Ritu Thamman MD
@iamritu
Followers
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Associate Professor #cardiologist #SoMe editor @CircOutcomes @JournalASEcho #BOD @ase360 @PittHealthSci @ColumbiaMed @NUFeinbergMed #echofirst #NewJersey girl
University of Pittsburgh SOM
Joined January 2010
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Last Seen Profiles
💔women wait 10 min longer to be seen for chest pain in ER
💔women less likely to be triaged as emergent case
💔women less likely to get ekg,or🫀monitor, or to
be seen by a cardiologist in the ER for CP
💔less likely to be admitted 🏥 for CP
#ACCWIC
#ACC21
#DisparitiesOfCare
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I am sad to inform that my family friend and physician Dr. Priya Khanna is no longer with us Thank you to all that tried to save her, a young doctor from
#COVID19
#HealthcareHeroes
@DrRupaliGandhi
@CardiacConsult
@DBelardoMD
@CMichaelGibson
@Atul_SharmaMD
PLEA for help!
Plasma donor needed urgently for Dr. Priya Khanna, a nephrologist in NJ currently in critical condition w/ COVID 19, intubated & fighting for her life!
Anyone that was COVID+ & symptom free for 2 weeks is an eligible donor. Contact group below.
Please RT🙏
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107
569
New 3D “Glass”
#echofirst
tool -transillumination (TI) integrates a virtual light source into data set :better depth perception & orifice definition:shape, size,borders
@JournalASEcho
@ASE360
@rajdoc2005
@ilya_tweets
@robertomlang
@DocStrom
@LucySafi
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176
544
🔺aortopulmonary window connection b/w ascending aorta & main PA
🔺presence of 2 semilunar valves distinguishes this anomaly from truncus arteriosus
🔺Both semilunar valves normal in position
from
@ASE360
member Pamela Henderson
@CASEfromASE
#echofirst
@kgzimmerman
@rajdoc2005
13
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464
pedunculated large mass with irregular borders attached to posterior P2 mitral annulus prolapsing into LV & smaller, secondary mass attached to Interatrial septum
#echofirst
Rare deadly spindle cell sarcoma
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107
416
Commotio Cordis is sudden blunt impact to chest ➡️sudden death in absence of cardiac damage
Most important variable is timing of impact relative to cardiac cycle:upstroke of Tw
🆚Contusio Cordis(contusion) blunt chest trauma➡️ structural cardiac damage
1
120
408
Multichamber myxoma: Carney complex (autosomal dominant, rare)
@ASE360
@CASEfromASE
By age 30, 35% of females & 45% of males had at least one myxoma
#echofirst
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118
403
Cutest
#Echofirst
ever:
in a
#African
pygmy
#hedgehog
🦔 examined due to a systolic heart murmur
Findings: dilated & hyperechoic LV, dilated LA & mitral regurgitation
#Preview
will be in
@CASEfromASE
from Rebecca Stepien
@uwvetmed
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91
391
@RoxanaDaneshjou
In our home, it was filled with atta (flour) used to make daily roti’s (bread):the round shape of the container was the perfect shape to coat the rolled rotis in flour- thanks for bringing up a happy memory
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5
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Rare cause of aortic stenosis: unicuspid unicommisural
aortic valve h/t
@echo_stepbystep
@DrBrianSolomon
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#Timing
of
#Mitral
#Regurgitation
Early systole
Late systole
Holosystolic
Biphasic
#color
#doppler
#echofirst
h/t
@BonitaEcho
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120
349
#GetVaccinatedNow
@Nature
meta analysis
#Covid19
long term effects happen in 80% pts
5 most common
fatigue 58%
headache 44%
attention disorder 27% hair loss 25%
dyspnea 24%
If
#SARSCoV2
➡️ substantial tissue damage leading to chronic dz still unknown
8
163
274
Remember by
#echofirst
we measure at
#vena
#contracta
where the velocity is highest( kinetic) and pressure is lowest & you can see same from herding 🐑 🐑 🐑
#ASEchoJC
@AragamJayashri
@DavidWienerMD
@DocStrom
@ash71us
@kgzimmerman
@rajdoc2005
@DrMarthaGulati
@ErinMichos
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Don’t be
#Patient31
who did not follow
#socialdistancing
Caused 2 clusters responsble for 80% of South Koreas infections
Do you want🩸on your 🤚?
#CancelEverything
#SocialDistancingNow
#Covid19
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Almost 50% of angina pts have non obstructive CAD on cath: 3 types of ANOCA & each has its’ own Rx:
🫀Coronary micro vascular dz B blockers
🫀Coronary endothelial dysfunction (? Rx)
🫀Coronary vasospasm (Ca channel blockers/nitrates)
@minissianm
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#TopTenThings
to tell surgeon
#echofirst
👇
@Baselalanazi6
1.What type of dissection?
2.What’s the extent?
3.Entry site
4.Exit site
5.Any rupture?
6.Any leak?
7. Aortic Regurgitation?
8.Pericardial fluid?
9.Great vessels?
10.Coronaries involved?
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That feeling when your Dad’s
@iRhythmTech
has a 9.1 second pause
& you end up taking him to
@HackensackUMC
for dual chamber ppm
#sicksinussyndrome
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10
224
Possible ⬆️ risk of
#COVID19
in people with HTN & heart disease may be related to ACEI ARB use:
these drugs upregulate ACE2 receptor expression which the virus 🦠 uses for entry
#SARSCoV2
ICU pts use AngII infusions if they need pressors
#cardiotwitter
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In Atrial Functional MR can get “Hamstringing”of posterior MV leaflet due to massive LA dilation;this “atriogenic” leaflet tethering is from displaced posterior annulus onto crest of LV inlet resulting in⬆️in annulopapillary distance restricting leaflet motion
#echofirst
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I'm grateful to have contributed to this
#WellnessTextbook
on
#burnout
Thank you to the other editors:
@drbrowncares
@KTamirisaMD
Available here (and free on Kindle Unlimited!):
…
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Tiny primary chordae rupture of
#anterior
#mitral
#valve
#leaflet
(excessive leaflet motion) & inferolateral MI/WMA with posterior leaflet tethering(restricted leaflet motion) both causing posteriorly directed
#mitral
#regurgitation
#EchoFirst
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215
@LopezOpitz
@almasthela
@falcardio
@KCL_CardiacMR
@tavoave
@omorenou
@purviparwani
@KemalogluOz
@vass_vassiliou
@cshenoy3
@venkmurthy
@rajdoc2005
@josejgdnews
@JRodriPalomares
@danilorenzatti
@fabrizioricci
@ohanloncmr
@drzgezdentok1
@DrFuisz
@chiarabd
@SISIACOficial
Beautiful case of constrictive pericarditis showing exaggerated RV LV interdependence w ⬆️ right sided filling w inspiration & septal shift/bounce t/w left : beautiful views of inspiration/expiration by
#WhyCMR
@MayoClinicCV
@JaeKOh2
@ASE360
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@strain_rate
@SBarrosGomes
@garvankane
@jeffreygeske
@VLSorrellImages
@mariovar55
@aelsab
@AlexBJanjic
@lpbadano
@gb_mackensen
@ottoecho
@BonitaEcho
@BartsEcho
@DavidWienerMD
@donoxorn
@ErinMichos
@edwardagill
@fpmorcerf
@GARCIAEDINSON95
@GWhalleyPhD
@onco_cardiology
Nice V cut-off sign on CWD TR trace ;reflects very high RA v-wave pressure due to 'wide-open' TR & broad, laminar flow, Doppler-derived RVSP via the simplified Bernoulli equation is inaccurate because inertial component of Bernoulli equation can’t be neglected (RSVP underestima
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#COVID19
#echofirst
Fulminent myocarditis
🔺⬆️ wall thickness& hypocontractility 2nd to inflammation/interstitial edema
🔺affects septum & inferior/infero-lateral walls
🔺best window PLAX & PSAX mid level
This is not acute myocarditis:1-2 mo after🦠 h/t
@The_Echo_Nerd
@ASE360
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109
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Tweetorial on Challenges in Quantification of Aortic stenosis before tonight’s
#ASEchoJC
on
@PPibarot
&
@E_Guzzetti
📝
~1/3 pts have DISCORDANT indices: AVA is severe <1 cm2 yet mean gradient is low <40 mmHG
Low Gradient types👇
14
99
204
#Gerbode
AV septal defect w LV-RA shunt
🫀systole, LV-RA (L to R) shunt since LVSP > RAP
🫀diastole,R-to-L shunt since RAP >LVDP
🫀Why is RAP⬆️?⬆️ RAP from severe TR
#echofirst
@CASEfromASE
@BonitaEcho
@JournalASEcho
@LucySafi
@NadeenFaza
@rajdoc2005
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79
196
“Flying W” sign Mid systolic notching,an abrupt⬇️in antegrade systolic velocity in pulmonary artery due to poor PA capacitance &reflectance waves out of pulmonary vasculature impeding RV systolic forward flow;Can see it w pulmonary embolism also
#echofirst
Simple quiz for residents. One hemodynamic finding from this M mode of pulmonary valve
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#COVID19
#myocarditis
37yo👨 Rx with 🔺methylprednisolone 200 mg/day x4 d 🔺immunoglobulin 20 g/day x 4 d
🔺norepinephrine 🔺toracemide &lasix
🔺milrinone
🚫
#echofirst
images
@ESC_Journals
#CHF
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Another Pickelhaube sign but not on
#echofirst
but on
#EKG
spiked-helmet sign (SHS):
elevation of isoelectric line precedes QRS, followed by a sharp R wave & then convex ST-segment elevation
mimics acute MI
Adrenergic excess/prolonged repolarization
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1/Tweetorial
#ASEchoJC
@CASEfromASE
86-yo man w class III CHF severe eccentric mitral regurgitation w ⬇️ functional capacity,🚫Sx candidate
Q:Can we treat w
#mitraclip
?
(Not typical central
#echofirst
regurgitantion)
A:Yes!how?start w nonstandard views
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@Dr_DanMD
@mmamas1973
@mirvatalasnag
@AnastasiaSMihai
@purviparwani
@ErinMichos
@MusaSharkawi
@DrJayMohan
@HeartOTXHeartMD
@DavidWienerMD
@dr_chirumamilla
@NadeenFaza
@evandrofilhobr
@GARCIAEDINSON95
@ShariqShamimMD
@PushpaShivaram
@AmitGoyalMD
😎
#EchoFirst
tissue doppler shows ⬆️medial E’ velocity in
#constriction
since lateral wall is tethered to the pericardium which is the reverse(annulus reversus)of normal where lateral 10-15 cm/s E’velocity is > medial 8-10 cm/s🆚CM both medial &lateral E’ velocity⬇️ h/t
@JaeKOh2
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For aortic stenosis
🔺measure LVOT diameter 5-10 mm below annulus??
🔺this UNDERestimates SV/AVA & OVERestimates AS severity & low flow status 🆚
#WhyCMR
🔺Measure LVOT diameter at annulus: agrees best with
#WhyCMR
SV & AVA
#echofirst
@JournalASEcho
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New
#CholesterolGuidelines
#AHA18
1 ❤️
#healthy
#lifestyle
2 ⬇️LDL 50%
3 if High Risk, + ezetimibe or PCSK9
4 LDL>190 Rx high statin
5 DM, age 40-70, & LDL>70 Rx moderat statin
6 👩🏻⚕️➡️pt talk
7 age 40-70,& intermed Risk ⬇️LDL 30%
8 risk enhancers?
9 intermed risk ➡️CAC
10 asses
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Happy to see our 📝 on
@twitter
&
#cme
? accelerated by
#COVID19
#pandemic
published today by
@ESC_Journals
Thanks to my co authors
@DrMarthaGulati
@mmamas1973
@AkhilNarangMD
@audvin
&
@DLBHATTMD
for making this paper a timely read
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A rare case of Mitral Arcade direct attachment of papillary muscles into mitral valve leaflets & results in a fibrous or muscular “arcade” formed by papillary muscles, short chords,& edge of anterior leaflet
#echofirst
Not the best image quality in this technically difficult study, but here’s an example of mitral arcade.
#echofirst
#CardioTwitter
#mitralvalve
@ASE360
@chiles_md
@HeartOTXHeartMD
@BonitaEcho
@BSWTemple_CVdoc
@VLSorrellImages
@MayoClinicCV
@CASEfromASE
@DrJUrbanczyk
3
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4
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172
1/Tweetorial on
#Subaortic
#membrane
prior to
#ASEchoJC
#Prevalence
-?, male predominance 2:1
Acquired,progresses over time
Theory: LVOT architectural irregularity,steepened aortoseptal angle,creates turbulence
Isolated lesion 40% assoc with valvular AS & other congenital lesio
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Gave a mutual friend of
@BethFratesMD
Mike Parkinson a Christmas 🎁 tonight: The beautiful
#Calendar
made with her quotes &
@Havenlust
Scott Hefti’s photos Still time to order the 2019 calendar. Worldwide shipping ... 💌 all proceeds to
@worldheartfed
…
5
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149
42,000 Chinese medical staff working for over 1 month w severe
#covid19
patients and NONE infected because of stringent
#PPE
@mswami001
@DrMarthaGulati
@hmkyale
@mmamas1973
@HeartBobH
@JGrapsa
@WilliamZoghbi
@ASlavitt
@ErinMichos
@rajdoc2005
@wendywangmd
#GetMePPE
@choo_ek
9
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Systolic anterior motion
#3DEcho
#echofirst
Watch the anterior mitral leaflet be sucked up & cover the aortic opening - a view from LV side
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161
@gonzaeperez
@smithECGBlog
@EM_RESUS
@Dr_DanMD
@jpcostabel
@edurontoFF
@ShariqShamimMD
@SIAC_cardio
@adribaran
@JuanM_Farina
@drdargaray
@rafavidalperez
@fazalabul
@GARCIAEDINSON95
@leonardo_seoane
@mencardio
Great case! Kounis syndrome (KS) hypersensitivity reactions by triggered mast cells from environmental/ pharmacological factors ➡️ acute coronary syndromes 🔺vasospasm (type I) 🔺native plaque destabilization (type II) or 🔺stent thrombosis (type III)
4
42
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No time to exercise?
RCT of ESKD patients doing intradialytic cycling (🚲while getting dialyzed) for 6 mo shows
🔺⬇️ in LV mass
🔺better T1 times & aortic pulse wave velocity( less fibrosis) c/w standard of care by
#whyCMR
@nephondemand
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calcific MS review
🔺calcium extends into mitral leaflet base,forms shelf,displaces mitral valve hinge into LV inlet, ⬇️mitral valve EROA
🔺calcific MS tubular🆚 rheumatic MS funnel impedance to LA emptying by LA y-descent & E-wave deceleration less steep
3
55
159
Our
@JACCJournals
📝 “Misinterpretation of
@ASE360
Mitral regurgitation algorithm ?”
@JudyHungMD
@VLSorrellImages
#echofirst
- know the limitations of imaging for the best outcomes in mitral regurgitation patients
@JGrapsa
@argulian
@WilliamZoghbi
6
43
159
Rare find <0.05% IRL but more common on
@twitter
#echofirst
quadricuspid aortic valve
Seeing Quad! A real rarity (<0.05%) - quadricuspid aortic valve
#echofirst
@amerjohri
@HeartDocSharon
@RodrigoBagur
@VLSorrellImages
11
131
588
4
26
158
8
64
153
B lines lung pocus
vertical reverberation artifacts impedance mismatch b/w 🌬️&💦
arise from pleural line:set focal zone to level of pleura
extend vertically into farfield ⬆️ gain in far field
use scan depth~ 15 cm
number of B lines correlate w extra vascular water
3
53
156
#EchoFirst
#VisualGraphic
The worse the
#aortic
#stenosis
The higher the peak velocity
The later (
#tardus
) peak velocity
The longer the ejection time
#ACCFIT
#CardioEd
#FOAMed
#TAVR
#RadialFirst
@ASE360
7
71
154
Which is better Night 🌖 Or Day 🌞 to take medications?
#Circandian
#Regulated
#apoptosis
in
#CVD
Night time....is the right time
9
80
155
Mitral Arcade
🔺severe shortening or complete absence of chordae tendinae
🔺direct attachment of papillary muscles into mitral valve leaflets
🔺results in a fibrous or muscular “arcade” formed by papillary muscles, short chords,& edge of anterior leaflet
1
67
153
Was asked “Can you suggest a few best reviews on ischemic MR”
#Echofirst
@ESC_Journals
@JudyHungMD
Secondary MR assessment & severity grading challenging
Need to treat underlying LV dilation/remodeling by GDMT
4
45
154
Thank you
@PittsburghMag
for naming me a top cardiologist in
#Pittsburgh
(out of 46 named only 4 female cardiologists)
#ACCWIC
#DiversityandInclusion
#WomenInScience
#ILookLikeACardiologist
35
12
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5 Abnormal septum motion patterns on
#echofirst
that are nonischemic
@BijoyKhandheria
1.LBBB septal flash-apical rocking
🔺LV apex moves t/w RV due to early septal shortening & posterolateral stretch
🔺delayed posterolateral
contraction leads to…
0
64
154
Mask = Love
Love yourself
Love your neighbor
Love the stranger you pass on the street
Love in the form of a mask
#COVID19
#ShowLoveWearAMask
#LoveIsLoveIsLoveIsAMask
@linmanuel_m
@ReneeGoldsberry
@DrMarthaGulati
@MassGenBrigham
@ACCinTouch
@DBelardoMD
@CardioSmart
@HeartOTXHeartMD
@fischman_david
@DocSavageTJU
@mmamas1973
@iamritu
@CDCgov
@mirvatalasnag
@keaglemd
@cardiojaydoc02
@willsuh76
@cardioPCImom
Thank you
@DrMarthaGulati
for amplifying this important public health message - time to wear a mask!
1
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3
28
148
What is the most common BENIGN coronary anomaly?
Coronary artery dual ostia (LAD & LCX) arising from left SOV found in 0.4% of coronary angiograms; this incidence may change with
#Yessct
#echofirst
6
46
151
#Tapse
is a Distance
T Tricuspid
A Annular
P Plane
S Systolic
E Excursion
#ASEchoJC
Use M-Mode to measure the height of excursion, NOT the slope!
#Longitudinal
mvmt
Correlates with RVEF, nl>16
⬇️ with severe TR, LV systolic dysfunction, prior Cardiac Sx
6
68
144
The
#echofirst
legend
Happy 90th Dr. Feigenbaum!!
Happy 90th birthday to ASE’s founder and first president, Harvey Feigenbaum, MD, FASE! ❤️
You have touched the lives of so many and your impact on the field of echocardiography is immeasurable. We hope you have a wonderful birthday.
12
42
159
2
18
146
What is the most common cause of aortic cusp prolapse?
transverse fold of right coronary cusp producing a partial & distal cusp prolapse
Leads to a very eccentric aortic regurgitation jet toward anterior mitral leaflet
#echofirst
5
49
146
#echofirst
cardiac cystic echinococcosis/hydatid cyst
Hydrated cyst of pericardium Echinococcus IgG positive
121
666
3K
8
36
146
Strain is not a pain
There’s much to gain
It’s not arcane
Don’t rack your brain
Know enough to come in out of the rain
Pre
#ASEchoJC
tomorrow 8 pm
@VicFerrariMD
@JiwonKimMD
@ambergtaylorgm1
@mariellesc1
@juancplana
@onco_cardiology
@alexFASE27
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37
141
🔺Abnormal coagulation is common in severe
#COVID19
🔺D-Dimer >1ug/dL is an independent risk factor for in 🏥 death
🔺Extensive intravascular microthrombosis seen at autopsy
🔺Rx w anticoagulation if possible
@ACCinTouch
1
87
137
aortic root sinus shape matters
Normals: sinuses have vortices that allow for smooth closure
Aortic root replacement:(straight tube) lacks sinus architecture & vortices are not formed
Loss of this function after root replacement may⬆️stress on leaflets
6
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#EchoFirst
to
#Stage
Cardiac Damage in
#AorticStenosis
💀
Stage 0 🚫cardiac damage 8%
Stage 1 left ventricular damage 24%
Stage 2 mitral valve or left atrial damage 49%
Stage 3 tricuspid valve or pulmonary artery vasculature damage 7%
Stage 4 RV damage 12%
4
67
140
Amazing rare case Takotsubo with free LV wall rupture
Watch this INCREDIBLE 3 second video clip. It’s an LV Gram showing Takotsubo with free wall rupture of the Left Ventricle. You can actually see the blood spurting out into the pericardial space with every heartbeat!
Courtesy:
@Julio_Farjat
#FOAMed
67
600
2K
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137
#covid19
#acute
#myocaditis
🆚 Stess CM
53 yo female 2d fatigue ( 1 wk before had fever/cough)
diffuse edema w wall thickening by
#whycmr
tropT .24-.89, bnp 5647, EF 35%,EKg diffuse st⬆️ h/t
@cshenoy3
@venkmurthy
@rajdoc2005
@purviparwani
@onco_cardiology
10
72
138
moderate Aortic stenosis
has mortality ratio> 2x controls (P < .001)even if LVEF or SVI preserved
⬆️ average E/e′ ≥ 14(w atrial fib E/e′ ≥ 11)discriminates patients at higher risk(HR 2.71) even after aortic valve replacement
#echofirst
@MayoClinicCV
5
56
139
For your next meta-analysis make your forest plots with emoji effect sizes in
#RStats
by
@dsquintana
@LesleyUttley
This is just a quick hack, but here you go people, knock yourselves out: (the text emojis probably won't on Windows) Credit to
@dsquintana
and ultimately
@LesleyUttley
for the idea.
8
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@DBelardoMD
@ajaykirtane
@ErinMichos
@purviparwani
@CMichaelGibson
@medicalaxioms
@netta_doc
@DocSavageTJU
@DrMarthaGulati
@mmamas1973
This can kill us:We need
#proper
protection
#COVID19
can infect via hair/eyelashes
#PPE
includes Dedicated
#covid
units, centralize pts & proper PPE, that you leave on/avoid need to take off
#ppe
, save time & gear. Slide deck by
@XihongLin
🇨🇳
8
87
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Flow velocity vectors superimposed on the color Doppler flow images in a dilated LV . With the opening of the mitral valve, there’s a shift in the filling jet direction t/w posterolateral LV wall which creates a swirling motion during diastole.
#echofirst
7
47
132
#visualgraphic
#acute
#mitral
#regurgitation
1 endocarditis
2 PM rupture
3 ischemia
4 iatrogenic devices
5 transient SAM fr Takotsubo
4
59
132
Type 1 acute aortic dissection:circumferential primary intimal tear leads to ascending aortic intima detachment: intimo-intimal intussusception into LV w aortic commissure detachment, impaired aortic valve coaptation by diastolic intimal flap prolapse into LV
h/t
@EllenWoodcock6
6
40
134
Difference b/w a posterior mitral valve cleft(goes all the way down to annulus) 🆚indentation(exaggerated demarcations typically involve posterior leaflet)
#EchoFirst
@AlsidawiMD
@adnanalkhouli
@AkhilNarangMD
@JoaoLCavalcante
@Pooh_Velagapudi
@atunuguntla1
@rajdoc2005
@JGrapsa
8
49
131
🧵SVC Imaging by TEE from
@JournalASEcho
Midesophageal bicaval view
mouth of SVC in upper right atrium (star in image A)
Slight withdrawal of probe & possible adjustment of angulation shows part of mid SVC(image B) & crista terminalis & RAA
#echofirst
5
43
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@NEJM
A sense of Belonging
#ILookLikeADoctor
#RepresentationMatters
#BlackLivesMatter
#payitforward
#YouBelongHere
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54
130
When LVOT VTI(CO) is normal to high, and patient has hypotension or worsening renal function don’t just push more fluids- check VExUS score (better prognostically than CVP)
#3DEchoBerlin
#echofirst
Easy & quick approach to 👀 at
#HF
beyond
#echofirst
&
#3DEcho
IMO should be become part of minimum dataset!
2
7
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How to measure
#Left
#atrial
#volumes
#ASEchoJC
@carron_hollie
@kgzimmerman
@carolKCW
@DavidWienerMD
@rajdoc2005
@KamuMaganti
6
60
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Bicuspid Aortic Valve in
@escardio
Sports Cardiology guidelines
🔺Unclear if bicuspid aortic valve accelerates aortic dilatation
🔺if Aortic root is >40 mm, exercise with less intensity
🔺if aortic root size is nl, no restrictions on exercise
🔺no intensive exercise w severe AS
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Mitral Color Doppler Splay
associated with more severe MR & worse outcomes
regurgitant flow at vena contracta generates a high-power signal in severe MR captured by side lobes of ultrasound beam (Splay)
#echofirst
@JournalASEcho
@rajdoc2005
@LucySafi
8
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#Top
5
#misconceptions
#amyloidosis
by
@BrettSperryMD
1.
#Rare
(under diagnosed)
2.
#low
voltage
#ekg
good screen (
#NOT
)
3.Fat Pad biopsy high sensitivity (only 15% + wild type ATTR
4.SPEP sufficient to exclude AL (
#NOT
-usually normal)
5. Everyone 💀 so not worth diagnosing
19
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@NMerke
@rajdoc2005
@ASE360
@DGK_org
Accessory mitral valve tissue Here’s another example Endocarditis & embolic events known complications from this rare congenital malformation
@CASEfromASE
@ASE360
0
45
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E/e’ on stress echo predicts ☠️beyond ischemia & LVEF
@MayoClinicCV
📝>14k pts
Pts w E/e’≥15 post exercise 1.39x⬆️risk(95% CI 1.18-1.65, p<0.0001)of all-cause☠️c/w pts w/o⬆️LV filling pressures
adjusted for age, sex, exercise capacity, LVEF, pulm htn
E…
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#Patients
with
#AFib
should be screened for
#SleepApnea
before initiation of
#rhythm
#control
Use MOODS score
Male 1
Overweight BMI>25 1
Obese BMI>=30 3
Diabetes 1
Stroke/tia 2
to ID pt subgroup where 🚫 overnight sleep study needed score 2 sensitive, 5 specific
#APHRS2019
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MVA ≥ 4.0 cm2 cutoff expands based on 3D Some w MVA before MC of 3.5 cm2 OK w 1 MC, minimal MVA 4.5 cm2 if 2 MC
tension induced by MC on anterio leaflet due to its U form
center🍃(green) is longer & will be less stretched after MC than lateral/medial more stretched yellow to red
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