There is considerable confusion in terms used to describe
#troponin
, including terms that are imprecise (e.g., “troponin leak”) or deprecated (e.g., “type 2 NSTEMI”) (Lang, 2022). What's the difference between 🫀myocardial injury, ischemia, & infarction❓ 🧐
#MedEd
🧵
Congrats
@nathanwchen
on a great senior thesis on novel somatic variants in human disease! And congrats to all
@yaledatascience
seniors on a very, very diverse set of projects. 👏👏👏
@jennkwanMDPhD
Congrats
@nathanwchen
on presenting 1) your senior thesis work evaluating CHIP/novel somatic variants & their effects on human disease! 2) Using Q learning on simulating optimal figure skating ⛸programs to maximize scores
@Yale
@yaledatascience
What a milestone!
Thank you residents
@YaleIMed
for the honor of Fellow of the Year. Thank you for loving to learn & engage in the CCU and develop your clinical decision making skills. It is so wonderful to see everyone grow. Congratulations esp. to the graduates!🎉🥂🍾
Jiun-Ruey Hu, MD, MPH, was voted as Consultant of the Year by residents and interns of the
@Yale_EM
at the Yale School of Medicine.
Read more about his career as a clinician-educator:
1⃣Is the Tn above the 99th percentile upper reference limit (URL)? If so, there is *myocardial injury* regardless of the underlying cause.
Myocardial injury can be acute or chronic.
Sanchez, Rege, and Hu Honored with Teaching Awards via
@yalemed
Congratulations to 1st Year Fellow,
@ruey_hu
, for this recognition of his fantastic teaching skills!
@YaleCardiology
👉Asymptomatic orthostatic hypotension (OH) is more common that symptomatic OH in outpatients.
👉Asymptomatic OH, historically, has led clinicians to avoid intensive blood pressure control.
❓Do patients with asymptomatic OH derive benefit from intensive BP control?
You've heard of Choosing Wisely. Now, we present to you: Stressing Wisely!🏃♀️
Congratulations 🎉🥂 and thank you to Drs
@camilatrejop
, Wright, Esin,
@attilafehermd
@edwardmillermd
and soon-to-be Dr Maayah
@YaleMed
for bringing this idea to life. Thank you to ASNC for the National
The American Society of Nuclear Cardiology (
@MyASNC
) named a
@YaleCardiology
team winners of the 2023 National Quality Improvement Challenge for their digital clinical decision support tool.
More on the tool Stressing Wisely ⬇️
@edwardmillermd
@ruey_hu
The Department of Internal Medicine’s 2022 Fellow of the Year is Ruey Hu, MD, MPH. At Yale,
@ruey_hu
has helped mentor medical students and residents on research and medical education projects.
Learn more:
@YaleMed
@YaleIMed
@edwardmillermd
Cardiologist Ruey Hu (
@ruey_hu
) is a Renaissance man. He plays 4 instruments, was in an East Asian acapella group in undergrad. He composes music, ice skates, does tae kwon do.
And he's hand-coding innovative tools for doctors.
#STATWunderkinds
It is my greatest pleasure to mentor everyone with an interest in
#ComputationalCardiology
! Thank you Dr
@MarkDSiegel1
for creating such a collaborative environment for
@TradIMYale
residents, who have really stepped up to the challenge!
Rates and risks of CVD differ significantly by Asian American and Pacific Islander subgroups. Another reminder of the importance of disaggregation. Check out this
#ACC24
poster by
@rachechang
from
@UCSFIMChiefs
The role of quadruple
#GDMT
💊 in patients with🫀 heart failure with reduced ejection fraction is widely accepted. But does the *sequence* and *speed* with which we initiate GDMT matter? 🤔
Blood pressure fluctuations *outside* the clinic setting are associated with risk of stroke (Kario, 2023, Hypertens Res), but current intermittent cuff-based BP devices, including home and ambulatory devices, are unable to capture the breadth of BP
variability across activities.
I wanna give a shout out to the 🌠 resident who carefully combed through hundreds of papers for this effort with me, Jiawei Tan.
#NephTwitter
#ERAS2023
fellowship PDs, please consider her! 🙏
Thank you to all the exceptional student leaders including
@donnatranmd
and
@msJoyceLee
who put in tireless work to advance the mission of
@APAMSA
. Thank you to all the residents, fellows, and med students
@YaleIMed
@YaleMed
who have directly contributed to the effort.
Concern about risk for orthostatic hypotension should not in itself be a reason to avoid or de-escalate treatment for
#HTN
Check out this meta-analysis of AASK, ACCORD BP, SPRINT, SPS3, UKPDS, HYVET, SHEP, Syst-Eur, and TOMHS led by Dr
@spjuraschek
@BIDMC_GenMedRes
@AnnalsofIM
New systematic review published in Annals of Internal Medicine suggests that
#hypertension
treatment lowers the risk for orthostatic hypotension, or extreme drop in
#bloodpressure
upon standing.
Read more .
According to current guidelines, the terms “STEMI” and “NSTEMI” should only be used when referring to type 1 MI, not type 2 MI. “Type 2 NSTEMI” is a misnomer.❌
CONGRATULATIONS to my friend and talented fellow Dr Devika Nair
@devimol
for placing 2nd at the National Young Investigators' Forum in Clinical Science
@NKFCLINICALS
!
@VUMCKidney
Spirit! 🏅🎉
Our commentary on validation protocols for cuffless BP monitors is in press, led by the brilliant
@ruey_hu
with
@lckovell
@rantocran
@TammyBradyMD
...
Read our thoughts on what validation should look like!
Validating cuffless blood pressure devices
I could not have dreamed of a better partner than my friend Rochelle Wong MS3
@VUSM
for this yearlong quality improvement project. Today we won the
@ACPinternists
National Medical Student Abstract Poster Competition among 150 finalists at
#im2018
! PDs, please consider Rochelle :)
Diabetes, which comprises over a quarter of PCI patients, is characterized by a state of increased platelet reactivity and abnormal platelet function, and is associated with more complex coronary lesions. What is the optimal duration of DAPT after PCI in patients with diabetes?
📖Pts w type 2 diabetes mellitus comprise more than a quarter of all pts undergoing
#PCI
& are at higher risk of adverse events. Authors reexamined the optimal duration of
#DAPT
post-PCI in pts w DM.🔎
➡️
.
@ekoikonomou
presenting at
@ACCinTouch
:
@cards_lab
ASSIST tool recommendation for CCTA was associated more severe anatomical disease and intensification of preventive therapies, which may explain the prognostic value of ASSIST
Can't get enough of metabolomics! 😅 Thank you
@DrTariqShafi
for mentoring me on this exciting research, Drs
@JoeCoresh
&
@meg21212
for mentoring me on prior metabolomics projects, Dr Myint for her ML acumen, and all coauthors Drs
@LAInker
@ASLtufts
Guallar, Hansen & Rhee
Congratulations to PGY3
@ruey_hu
who placed 1st at the Mid-Atlantic Young Investigators' Forum for his research on uremic symptoms and the serum metabolome! Ruey will represent
@VUMCKidney
@VUMCMedicineRes
at the national competition
@NKF
in April.
<25% of eligible patients initiate🫀cardiac rehab after MI or HF 🏥.
PERCEIVED health competence–belief in one's ability to achieve health-related goals–is a psychological factor🧠strongly associated with likelihood of initiating cardiac rehab.
@JCRPjrnl
Psychological factors such as perceived health competence (PHC) may play a role in CR initiation. Dr. Hu et al. evaluate the association of PHC with CR initiation among pts hospitalized for ACS & find need for interventions designed to support PHC.
Dr
@SpatzErica
@YaleCardiology
outlines the change we need to see in the future of blood pressure monitoring
@AHAScience
@HyperAHA
:
1️⃣ Validation of novel cuffless BP devices in diverse populations
2️⃣ Utilization of contextual data to identify contributing factors for
In
@JAMANetworkOpen
today: Older adults (>65/>75yo) are simultaneously at the highest risk for MACE and also bleeding.🩸What is the optimal duration of DAPT in older adults after PCI?
Please check out this
#SystematicReview
and Network
#MetaAnalysis
of 14 RCTs by
@daeyongp92
📖 Another one of our studies on DAPT - this time in older adults.
👴🏾👵🏽 Older adults, defined as age >65 or >75, depending on the RCT have higher ischemic ❤️🩹 and bleeding 🩸 risks, but prior trials have not studied shortening DAPT specifically in this higher-risk population.
What digital tools can assist in decision-making in acute coronary syndrome?🧵
Validated scores readily available on
@mdcalc
include:
GRACE:
HEART:
HE-MACS:
T-MACS:
The GRACE ACS
Smartphone- and web-based digital aids can bring evidence-based risk estimation models to the point of care. Proud of
@YaleMed
students
@see_laudia
,
@ScottGrubman
, and Daniel Grubman for putting together this review on digital tools for decision-making in coronary artery disease,
There are actually 5, not 2, categories of MI.
Type 1 MI refers to plaque rupture and/or erosion, which can occur with or without an occlusive thrombus.
Type 2 MI refers to MI where there is no plaque rupture or erosion.
El INS y
@YaleCardiology
de la
@Yale
invitan a participar en modalidad virtual, en el Simposio Cardiovascular, a realizarse el viernes 15 de marzo, 2024, a partir de las 9:00 a.m. desde el INS.
If you are entering residency in any of these specialties or preparing for a sub-I, please register below to watch! We are working hard
@APAMSA
to put together quality review content for you!
We are excited to announce the return of the National APAMSA Bootcamp Series for 2024! Alumni residents, fellows, and attendings will provide a rapid review of core topics and offer practical tips for medical students preparing for their sub-internship or intern year. Links 👇
#GDMT
reduces mortality and hospitalizations but is consistently underutilized, especially in patients with concomitant
@KidneyInCVD
. Back in 2022,
@jiiiiawei
@StanfordNeph
and I created an educational tool to assist in decision-making for GDMT in
#HFrEF
.
@ekoikonomou
and colleagues at
@cards_lab
@YaleCardiology
have developed an automated end-to-end machine learning phenomapping-guided algorithm for adaptive,
#PredictiveEnrichment
of RCTs.
The algorithm can be defined at the protocol stage without any a priori knowledge and no
Medical students, ever wonder what to make of 🫀 telemetry?
Join National
@APAMSA
this Saturday, May 18th from 2-4 PM PT (5-7 PM ET) for our EKG & telemetry workshop by Frank Qian
@frankq1368
@BUCards
& Alex Choy
@MSHCardsCT
(incoming EP fellow)
✏️Register now at
Take home points from
@Carlos_DavilaMD
@YaleCardiology
about mechanical circulatory support devices in cardiorenal syndrome
@AHAScience
@KidneyInCVD
:
1️⃣ Acute MCS devices are increasingly used in CRS
2️⃣ Defining and reporting renal outcomes in patients receiving acute MCS remains
Dr Paul Ridker at Brigham
@bwhcvls
points out
@CVCTForum
that the relative risk reduction in MACE in double-blind placebo-controlled trials of colchicine excdeeded that of PCSK9 inhibitors and ezetimibe as an adjunct to statin therapy.
Absolutely phenomenal Grand Rounds talk by
@ruey_hu
about building digital tools for decision making in cardiology
@YaleMed
@YaleIMed
!! So eloquently delivered and so inspiring
To understand how to interpret Tn elevation in each non-ACS condition (e.g. exercise, sepsis), it may be helpful to know the prevalence of Tn elevation in each condition.
Had the pleasure to meet
@ruey_hu
@carsalpajarillo
and Scott from Yale during
#AHA2023
this weekend. Check out Ruey’s incredible app for quick and accessible recommendations on GDMT at !
(A) Statins–as we all know–competitively inhibit HMG-CoA reductase, leading to reduced hepatic cholesterol synthesis.
(B) Ezetimibe binds to the transmembrane protein NPC1L1 at the small intestinal brush border, reducing cholesterol uptake.
(C) Bempedoic acid inhibits
6⃣Note that each disease entity (e.g., anemia) exists on a spectrum. It can present in isolation with no myocardial injury, with myocardial injury, or with acute myocardial ischemia leading to myocardial infarction.
What digital tools can assist in PCI planning?🧵
@SCAI
's Point-of-Care App offers quick access not just to guidelines but also its PCI Risk Assessment Tool, which predicts the risk of in-hospital mortality, bleeding, AKI, and femoral complications. Based on data from Brennan
Smartphone- and web-based digital aids can bring evidence-based risk estimation models to the point of care. Proud of
@YaleMed
students
@see_laudia
,
@ScottGrubman
, and Daniel Grubman for putting together this review on digital tools for decision-making in coronary artery disease,
To read more about the promise and limitations of cuffless BP devices, please check out our review "The Promise and Illusion of Continuous, Cuffless Blood Pressure Monitoring" published today
@SpringerCurRpts
with
@daeyongp92
@spjuraschek
@rantocran
Come join APAMSA on Sunday, April 23 from 3-5PM EST for our first bootcamp of the season — Internal Medicine!
Our fabulous residents from Yale will be covering high-yield topics seen on the wards to prepare us for success this coming year! Register at
If so, that is acute myocardial ischemia.
If there are no ischemic ECG/echo changes and no ischemic symptoms, there is likely no myocardial ischemia. A diagnosis of non-MI Tn elevation due to [specify underlying cause] would be more appropriate.✅
Congratulations to
@DrJESalem
@mathieukerneis
on this terrific
@NEJM
paper! Terrific team now in place
@APHP
for transatlantic efforts 2 better understand immune checkpoint inhibitor-associated myocarditis! Look forward 2 future collaborations!
@VUMC_heart