Pooja S. Jagadish, MD
@PoojaJagadishMD
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To be a good cardiologist, one must be a great internist. Cardiologist & Clinical Educator 🫀 @UAZHeart | IM @UTHSC | MD @ETSU ≠ medical advice | ≠ employer's
Joined March 2022
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Pinned Tweet
I post a daily
#CVBoardPearl
every weekday at 11 AM ET/8 AM PT. Typically, there's a theme of the week so it's easier to study along with me. Please read independently to learn caveats and nuances. I appreciate all interactions!
#MedTwitter
#CardioTwitter
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I accidentally confused a Medicine Chief Resident when I grabbed my team and said "Come Quickly!" He followed us expecting a decompensating patient but instead was met with a therapy dog who needed pets. I think this was an important reason to rush.
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A STEMI🧵
Dx STEMI with ST↑ in leads V2-V3:
🫀≥ 2.5 mm in M < 40 y
🫀≥ 2 mm in Mn ≥ 40 y
🫀≥ 1.5 mm in all F
AND/OR
🫀≥ 1 mm in ≥2 contiguous chest leads or two limb leads
- EXCLUDES LBBB & LVH (use Sgarbossa Criteria)
Ref:
#CVBoardPearl
#MedTwitter
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STEMI Complications: Papillary Musc Rupture
- Etiology: ischemic necrosis of single-blood-supply posteromedial papillary mus
- Time: 2-7 d post inferior MI
- Pres: acute pul edema, cardiogenic shock
- Tx: afterload↓, cardiac surg may incl MV replacement
#CVBoardPearl
#MedTwitter
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@hsafaMD
It's better to answer questions when the context for the question is right in front of me. The ability to apply knowledge to context helps cement application. Often, looking it up later leads to inability to "circle back" for clarification and missed learning potential.
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Fibrinolytics for STEMI, a 🧵:
🫀Per the 2013 STEMI Guideline: Give fibrinolytics for STEMI when ischemic symptoms started within the PAST 12 HOURS, and PCI can't be done w/in 120 MINUTES of first medical contact (barring contraindications below).
#CVBoardPearl
#MedTwitter
(1/6)
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Memorize CHA2DS2-VASc score & relative stroke risk!
Common User Errors:
🫀Give a point for female sex of ONLY if there is another risk factor (e.g. 60 F with DM = 2; 60 F with no risk factors = 0).
🫀DVT/PE is not an arterial embolism. Do not give a point.
#CVBoardPearl
#MedX
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🫀Cangrelor and Ticagrelor are reversible P2Y12 inhibitors.
🫀Clopidogrel and Prasugrel are IRREVERSIBLE P2Y12 inhibitors.
#CVBoardPearl
#MedTwitter
Chart from the JACC State of the Art Review "Antiplatelet Agents for the Treatment and Prevention of Coronary Atherothrombosis"
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The heart is supplied by coronary arteries, but how does it drain?
The Greater Cardiac Venous System (70%) & Thebesian Veins (30%) drain the the myocardium into the heart chambers. Thebesian Veins are more prevalent on the right heart, esp. RA.
#CVBoardPearl
#MedTwitter
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How is vasospastic angina diagnosed?
(1) Nitrate-responsive cp with
🫀Rest Angina/Occurs from midnight to early AM
🫀Exercise tolerant (but worse in the AM)
🫀Precipitated by hyperventilation
🫀Improved by CCBs but not beta-blockers
#CVBoardPearl
#MedTwitter
(1/2)
(PMID 26245334)
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Tomorrow is my last day as a cardiology fellow. Time flies! Seems like just yesterday, I was an Intern. Excited for the future!
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What factors ↑ mortality in STEMI?
🫀Presenting Hyperglycemia (even w/o DM)
🫀DM
🫀Signs of Heart failure or LV Dysfunction (see Killip Class)
🫀Anterior MI
🫀More ST↑
🫀Adv. Heart Block or New Intraventricular Conduction Abnl
🫀RBBB w/ Anterior MI
#CVBoardPearl
#MedTwitter
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🫀Coronary Aneurysm: FOCAL dilation of ≥1.5x adjacent normal segment.
> Subtypes: saccular (wider>long) & fusiform (longer>wide)
🫀Coronary Ectasia: DIFFUSE dilation ≥1.5x adjacent normal segment.
>Subtypes: Type I-IV
(Click ALT on Fig for Ref)
#CVBoardPearl
#CardioTwitter
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Triage System for Cardiac Tamponade (ESC 2014):
- A score ≥6 should be treated immediately (barring contraindications).
- If unstable/crashing, do not delay for labs!! Treat anemia & reverse AC DURING THE TAP!!
Link:
#CVBoardPearl
#MedTwitter
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Pulmonary Hypertension (PH) is a high pulmonary artery pressure, with mean PA pressure ≥ 20 mmHg.
PH is defined as:
- Pre-Capillary PH
- Isolated Post-Capillary PH
- Combined Pre-/Post-Capillayr PH
- Exercise PH
2022 ESC Guideline Definitions:
#CVBoardPearl
#MedTwitter
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Ever struggle when your attending wants you to present something on rounds the next day?
Meet Olly, a smart-tool created by my colleague, Dr. Jeff Tran. Ask it a question, and it will scan guidelines for a FREE, AI-powered answer.
#MedTwitter
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There are 5 clinical classifications of PH (WHO Groups):
1. Pulmonary Arterial HTN
2. PH assoc w/ L Heart Disease
3. PH assoc w/ Lung Diseases/Hypoxia
4. PH assoc w/ Pulmonary Artery Obstruction (incl. CTEPH)
5. Unclear/Multifactorial Etiology
#CVBoardPearl
#MedTwitter
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It is not okay that initial certification exams cost as much as they do! Cardiology Boards cost $2480. I reached out to ABIM about lowering the cost, and they said they sympathized while saying "costs must be applied in the same way to all physicians."
#MedTwitter
#CardioTwitter
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CK-MB and myoglobin are no longer used to diagnose acute MI (at least when troponin is available) - Class III, No Benefit.
#CVBoardPearl
#MedX
Ref: 2021 ACC Chest Pain Guideline
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We may do
#EchoFirst
for aneurysm assessment, but it has a LOW diagnostic accuracy for pseudoaneurysms. Pseudoaneurysms are better identified through CMR or CCT.
Distinguish True from Pseudoaneurysms by neck size (large vs. small) and wall composition.
#CVBoardPearl
#MedTwitter
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4 Types of Double Outlet Right Ventricle (DORV):
1. VSD Primary: Large VSD WITHOUT Pulm Stenosis
2. Tetralogy of Fallot-Like: Subaortic VSD w/ Pulm Stenosis
#CVBoardPearl
#CardioTwitter
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Image Ref: Fig 22.1 in Krishnamurthy, Y. (2018).
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The 4 Major Types of Stroke, a 🧵 of Definitions based on the 2021 AHA Stroke Prevention Guideline:
🤯Lacunar: Normal CT/MRI OR subcortical stroke < 1.5 cm diam on CT/MRI. Usually due to small vessel disease.
#CVBoardPearl
#MedTwitter
#CardioTwitter
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Post-Ischemic Stroke Lipid Goals (Class I):
🤯 If NO CAD or cardioembolic source BUT LDL >100, start atorva 80
🤯If ASCVD is present (intracranial, carotid, aortic, coronary), use a statin + ezetimibe to target LDL < 70 mg/dL
#CVBoardPearl
#MedTwitter
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Key slides on Lp(a) by
@SamiaMoraMD
.
Takeaways:
🫀 Lp(a) should be checked once in a lifetime
🫀 Lp(a) can provide additive risk stratification
#ACC24
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Repair of DORV w/ subpulmonary VSD (no PS) requires:
1. Baffle closure of the VSD from the LV to the pulmonary artery
2. A Jatene arterial switch operation
3. Reimplantation of coronaries.
So it's like a d-TGA repair.
Ref:
#CVBoardPearl
#CardioTwitter
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Avoid nitrates (nitroglycerin, isosorbide) w/in:
🫀12 hrs of avanafil
🫀24 hrs of sildenafil or vardenafil
🫀48 hrs of tadalafil (package insert)
Nitroglycerin w/in 8 hrs of riociguat appears to lower BP, leading to syncope (package insert riociguat).
#CVBoardPearl
#MedTwitter
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💊Avoid pioglitazone in pts with T2DM & LVEF <50% (even if no HF sxs). It ⬆️ the risk of HF and HF hospitalizations by promoting fluid retention (Class III).
💊Avoid diltiazem and verapamil in HF. They are myocardial depressants/negative Inotropes (Class III).
#CVBoardPearl
#MedX
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Thank you to
@UAZHeart
for a beautiful graduation ceremony. This program has provided tremendous opportunities for growth, and I'm grateful for the time I spent here.
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A 🧵 on Prosthetic Valve AC:
Mechanical Valves get Warfarin (Class I). Here are Class I INR Targets:
🫀Bileaflet/Current-Gen Single-Tilting Disk AVR and NO VTE Risk Factors: 2.5
🫀AVR w/ VTE Risk Factors OR Older-Gen valve: 3.0
🫀MV Replacement: 3.0
#CVBoardPearl
#MedTwitter
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After neuro imaging, a standard Stroke Workup includes:
🧠EKG
🧠Arterial Imaging
🧠TTE (+/- Bubble Study)
🧠Extended Rhythm Monitoring
🧠Labs: CBC, PT/INR, PTT, BMP, lipids, A1C
Use this algorithm (Figure 2) to plan workup.
#CVBoardPearl
#MedTwitter
#CardioTwitter
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The SYNTAX score divides the coronary tree into 16 segments (Fig 1) and is used to grade CAD complexity based on multiple factors (Fig 2) to guide recs for CABG vs. PCI.
Higher SYNTAX = worse prognosis with PCI revascularization.
#CVBoardPearl
#MedTwitter
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In CHA2DS2-VASc, the V refers to complex vascular disease--history of MI, significant angiographically-demonstrated CAD, PAD, or complex aortic plaque noted on imaging. It doesn't refer to just any degree of CAD.
#CVBoardPearl
#MedTwitter
#CardioTwitter
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Here's a
@jct_ucb
trick: Give your patients with HCM a copy of their EKG to keep in their purse/wallet as a baseline. These patients get repeated, unnecessary cardiac caths due to a "scary EKG" and nonspecific chest pain expected with the condition.
#ClinicalPearl
#MedTwitter
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I want to thank each and every one of the
@UAZTucson_IMRes
residents for allowing me to be a mentor, for trusting me with your education, and for helping me grow as a physician through these experiences. I will cherish this award forever!
@UAZHeart
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When treating AFib:
🫀 Avoid Class Ic agents (propafenone and flecainide) in patients with CAD, HF, severe LVH.
🫀 If using a Class Ic agent, ALWAYS add a nodal blocker (e.g. metoprolol) to ⬇️ the likelihood of AFlutter with 1:1 conduction through the AV node.
#CVBoardPearl
#MedX
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The preferred anti-HTN agents for those with a prior CVA/TIA to ⬇️ recurrent stroke:
💊Thiazides
💊ACEI/ARBs
⭐Target a BP goal of < 130/80 mmHg
CCBs don't have as much data for 2° stroke prevention but can be added for extra BP lowering, if needed!
#CVBoardPearl
#MedTwitter
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STEMI Complications: VSD
🫀Cause: ischemic necrosis of intervent septum
🫀Time: w/in 24 h
🫀Pres: cp, cardio shock, +/- pulm congestion, NEW LOUD HOLOSYSTOLIC MURMUR w/ THRILL
🫀Assoc. w/ large MIs & incomplete reperfusion
🫀Cardiac surg>>percutan repair
#CVBoardPearl
#MedTwitter
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Thank you to
@Ed_Gerst
and Dr. Henrikson for a phenomenal Hands-On Fellows' session on Cardiac Mapping! I'm really proud of the map I made with Natalie of
@AbbottCardio
! These teaching sessions make me a better future EP Fellow!
#HRSS2022
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AFib Classification:
🫀 Paroxysmal: Cardioverts (self or intervention) within 7 days of onset
🫀 Persistent: Lasts > 7 days
🫀 Longstanding Persistent: Lasts > 12 months
🫀 Permanent: Stop trying to convert the patient. Focus on rate control alone.
#CVBoardPearl
#MedX
#CardioX
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BrS is diagnosed in Type 2 & Type 3 Brugada pattern when provocation testing with flecainide, ajmaline, or procainamide induces a Type 1 Brugada pattern.
EKG Lead Placement to improve sensitivity: standard R-precordial V1-V2 with additional "high" leads.
#CVBoardPearl
#MedTwitter
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The Class I indications for intervention for rheumatic MS are:
🫀 Symptomatic Severe RMS with a pliable valve, no clot, & <2+ MR gets 🎈 (PMBC)
🫀 Symptomatic Severe RMS withOUT favorable valve features but IS a surgical candidate gets MV surgery.
#CVBoardPearl
#CardioTwitter
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@DrAkhilRaghavan
Someone is going to be seeing yellow snow this Christmas. . .
Bidirectional VT - digitalis toxicity vs. CPVT!
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Am I the only one who thinks we should be doing BPs in both arms at every cardiology visit? What do you think
@BakhshiHooman
?
#CardioTwitter
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#MedTwitter
: If a med student writes a manuscript but there's also a a resident/fellow and attending on the paper, who should pay the manuscript fees? Assume the med student did >90% of the work, the resident edited, and the attending approved. Wish this weren't controversial.
Medical Student
51
Resident
19
Attending
1121
Shared Equally Among All
145
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Transfer to PCI-Capable Hospital Post-Lytics & Perform PCI of Infarct Artery (Class I, 2013 AHA/ACC):
🫀Cardiogenic Shock or acute severe HF
🫀Concerning (int-/high-risk) findings on predischarge stress testing
🫀Easily provoked myocardial ischemia
#CVBoardPearl
#MedTwitter
(1/5)
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Diabetic patients aged 40-75 years ALWAYS get at least a moderate-intensity statin (Class I). Why? Statins reduce MACE regardless of baseline and post-therapy LDL levels. Also the first ASCVD event has higher morbidity & mortality compared to non-DM pts!
#CVBoardPearl
#MedTwitter
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What do you do if your patient has angioedema on an ACE Inhibitor?
💊Switch to an ARB
💊Do NOT switch to an ARNI; sacubitril risks angioedema.
The angioedema risk with overlap is also why you need a 36-hour washout of the ACEI when transitioning to an ARNI!
#CVBoardPearl
#MedX
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Learn the typical coronary distributions because wall motion abnormalities on echo (TTEs) & nuclear studies have coronary implications! True, anatomic differences in coronary perfusion exist, but this is a good starting point. (Credit ASE - click ALT)
#MedTwitter
#CVBoardPearl
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When did obtaining a Coronary Calcium Score in patients with familial hypercholesterolemia become an "Investigational / Noncovered Study" by insurance plans? It's a low-dose, quick test that can help risk-stratify patients who need statin optimization!
@DrMarthaGulati
@drscottyk
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Mgmt of AS is based on SYMPTOMS first. Class I Recs:
🫀Symptomatic Severe AS (Stage D1, D2, D3) warrants AVR (SAVR or TAVR).
🫀Asymptomatic Severe AS w/ LVEF <50% warrants AVR,
🫀Asymptomatic severe patients undergoing another cardiac surgery need AVR.
#CVBoardPearl
#MedTwitter
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How do we manage AFib in patients getting chemo? Key slides by Dr. Janice Chyou.
🫀Beware amio use with ibrutinib due to CYP3A4 inhibition
🫀QT prolongation can be exacerbated in setting of bradycardia
🫀Scant data on catheter ablation in the cancer patient
#ACC24
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Absolute Indications to Stop a Stress Test: Patient request, SBP↓ > 10 mmHg, Presyncope/Dizziness/Ataxia, signs of poor perfusion, Symptomatic arrhythmias/sustained VT, ST↑ w/o diagnostic Q-waves, ST↓ > 2 mm from baseline, new LBBB, BP > 230/115.
#CVBoardPearl
#CardioTwitter
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What characteristics in NSTE-ACS warrant an IMMEDIATE invasive strategy (within 2 hours)?
🫀Refractory Angina
🫀CHF OR new/worsening MR
🫀Recurrent Angina / Rest Ischemia despite Med Therapy
🫀Sustained VT/FR
(Per 2014 AHA/ACC NSTE-ACS Guidelines)
#CVBoardPearl
#MedTwitter
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A patient is ready for discharge but is still on IV antibiotics for IE. Can you switch to PO?
🫀Get a baseline TEE (not TTE) to prove the IE is stable BEFORE switching to PO.
🫀REPEAT the TEE 1-3 days before completion of the PO antibiotics.
(Class I)
#CVBoardPearl
#MedTwitter
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Severe Aortic Regurg:
🫀Jet Width ≥65% of LVOT
🫀VCW >0.6 cm
🫀Holodiastolic Flow Reversal in Proximal Abd Aorta
🫀Regurg Vol ≥60 mL/beat
🫀Regurg Fraction ≥50%
🫀ERO ≥0.3 cm2
🫀Angio Grade 3-4
🫀Chronic Severe: LV dilation
2020 Valve Guideline
#CVBoardPearl
#MedTwitter
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DO NOT perform valve surgeries on pregnant women with valvular heart disease in the absence of SEVERE HF symptoms that are REFRACTORY to medical therapy (Class III).
#CVBoardPearl
#MedTwitter
#CardioTwitter
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🫀Bicuspid Aortic Valve—regardless of symptoms—with an aortic sinus or ascending aorta diameter >5.5 cm needs aortic surgery (Class I).
🫀BAV with SAVR indications warrants surgery for aortic sinus or ascending aorta diameter ≥4.5 cm (Class IIa).
#CVBoardPearl
#MedTwitter
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Identify Severe AS with these criteria (2020 Valve Guideline):
🫀Aortic Vmax ≥4 m/s OR Mean ΔP ≥40 mmHg
🫀AVA typically ≤1.0 cm2 OR AVAI ≤0.6 cm2/m2 (not required to define severe AS)
🫀If aortic Vmax ≥5 m/s or mean P ≥60 mmHg, then Very Severe AS.
#CVBoardPearl
#MedTwitter
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My question is, why not lower the cost for all physicians? Nuc, CT, and Echo are an additional $995 each. Trainees shouldn't have to sell a kidney to practice medicine, especially when there's a physician shortage!
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There are 3 main strategies for anticoagulation in pregnant patients with mechanical valves:
1. Continue warfarin if low-dose (<5 mg/day)
2. Dose-Adjusted LMWH
3. Combination of Warfarin/LMWH
[Ref: Fig 18 from 2020 Valve Guideline]
#CVBoardPearl
#MedTwitter
#CardioOB
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When should you get a TTE for Prosthetic Valves?
Class I:
🫀Post-Procedure
🫀Symptoms Changed Suggesting Valve Dysfunction
Class IIa:
🫀5 & 10 years then ANNUALLY post-Bioprosthetic Surgical Valve–even if asymptomatic
🫀Annually post-Bioprosthetic TAVI
#CVBoardPearl
#MedTwitter
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Severe Mitral Stenosis:
🫀 Based on symptom severity
🫀MVA ≤1.5 cm2
🫀Diastolic pressure half-time (PHT) ≥150 ms
🫀Mean gradient is dependent on HR: A Mean Gradient > 5-10 mmHg at normal HR is typically severe.
Assoc w/
🫀Severe LAE & PASP >50 mm Hg
#CVBoardPearl
#MedTwitter
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Hallmarks of VT (to differentiate from wide-complex SVT) are:
🫀AV dissociation
🫀Fusion & Capture Beats
🫀QRS > 140 msec
🫀Precordial concordance (QRS pointing same direction)
🫀Northwest Axis (extreme axis deviation)
🫀Atypical bundle branch morphologies
#CVBoardPearl
#MedX
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Aortic Dissection in Pregnancy occurs most commonly in the 3rd trimester & up to 12 weeks postpartum. Type B Dissection can occur w/o aortic dilation. In pts w/ aortopathy, get a TTE at least each trimester & postpartum. (2022 ACC/AHA Aortic Guideline)
#CVBoardPearl
#MedTwitter
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Class I Mgmt of 1° MR:
🫀Mild symptoms from severe MR–even w/ normal LVEF–has worse prognosis. Perform MV surgery for symptomatic severe 1° MR, regardless of LV function.
🫀Perform MV surgery in asymptomatic severe disease w/ LVEF ≤60% or LVESD ≥40 mm.
#CVBoardPearl
#MedTwitter
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The RAO separates the right coronary sinus from the non-coronary sinus. However, RAO results in an overlay of the Right-over-Left coronary sinuses. Use RAO to visualize the Anterior RV Free Wall during EMB, RV lead implantation, & R septal ablation.
#CVBoardPearl
#CardioTwitter
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Patients with a noncardioembolic ischemic stroke should NOT receive DAPT (ASA+Clopidogrel) for >90 days and should NOT be on triple therapy due to excess bleeding risk (Class III: Harm).
Choose ASA 81mg OR Clopdiogrel 75mg OR ASA 25mg+Dipyridamole 200mg.
#CVBoardPearl
#MedTwitter
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Witnessed an ablation complication for the first time, and wow was it sobering. There's no truly benign procedure--just benefits that outweigh risks (that's different for each patient). He's doing well and home soon. So important to stay calm in the moment.
#EPeeps
#CardioTwitter
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What is the Shanghai Score? Diagnostic score for Brugada Syndrome incl. clinical hx, family hx, genetics. Diagnose BrS with ≥1 EKG finding and >3.5 points.
Image and Reference Link:
Deep Dive into BrS:
#CVBoardPearl
#MedTwitter
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I will be presenting Grand Rounds on Thursday, March 28 from 12:15-1:15 PM EDT.
Topic: "Demystifying Cardiac Testing: A PCP's Guide to Interpreting Cardiac Results."
Non-Harvard individuals may attend but CANNOT apply for CME Credit. I still hope you will join (link coming)!
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Peripartum Cardiomyopathy is defined as:
🤰NEW onset LVEF<45%
🤰± ventricular dilation
🤰NO reversible causes (dx of exclusion)
🤰Occurs towards the end of pregnancy up to the months following delivery (no longer a specific time before/after delivery)
#CVBoardPearl
#CardioTwitter
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Triggers of Vasospastic Angina:
🫀Increased Vagal Tone
🫀Cocaine, Meth, Marijuana, ETOH, Butane
🫀Cold-medicine (ephedrine)
🫀Sumatriptan & Ergots
🫀5-FU CHemo
🫀Food-Born Botulism
🫀Magnesium Deficiency
🫀Hyperventilation
🫀Cold Exposure
🫀Allergic Rxn
#CVBoardPearl
#MedTwitter
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Myocardial Bridging (MB) is typically Silent. Functional MB can sometimes results in angina, ischemia, ACS, VT, or sudden death. A "Milking Effect" may be noted on Cardiac Cath.
Click ALT on the Figure for the image credit & description.
#CVBoardPearl
#CardioTwitter
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So excited to have my mentor, Dr. Timir Paul, here for Sarver Heart Center Grand Rounds! He has an exciting two day itinerary planned, meeting all our amazing faculty at
@UAZHeart
!
#CardioTwitter
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Sanjay knows he's loved when TWO cakes (with candles) show up to morning conference. He always goes out of his way to recognize peers and care for our mental health, so just a small token of our appreciation for a great colleague!
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How are Lytics dosed?
🫀Give fibrinolytics w/in 30 min of hospital arrival, preferably within 10 min of STEMI diagnosis.
🫀I made the table below to summarize dosages based on the guidelines. Streptokinase isn't available in the US (thus omitted).
#CVBoardPearl
#MedTwitter
(2/6)
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🫀Do NOT perform exercise testing in SYMPTOMATIC SEVERE AS (Stage D1, aortic velocity ≥ 4.0 m/s, or mean pressure gradient ≥40 mmHg) due to the risk of severe hemodynamic compromise (Class III).
🫀DSE is Class IIa in Stage D2.
Ref: 2020 Valve Guideline
#CVBoardPearl
#MedTwitter
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The 2023 AHA/ACC Guidelines for the Management of Patients With Chronic Coronary Disease dropped yesterday!
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POTS:
🫀Abnormal increase in HR to > 120 bpm within the first 10 min of standing.
🫀Syncope is driven not by this abnormal increase in HR but rather by an overlapping condition.
🫀Encourage hydration +/- electrolytes, compression socks, standing slowly.
#CVBoardPearl
#MedTwitter
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Got to meet
@BakhshiHooman
in real life, and he has such sage advice on
@ACCinTouch
involvement. Looking forward to working together in the organization in the future!
#ACC23
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Continue GDMT in patients with HFimpEF, regardless of symptoms, to prevent relapse of HFrEF.
Relapse:
🫀⬇️LVEF>10% & <50%
🫀⬆️LVEDV >10% and to above the normal range
🫀2-fold ⬆️ in NT-proBNP concentration and to >400 ng/L
🫀Clinical evidence of HF
#CVBoardPearls
#MedX
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Glucose-lowering therapy in patients with a hx ischemic CVA/TIA:
🧠GLP-1 Agonist (e.g. semaglutide): Add to metformin, regardless of baseline A1C, to reduce recurrent vascular events
🧠SGLT2i ("flozins"): Add to the regimen for patients with HF of CKD
#CVBoardPearl
#MedTwitter
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@RodGerardo
I'm a cardiology fellow. I go every 6 months. My program supports fellow wellness and the need for healthcare maintenance. And it makes us less hypocritical when we recommend prevention to our patients! Shout-out to
@UAZHeart
!
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Through ACC, I met so many inspirational women in the world of cardiology. I hope to be even a fraction like them someday!
@KTamirisaMD
@DrMarthaGulati
@JasneetDevgun
@gina_lundberg
@DrToniyaSingh
@shelleyhallmd
@NanetteWenger
@SharonneHayes
@NanditaCGupta1
@Drroxmehran
#WIC
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Screen for primary aldosteronism in patients with HTN & hypokalemia, resistant HTN, HTN w/ adrenal incidentaloma:
🫀Eval: Morning Plasma Aldosterone & Renin while SEATED
🫀POSITIVE Result: PAC/PRA ≥20 ng/dL AND PAC ≥15 ng/dL
🫀Find lesion on adrenal CT
#CVBoardPearl
#MedTwitter
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Next topic of the night is Commotio Cordis by Dr. Mark Link!
What did I learn?
🫀NOCSAE standards for chest wall protectors reduce VF from chest wall impact
🫀This slide shows variables that affect incidence of VF with chest wall impact.
#MedTwitter
#CardioTwitter
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Diagnostic Criteria for Takotsubo: new EKG abnormalities OR elevated troponins; TRANSIENT LV systolic dysfunction in non-coronary distribution, a negative eval for occlusive CAD, pheo, and myocarditis, and a “trigger” (emotional, physical, neuro).
#CVBoardPearl
#CardioTwitter
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Next is Long QT Syndromes by Dr. Salim Idriss. Great graphic explaining the overlap in QTc between LQTS patients and those without the disease. "Dx is not solely based on the QT Interval." Use the Schwartz Criteria!
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I Tweet a
#CVBoardPearl
every weekday at 11 AM EST/8 AM PST. Tweets are not medical advice but rather a point to start studying and discuss CV-relevant topics with
#MedTwitter
and
#CardioTwitter
colleagues. Thank you to everyone who comments, shares, and likes! Happy 2023!
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Just found out our abstract was accepted for poster presentation at
#ACC23
! Congrats to our team: Student Doctor Arturo Hernandez, Chief Resident Dr. Brendan Andres! With mentorship from Dr. Deepak Acharya, Dr. Tushar Acharya, and Dr. Elizabeth Juneman!
@ACCinTouch
@ArizonaACC
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Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an autosomal dominant disease of desmosome dysfx char. by RV involvement with LBBB VT & Fibrous/Fibrofatty replacement of RV myocardium. Genetic Variants: PKP2, JUP, DSC2, DSG2, DSP, SCN5A
#CVBoardPearl
#CardioTwitter
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I never used to believe the people who said that a fellowship is defined by its people. 3 years in, and it's 100% true. This journey is so much more special and "worth it" because my colleagues (friends) exist. It makes rough days better and good days the best!
@UAZHeart
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HAS-BLED should be used to determine how to correct the underlying risk factors for bleeding--not how to avoid AC. Those with a HAS-BLED ≥3 may need closer follow-up and earlier review of AC.
#CVBoardPearl
#MedTwitter
#CardioTwitter
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At the
#WIC
and
@WomenAs1
reception, and look how many amazing Women in Cardiology are here! So thankful to those who have paved the way for us to continue in this path as strong female cardiologists.
@DrToniyaSingh
@Drroxmehran
@KTamirisaMD
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Due to the risk of sudden death, even asymptomatic patients with confirmed anomalous left coronary artery from the right sinus with interatrial (path between the aorta & pulmonary artery) course should be considered for corrective surgery (Class IIa).
#CVBoardPearl
#CardioTwitter
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Bidirectional VT is seen in digoxin toxicity & catacholaminergic polymorphic ventricular tachycardia (CPVT). CPVT can present with syncope triggered by exercise/emotion or SCD. Mutation in RyR2 (Ca release from sarcoplasmic reticulum) is most common.
#CVBoardPearl
#MedTwitter
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When overseeing an exercise stress test, pay attention to HR and BP recovery! Why? Abnormal BP ratio (BP at peak stress:BP at 3 min) < 0.9 is assoc. w/ CAD. Poor HR recovery (≤ 12 bpm stand, ≤ 18 bpm lying, ≤ 22 bpm sit) is assoc w/ poor prognosis.
#CVBoardPearl
#CardioTwitter
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To be matched with someone who I aspire to be more like professionally shows me I'm moving in the right direction!
Who is your Twitter twin? 👯
@PoojaJagadishMD
=
@DrMarthaGulati
PoojaJagadishMD and DrMarthaGulati are Twitter twins!
#twitterTwin
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