations for peri-procedural care. (and 90% of the time it's a useless exercise).
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An important observation, BUT. 35 authors and 5 "co-first authors" on a 3 patient case report?? Come on, NEJM. Are we sacrificing quality in pubilshing in the COVID era? Some of the things I have seen in top journals makes me worried we are.
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Dear Co-authors: "Editing" a paper does not mean adding innumerable comment bubbles suggesting changes but without actually EDITING. It's non-collegial and slows down the process of moving an important paper forward to tight deadline. If you're too busy to edit, remove thyself.
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Isolated rise in creatinine does not equate to "acute kidney injury". It's time to move beyond this antiquated definition. I have nothing more to say today.
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Be an ally for women.Be a mentor for women.Hire women.Pay women.Promote women.Put women in positions of power. We shouldn't have to be saying these things, but until we don't have to anymore, support women. #HeForShe .#InternationalWomensDay .#InternationalWomensDay2022.
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š¢2021 Update to the @ACCinTouch Expert Consensus Decision Pathway for Optimization of HFrEF Treatment. šØMAJOR CHANGES:. #ARNIfirst: ARNI now the foundational RASi, no pretreatment with ACE/ARB. #SGLT2i's now a part of pivotal meds. #GDMTworks #ACCBOT.
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In one month, I've diagnosed more cases of ATTR cardiomyopathy than I did in 10 years. If you don't look for it, you won't find it. A micro-tweetorial. What should you look for?. @HannaGaggin @frederickruberg.
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I'm on service presently. It's clear that folks WANT to titrate #GDMTworks for their pts with #HFrEF but the need for guidance HOW to do it is massive. This review provides a practical approach for how to titrate #GDMT, written by experienced clinicians.
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What happens to BNP when a person is started on #sacubitrilvalsartan?. #BNP should go up, right?. Thanks to work by @pmyhre in our group, we have some new and interesting data. A š§µ, read on! š.
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On clinical service, and starting SGLT2 inhibitors on *all* acute heart failure without asking about LVEF is oddly liberating. #GDMTworks.
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I donāt often do this sort of thing but today is my dadās 82nd birthday and wanted to recognize how much this guy has taught me about life, family, and medicine. #Grateful for his amazing presence through it all.
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Coronavirus is in my hometown, my employer just shut down my work travel, the government is in shambles, the stock market is in disarray, a recession is looming and I'm thinking things could not be any worse. *Realizes we lose an hour of sleep tonight*
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So proud of my daughter, graduating from @uvmvermont today. These students have had such a tough year but this morning, in the sun, it was all forgotten. Congratulations Catamounts, Class of 2021.
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Day 6 on service at @MGHHeartHealth and we're running on fumes. But Thanksgiving is just around the corner, so all is well. At the request of Dr. @CoronaryDoc, a thread on appropriate use of natriuretic peptides. There's a time to measure them. And a time not to.
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Published in @JAMA_current, a masterful comprehensive review on cause, evaluation, management and follow up of #HeartFailure with reduced ejection fraction. Strong work by @SeanMurphyMBBCh and @DrNasrien. @MGHHeartHealth @mghmedres @MGHMedicine .
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The man who inspired me to stay at @MGHHeartHealth has left us. Dr. Roman DeSanctis was a giant among men, a dedicated clinician who took care of countless patients over the years and taught generations of cardiologists. He was like a father to me, and will be terribly missed.
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Dear clinicians talking to your patients: stop calling LAD disease the "widow maker". For that matter, don't use that term for any coronary disease. All it does is scare people, and lead them to make hasty and sometimes incorrect decisions. Words matter.
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Presented today as late-breaking data at #HFSA2022 and posted online @CircAHA, new data from PROVE-HF regarding impact of #sacubitril/valsartan on #mitralregurgitation in #HFrEF. Thanks to @DukeHFDoc for presenting in my absence. What did we find? A š§µ.
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What an incredible honor to serve as the first recipient of the Gibson Chair at the Baim Institute. Iām so grateful to Dr. Gibson for his support and excited to have his name forever attached to my career.
The Baim Institute is proud to announce that Dr. James Januzzi (Chief Scientific Officer) has been selected as the inaugural incumbent of the C. Michael Gibson Chair of Medicine at the Baim Institute for Clinical Research. @JJheart_doc @CMichaelGibson
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@AndrewJSauer @MichaelNassifMD @DrNasrien @yaleHFdoc @JagSinghMD @RyanTedfordMD @JonathanDavisHF @ajaysmd @mpsotka I love each one as if they were my kids. Thereās the solid one that takes work (BB). The one that is a superstar student but may make you dizzy (ARNI). The one that you are grateful for but you need to watch (MRA). And the surprise child one no one expected (SGLT2i). #GDMTWorks.
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I just finished reading another poorly-composed position paper from a major society regarding COVID19 with recommendations based on a handful of sometimes questionable papers and have a few thoughts. 1).
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Congratulations to the exceptional @drmalissawood as she is named the incumbent recipient of the Cathy E. Minehan Endowed Chair in Cardiology. A well deserved honor for this star in cardiology. @MGHHeartHealth #ACCBOT #WIC
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Day 5 on service at @MGHHeartHealth. No better time than now to think about the favorite drug of @AndrewJSauer. spironolactone. The story of how the drug was discovered is interesting, and gave a hint as to the fact the drug would eventually become a pillar of HF care.
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One of the single most important things clinicians must remember when managing HF is that when starting an SGLT2 inhibitor, one should expect a small decrement in eGFR. This is from reduced afferent arteriole tone and not AKI. Keep on titrating #GDMTworks!.
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20 years ago today, a very nervous new attending started his job at @MGHHeartHealth. The ride has been incomparable, and while there are too many people to thank for the past 2 decades, I'd be remiss in not recognizing @RobertaSJanuzzi, who supported me through it all. #grateful.
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This is TRULY spectacular. "Carl" is mansplaining COVID19 to one of the most brilliant ID specialists at one of the best hospitals in the world. What has our world come to?.
A man who only gave his first name, Carl, argues with Dr Nesli Basgoz (R), an infectious disease doctor at Massachusetts General Hospital, that masks are not necessary to fight the spread of coronavirus during a protest in Boston. Photo by ā¦@Brian_photogā©
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It is with profound sadness that I learned of the passing today of my mentor, Dr. Adolph M. Hutter Jr. So much will be said about Dolph--President of the ACC, master clinician, educator, sports cardiologist, leader. But most of all--he was a friend.
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The Federation of State Medical Boards just issued a statement saying that providing misinformation about the COVID-19 vaccine may lead to disciplinary actions, including suspension or revocation of medical licensure. The ABIM and ABP has affirmed this stance. It's about time.
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A useful pearl: if you are considering changing a patient with acute HFrEF from a home ACEi to sacubitril/valsartan during their hospitalization, on admission change them to an ARB so you won't need a 36 hour period of RASi wash out. #GDMTworks.
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Dear social media: It's terrible when people die from COVID-19, but it would be also nice to hear about the thousands that are surviving. It seems there's little mention of the victories on the front lines by our intrepid clinicians. Need some #CoronaGoodNews every now and then.
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A year-end #Tweetorial for #MedTwitter about serial biomarker testing for clinical evaluation of patients with #HeartFailure. The use of serial #NTproBNP testing, often at every office visit has grown. New data are available that emphasize the importance. Read on š.
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Bags are packed. Talks are done. Checked in for my flight and heading to Logan. Proudly my ACC socks and sporting the white bottom sneakers in honor of incoming #ACCPresident @EdwardFryMD. #ACC22 here I come. Excited to serve another round on the #ACCBOT.
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It's a rare thing--it has only happened twice to me in nearly 900 publications--but @CianPMcCarthy had a paper accepted today by one of the top journals in the world. without any requested edits. #perfection . Congratulations to Dr. McCarthy.
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Here's a question that you might not have considered: how did the dose for #sacubitril/valsartan in #HFrEF get chosen?. Out today is a paper in @JACCJournals led by @RezaMohebiMD that addresses some questions about sac/val dose in HFrEF. a š§µ.
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Today, for the first time, my entire panel of clinic patients was vaccinated against COVID. Steps in the right direction.
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Dear clinicians: a slightly abnormal troponin that does not rise or fall in a patient with sepsis without ECG changes, and without change in a normal echo is almost certainly not "due to ischemia". Please do not brand patients as having a diagnosis they lack. #TroponinTwitter.
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Dear Journal Editor (ironically, the same journal @mmamas1973 tweeted about yesterday),. Thanks for inviting me to review a paper I am a co-author on. Much as I'd like to review, it's probably best I decline, yes?. #bestpaperever #acceptwithoutrevisions. Best regards,. Jim.
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Grateful to @CMichaelGibson for his leadership and support. I am looking forward to this next chapter at @BaimInstitute!.
Iām honored to announce the appointment of world class researcher Dr. James Januzzi @JJheart_doc as Director of Heart Failure and Biomarker research at the Baim Institute (formerly known as Harvard Clinical Research Institute) @BaimInstitute
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šØThe 2024 ACC Expert Consensus Decision Pathway for HFrEF just landed. This is truly a "living document", updated with new information for clinicians and patients. Thanks to the Writing Committee and @ACCintouch for their commitment to this work.
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Hey @escardio, perhaps it is worth consideration about the large amount of tobacco use outside the meeting hall. It sends an absolutely terrible message given all the discussions about prevention and treatment of heart disease going on 20 meters away inside the center.
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Happy moment in clinic today. Pt with "stable" Class II on standard #GDMT in 2016: LVEF 35%, LV in diastole 54 mm, LBBB. Changes: S/V added (dose level 2), BB to target, spiro maintained, ivabradine for HR>70, CRT-D placed. Today: LVEF 68%, LV in diastole 43 mm. #GDMTWorks.
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I need a break from all the awful news. I just found myself explaining how stressed I am about the #coronavirus to my dog Duncan. He seems to feel my anxiety, and is lying across my feet. We donāt deserve dogs.
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Best part of clinic today: my 94 year old patient with new HFrEF recounting how he served on a destroyer in WWII--an amazing story. Then I told him that his LVEF had risen from 29% to 44% on aggressive med titration. He hugged me. #GDMTworks. @IAmDrIbrahim @gcfmd.
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Had a big rush of emotion today when I got the news my parents got their COVID vaccines. It's amazing how much we keep bottled up.
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A day after returning from #ACC19, I'm happily running around with my stethoscope seeing patients, working on grants, running data, having research meetings, and loving what I do. A prime component to #wellness is finding purpose in what we do. Thank you @ACCinTouch.
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When we see patients with #heartfailure in the office, we often measure natriuretic peptides. It is known that serial measurements add to a single measurement, but do patterns of change matter? In the current issue of #JACCHeart Failure, we address this question. Read on šš§µ
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Breaking habits in medicine can be hard. Case in point: "trending troponin to peak" in patients with MI. Why is this done? Is it useful? You might be surprised at the answer. 1/ @NinoNJ @CianPMcCarthy @MGHMedicine @MGHHMU @MGHHeartHealth @chapdoc1 @HighSTEACS @troponinpapers.
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Miss Phoebe is having a tough time. Labs arenāt designed to be 14.5 years old. Please send good thoughts to the queen.
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Edited. It has begun. We now have a first (triple vaccinated) family member with breakthrough COVID. Merry Christmas everyone. For all who don't take this seriously--it affects us all when cases spread.
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Day 2 on service at @MGHHeartHealth. Hereās a tip: if youāre admitting someone with HFrEF on an ACEi and are planning on rxāing sacubitril/valsartan eventually, change the ACEi to an ARB on admission to avoid need for 36H off ACEi later in the hospitalization. #GDMTworks.
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Our Queen Phoebe left us today š. She lived an incredible life, making it well over 15 years. The first pic was her āgotcha dayā and the second was her last. As the saying goes: having a loved dog means a lifetime of happy days and one simply awful one. Today is that day.
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When your daughter is an award winning bartender, this is how we kick off prepping for Thanksgiving. Grateful for you all, friends. š¦
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This photo seems like just yesterday. Senior residency @BrighamWomens @BrighamMedRes in 1996-7. I see people who became legendary clinicians, trialists, scientists, chiefs, and even govt administrators. Most of all--we were family. It was an honor to train with them all.
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Is anyone else missing the simplicity of a month ago?.
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Snowy day today here at @MGHMedicine. The @MGHHeartHealth consult team is busy stamping out heart disease, regardless of whether it is FROM COVID or WITH COVID (š). And there is a lot of COVID.
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For decency.For science.For inclusion.For collaboration.For good. A nation divided cannot stand--the time to work together is now. Let us never make such a terrible mistake again. American CAN truly be great again. Donald Trump, #YOUREFIRED. #Election2020 #bidenharis2020.
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In clinic today, I recommended to two separate patients that they consider stopping fish oil, given lack of obvious benefit. The response from both? "Is there any harm from continuing it? No? I'll stay on it." So much for evidence based medicine.
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Today so far in clinic, we're 1-for-1 on recovered EFs. 2017: LVEF: 19%, LV diastolic diameter: 61 mm, LAVi: 48. Sacubitril/valsartan = target.Carvedilol = target.Spironolactone = target.No SGLT2 (pre DAPA HF). 2020: LVEF: 59%, LV diastolic diameter: 43 mm, LAVi: 29. #GDMTworks.
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Hey, look what just arrivedāa book full of #KittlesonRules. It just dropped on Amazon. I canāt wait to read it.
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A little louder for the people in the back to hear: . An abnormal troponin ā āNSTEMIā. That is all. @cardiojaydoc02 help me here. Please.
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Congratulations to @HannaGaggin on her promotion to Associate Professor of Medicine at @harvardmed!. It has been a privilege to work with you and to watch your career grow. Iām grateful you are a member of the family here at @MGHHeartHealth!. #WIC #RockStar
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Day 4 on service @MGHHeartHealth. 4 thoughts on beta blockers. Donāt worry @AndrewJSauer, MRA are coming tomorrow. @cardiojaydoc02 @AHajduczok.
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Out today in @JACCJournals is our work focused on projecting future prevalence of cardiovascular risk factors and disease in the United States. Published at Credit goes to @RezaMohebiMD for his hard work on this very interesting project. A š§µ.
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A powerful moment. Let us not make this only a symbolic gesture. The time for real change is NOW. #blacklivesmatter #MGHtakesaknee #medtwitter #WhiteCoatsForBlackLives.
Earlier today, hundreds of #MGH employees showed up for a kneel-in vigil honoring #GeorgeFloyd. We stood together acknowledging the injustice of systemic & individual racism, as well as #GunViolenceAwarenessDay.
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How can I concentrate on the EMPEROR manuscript Iām writing when this good boy is looking at me like this?. #dogsoftwitter #CardioTwitter #GDMTworks
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"Heart Failure: An Underappreciated Complication of Diabetes. A Consensus Report of the American Diabetes Association". This consensus report from the @AmDiabetesAssn (endorsed by the @ACCinTouch) was just published in #DiabetesCare.
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Do you find it challenging to manage borderline blood pressures in your patients with #HFrEF? With complex polypharmacy, this is a common issue. Check out this timely and useful review on how to manage through! #GDMTworks @escardio @JACCJournals
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My fear is that bad papers + rush to publish = long term harm to our patient care. #Medtwitter, let us affirm our commitment to the research standards that were present before the pandemic and be methodical in how we evaluate new data. Our patients deserve it from us. fin.
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My heart is very sad for my country. "A house divided cannot stand", a quote never more accurate than it is today. This is not a great America. There is another path: Equality, communication, tolerance, understanding and collaboration. It is possible, but change must occur.
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This week in Boston:.Monday: Incredibly cold.Tuesday: Ridiculously cold.Wednesday: Less ridiculously cold. but wait. Thursday: A foot of snow with blizzard conditions.Friday: Record setting cold.Saturday: Surface of Mars cold.Sunday: dont-even-think-about-going outside cold.
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Back at it on service here at @MGHHeartHealth. The pearl for the day: a history of prior UTI is NOT a contraindication for #SGLT2i treatment. Heard that a lot this morning on rounds. #GDMTworks.
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@DrHarryThomas How many of you have a pile of used N95s in your office that you can't bring yourself to discard? Am I the only one?.
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Troponin testing may have a role in non-MI settings but interpretation varies in different situations. @InbarRaber and @CianPMcCarthy summarize the current understanding in their 'Test in Context' Review Topic of the Week in @JACCJournals:
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A big day for treatment of obstructive #HCM. We now have a second treatment option in the #myosininhibitor class. Amazing data. Grateful to have contributed and more data are coming!. Aficamten for Symptomatic Obstructive Hypertrophic Cardiomyopathy:
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In all my years I have never seen someone presenting 3 simultaneous posters at a national meeting. @RezaMohebiMD showing the world how to do it. Superstar. #machine_learning #ACC23 @MGHHeartHealth @MGHMedicine @MGHCVFellows
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Wrapping up a week on consults, and I'm sorry to say. COVID is still out there.COVID is still killing people.COVID is still a thing. wear your mask, get your vaccine. this has not been an easy week. š·š¦ š.
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Alright #MedTwitter, here's some š„ data on optimizing #GDMT for #heartfailure and highlight the recent work of @AferditaMD and @laurapco . Want a solution to #GDMT gaps? Read on about our GDMT Clinic manuscript currently in press at #JACC-HF. ļæ½
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Thankful to my nominator, @pnatarajanmd and to my supporters for this honor. Grateful to the @ACCinTouch for the award--something impossible were it not for years of amazing collaborators. @BaimInstitute @CMichaelGibson @MGHHeartHealth @MassGeneralNews @patrick_ellinor.
The ACC is pleased to announce the recipients of its 2025 Distinguished Awards. Award recipients will be formally recognized and honored as part of ACC.25 in Chicago, IL. Learn more and register for #ACC25:
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A tip for those taking care of acute #HeartFailure. Don't over-focus on loop diuretics to lower filling pressures. Loop diuretics are what people reach for, but remember that #GDMTworks (including sacubitril/valsartan) drop filling pressures AND with a mortality advantage.
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Dear clinicians: please stop ordering tests like a BNP in someone with low pre-test probability or CAC score in someone on potent statin only 2 years after their last CAC score. The results add nothing clinically and only cause anxiety.
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Day 3 on service at @MGHHeartHealth. Hereās another #GDMTworks tip: when starting ARNI in AHF donāt wait til youāve reached a diuretic limit to initiate. Start with some relative congestion to avoid hypotension. Having started it with a PAC, Iāve seen the PCW go from 16 to 4!.
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In light of recent data supporting use of finerenone in HF, there has been a chorus of "why not just use spironolactone?". A reminder that finerenone reduced CV events in CKD. And now in this trial of spironolactone in CKD? A solidly negative trial.
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This Queen is 14 years old today. Happiest of birthdays to Phoebe, who has taught me a lot about life and how to live it. Photo at Ladies Beach, Nantucket, 2022. #LabsofTwitter #dogsoftwitter #birthdaygirl
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Hey #CardioTwitter, what exactly is "gentle" diuresis? Is there a definition for this awesome strategy? How did that term get into medical slang?.
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24 years ago, these two crazy kids got married in Rome. Happy anniversary, @RobertaSJanuzziā©. Thank you for bringing so much light into my world.
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As a physician, I have learned that even the most "successful" people in this world often carry deep pain. Just because people appear to "have it all" does not mean they have what matters. Appearances deceive; please look beyond the exterior. #AnthonyBourdain #KateSpade.
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Hands down, the best part of a life in academics is seeing trainees becoming the next leaders in medicine. The research team out in New Orleans. So proud. #ACC2023 . @MGHHeartHealth @MGHMedicine
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From the annals of a non-scheduled clinic day: . Referral of a pt with severe COPD, prior lung XRT, chronic aspiration, and recent spontaneous pneumotx. The reason for the urgent cardiology referral? "?cardiac cause of dyspnea". Where is the common sense in modern medicine?.
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With yet another COVID exposure in our family, we're one of many having a quiet, small evening instead of the (slightly) larger get-together we hoped for. So done with this. I wish all #medtwitter a merry Christmas. Let this whole experience show us what matters most in life.
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Timeline cleanse. No COVID. No monkeypox. No Red Sox implosions. No other stresses here. Just a boy and his dog after time away from all that stuff. #Duncan
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I just LOVE being called for an URGENT cardiology consult for syncope. in a patient just started on tamsulosin. who also had had a PE CT ("for elevated d-dimer") and echo. Caregivers: please remember that Flomax is a repurposed BP med?. So much waste in our healthcare system.
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The cardiology world has lost a giant. Dr. Arthur "Ned" Weyman, pioneer in cardiac ultrasonography and founder of the MGH Echo Lab passed away today at age 82. Ned was an exceptional teacher, mentor, and researcher. He was also a friend to my family. He will be missed.
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The Januzzi Research Team. Quite a mix of amazing people. Grateful for all they do. #biomarkers #HeartFailure #CAD @MGHHeartHealth @MGHMedicine @MGH_RI
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Gearing up for #ESCcongress and ready to unveil the primary results of #PROVEHF on 2-SEP. What is the effect of #Entresto on #NTproBNP and cardiac #remodeling in #HFrEF? Hoping to see some of my tweeps there and tweeting up a storm! . @MGHHeartHealth @BaimInstitute @escardio
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Enjoying #TipsForNewDocs. Here are a few from the cardiac #biomarker guy:. 1) Almost no one needs daily labs.2) High BNP/NT-proBNP is bad but not always HF. 3) Elevated troponin = cardiac injury. Don't call it "troponinemia" (UGH). 4) Ambiguous troponin: recheck in an hour.
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I just received an email from a really nice person in South Africa interested in depositing $85 million to my bank account. And I thought today was not going to be a good day. I was so wrong. #winning #retirement #greetingsoftheday.
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