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
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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Hi all. I will be taking a brief hiatus from Twitter for the next couple of weeks to focus on my personal life! #CVBoardPearl #MedX.
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Int-risk patients do not have significant troponin elevations and warrant cardiac testing. Consider inpatient or obs monitoring with a chest pain protocol. These patients need a bedside echo to evaluate LV function, valves, wall motion, & pericardial effusion. #CVBoardPearl #MedX
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đź«€ Low-Risk Chest Pain: 30-day risk of death or MACE is <1%. Determine true risk based on a validated clinical decision pathway, e.g. HEART score. đź«€Truly "low risk" patients can be discharged home without admission or urgent cardiac testing (Class IIA). #CVBoardPearl #MedX
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HEART PATHWAY is a validated clinical decision score to risk-stratify patients presenting with chest pain:.Low: HEART score <3, Neg 0, 3-h cTn, Neg 0, 2-h hs-cTn .Int: HEART score 4-6 .High: HEART score 7-10.Goal: ↑ ED discharge w/o missing 30-d or 1-y MACE .#CVBoardPearl #MedX
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Definition of Low Risk Chest Pain by hs-Troponin:.🫀Initial hs-trop < assay limit of detection or "very low" threshold.🫀Initial hs-trop & both 1h,2h delta < assay “low” thresholds.Only rule out with a single negative hs-cTn if sxs started > 3 h before arrival.#CVBoardPearl #MedX
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In patients whose chest pain or chest pain equivalent symptoms are unchanged, prior testing has a "warranty period" that can reduce unnecessary repeat testing. đź«€ Cardiac CTA: No stenosis or plaque - 2 years.đź«€ Stress Testing: Normal stress test - 1 year.#CVBoardPearl #MedX
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RT @COREIMpodcast: 1/ 🚨 NEW #5Pearls: Lp(a) and ASCVD Risk. Lp(a) is a lipoprotein similar to LDL but a different entity!. Lp(a) has import….
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RT @DFCapodanno: #ACC25 Day 2, here is the summary of today’s trials (I haven’t included the follow-up extensions of Evolut Low Risk, Trilu….
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RT @MKIttlesonMD: #TipsForNewDocs. Before ordering a test, have a plan for a normal, abnormal, or indeterminate result. If this thought exp….
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RT @a_l_bailey: One of the most important trials at @ACCinTouch #ACC25 ! Compared fluid restriction to liberal approach in #HeartFailure.….
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RT @DrMarthaGulati: Okay you asked for a TweetUp or whatever we should call it now. So for those of you that don’t have plans Sunday come….
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Cardiac CTA Contraindications:.1. Iodine Contrast Allergy.2. Can't follow breath-hold instructions.3. Clinical instability (e.g, decomp CHF).4. Advanced renal dz (by local protocol).5. If Beta-Blocker contraindicated & no alt way to lower HR.6. Sig Arrhythmia.#CVBoardPearl #MedX
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Contraindications to Stress CMR:.1. GFR (<30 mL/min/1.73 m2) - due to gadolinium.2. If vasodilator contraindicated.3. CIEDs not MR conditional or affecting scan quality/interpretation.4. Significant claustrophobia.5. Caffeine use within past 12 h .#CVBoardPearl #MedX
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Contraindications to Stress Echo (beyond ETT contras):.1.Poor echo windows.2.Decomp CHF, Resp failure, severe COPD, PE, Severe pHTN.3.BP ≥200/110.-Dobutamine contraindications: severe AS, AV block.-Atropine contraindications: MG, narrow-angle glaucoma, etc. #CVBoardPearl #MedX
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RT @ACCinTouch: Artie’s all packed—are you? 🎒. 📱 #ACC25 App ✅.Pro Tip: Make sure to download the app & set ⏰ for your must-attend sessions!….
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Stress Nuclear Contraindications (Beyond ETT contras):.1. VT, high-grade AV block, sinus brady<45 bpm.2. SBP <90 mmHg.3. Bronchoconstrictive/Bronchospastic dz.4. Caffeine w/in 12 hours .5. SBP ≥200/110.6. If Contraindication to Vasodilator, avoid vasodilator.#CVBoardPearl #MedX
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ETT Contraindications (per chest pain guideline):.1. Abnormal ST on baseline EKG (e,g, WPW, LBBB).2. Cannot exercise 5 METs / Unsafe for treadmill.3. Active ACS within 2 days.4. Decomp. CHF.5. CHB, VT.6. Sxs Severe AS.7. PE, Aortic Dissection, Myocarditis.#CVBoardPearl #MedX
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CK-MB is no longer utilized in evaluation of acute myocardial ischemia if troponin is available (Class III). High-sensitivity troponin is the preferred biomarker. It allows rapid detection/exclusion of myocardial injury and increases diagnostic accuracy. #CVBoardPearl #MedX
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When clinical suspicion for ACS is high, even if the initial EKG is nondiagnostic, serial EKGs should be performed to evaluate for potential ischemic changes over time (Class I). #CVBoardPearl #MedX
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