More
@DrJCheungEP
this afternoon for ECG conference on wide-complex tachycardias! Great practice on localizing VT (
#EPeeps
):
- Use V1 to determine RV vs LV source
- Use inferior leads to determine anterior vs posterior
- Use precordial leads to determine basal vs apical
Incredibly excited to welcome this phenomenal group to our Cornell Cardiology family! We can’t wait to see our new fellows in July!! And congrats to all who matched! 😍🌟🥇🫀❤️
Our very own Dr. Dmitriy Feldman running for NY ACC Governor (
@NYSCACC
)! Triple threat in terms of clinical skills, research, and education. Vote before polls close tomorrow!
#Cardiotwitter
#ACCFIT
(
@ACCinTouch
@SCAI
)
Excellent talk by Dr Kim on the hemodynamic approach to shock in the cath lab. With evidence of biV failure (PCWP>18, PAPi<1), need to consider bipella or VA ECMO+vent to unload the LV.
#CathLab
#cardiogenicshock
Comprehensive overview of treatment of scar-mediated VT by electrophysiology
@DrJCheungEP
. Review of principles of activation and entrainment mapping for catheter ablation. Key is to target the critical isthmus in reentrant circuit to terminate the tachycardia.
#EPeeps
Congrats to our graduating cardiology fellows
@nyphospital
-
@WeillCornell
! Great night celebrating their achievements during their time here and looking forward to their many more in the years ahead.
#Cardiotwitter
EP conference with electrophysiologist Dr. Bruce Lerman on idiopathic ventricular tachycardia. Great anatomic depiction on localizing VT based on ECG findings. Determining LBBB vs RBBB and superior vs inferior axis can help localize into quadrants.
#EPeeps
Absolutely fantastic Cardiology Grand Rounds this morning from our Dean of Medicine Dr. Robert Harrington (
@HeartBobH
) on the future of clinical trials, randomization, and leveraging useful data!
Throwback to our phenomenal heart dissection with EP anatomist Dr Liu! The Triangle of Koch is an important landmark for the AV node in the right atrium, which is delineated by the coronary sinus, tendon of Todaro, and the septal tricuspid leaflet
#EPeeps
Excellent Cardiology Grand Rounds by Dr. Natarajan
@pnatarajanmd
@MGHMedicine
on polygenic risk scoring for
#CAD
. In an era of precision medicine & direct-to-consumer genetic testing, PRS may emerge as a risk-enhancing factor for CAD across diverse cohorts.
#Cardiotwitter
🧬🫀
Interventional fellow
@JosephWangMD
with comprehensive talk on use of IVUS in cath lab for cath conference. Crucial tool for identifying issues in stent deployment including underexpansion, malapposition, and edge dissection.
#CardioTwitter
Excited to welcome
@MKIttlesonMD
to Cardiology Grand Rounds! Informative talk on the approach to antibodies in heart transplant followed by a great fellows session talking about work, life and Twitter.
Third-year fellow
@JosephWangMD
with new paper in
@JAHA_AHA
showing that for patients with cardiogenic shock, risk-adjusted mortality is lower for patients admitted to LVAD centers. Specialized shock centers may be better suited to treat these patients.
Excited to learn from
@DrLaPrincess
for Cardiology Grand Rounds on best practices for community-based participatory research. CBPR can build and maintain community partnerships to address health disparities and share knowledge and power between researchers and community partners.
Angiography teaching in the
#cathlab
! Dr.
@DNFeldmanMD
reviews standard angio views w/1st yr fellow, as well as tips to capture images (or “pan”) effectively w/this year’s IC class. “The less you have to pan, the better; for this, setting up your shot well is key.”
#cardiotwitter
Overhead projectors, oversized calipers, and master electrocardiographer Dr. Peter Okin for the return of ECG conference. Always look for the hidden P-waves!
#cardiotwitter
#ecgfirst
EP conference with second-year EP fellow
@JamesGabriels
. Great explanation of how to conceptualize sensing threshold utilizing fence analogy. Fence too high (sensitivity low) you can’t see QRS or T wave. Fence too low (sensitivity high), you see both.
#CardioTwitter
#EPeeps
Great celebration last night for graduating interventional cardiology fellows! Look out for big things from Dr. Joe Wang (attending
@WeillCornell
), Dr. Nazir Savji (attending at Morristown Cardiology Associates), and Dr. Konstantinos Voudris (structural fellow
@MHIF_Heart
).
TVP 101 w/ Dr Cheung! Should use fluoro if possible but if in a pinch, can look for changes in EGM morphology and current of injury to guide placement into the RV. Urgent indications: symptomatic/HD unstable bradycardia, CHB w/ slow & wide ventricular escape, TdP
#Cardiotwitter
Excited to welcome
@ericjvelazquez
of
@YaleCardiology
today for Cardiology Grand Rounds! Great talk focusing on inpatient management of HF. Key point: hospitalizations are critical opportunities to implement GDMT in order to improve patients long-term trajectory.
#cardiotwitter
First-year fellow Ada Ip (
@adadrip
) presents interesting case of post-MI VSD. Important 🚨: don’t forget to auscultate in setting of STEMI to evaluate for mechanical complications. Great review on how to differentiate VSD from papillary muscle rupture here:
When you don’t have a chalkboard, improvise! Great bedside teaching during CCU rounds by heart failure attending
@DavidMajureMD
on cardio renal syndrome. Most common things to consider: low output states and renal venous hypertension.
@WCM_MedChiefs
#cardiotwitter
Cornell Director of Endovascular Services and interventional cardiologist Dr. Dmitriy Feldman
@DNFeldmanMD
discusses live complex coronary case at
#TCT2022
!
@TCTConference
Standing room only for afternoon teaching with third-year fellow Raffi Hagopian (
@AiMedicalDoctor
) to internal medicine residents. Great overview of basics of HF management for all internists to know.
#cardiotwitter
#ACCFIT
@WCM_MedChiefs
Cardio-oncologist
@saadhealth
kicking off the Cardio-Oncology Lecture series discussing cardiotoxicities of breast cancer therapies. Key point: Anthracycline-induced cardiomyopathy is 1) dose-dependent and 2) most often occurs within the first year.
#cardiooncology
Journal club with first-year fellow
@Diala_steitieh
focusing on recent
@NEJM
article showing impressive 15% reduction in body weight with once weekly GLP-1 agonist. Important study for prevention of cardiovascular disease. (Reference: )
Fascinating Grand Rounds with
@rwyeh
from
@SmithBIDMC
on modern approaches to scientific evidence generation. Thought provoking discussion on how strongly held beliefs can hamper ability to enroll and complete RCTs. Need to generate evidence before standards of care develop.
Our first in-person CCC since Covid!! Excellent talk by second year
@dolshanMD
about lyme carditis with high incidence of CHB. If recovery of 1:1 AV conduction s/p 14 days of abx, can consider stress testing to determine point of wenkebach for risk stratification.
#EPeeps
Cath conference with interventional fellow
@JosephWangMD
discussing angiographic projections. Important to utilize multiple projection: eccentric lesions can be underestimated when using only one view.
#CardioTwitter
Clinical Case Conference with first-year fellow
@nickysinghmd
on a complex case of chronic thromboembolic pulmonary hypertension. Echo can be an important tool to differentiate acute and chronic components of RV failure when determining patient management.
#CardioTwitter
Interesting Clinical Case Conference with first year fellow
@YosefSchwartz
on Wolff-Parkinson White syndrome. Great overview of high risk features for sudden death for patients with WPW.
#CardioTwitter
#EPeeps
Impella in-service for our new Cath fellows! 🫀Frequently used in pts w/cardiogenic shock & undergoing complex PCI,
#Impella
utilizes the principles of flow & pressure augmentation to optimize cardiac output & coronary perfusion while unloading the LV.
#Cardiotwitter
#CathLab
Clinical case conference with first year fellow
@jaya_kanduri
on complex case of bioprosthetic mechanical aortic valve thrombosis leading to cardiogenic shock needing VA ECMO. To vent or not to vent? Great review of options for venting.
#cardiotwitter
Happening Now:
#SCAI2022
Program Chair, Dr. Dmitriy Feldman, and SCAI President 2021-22,
@henrytTimothy
, officially open Scientific Sessions and present the Mason Sones Distinguished Service Award, Helping Hearts Lifetime Service Award, and Helping Little Hearts Service Award.
Third-year fellow Guillaume Bassil presenting morning report with case of tricupsid valve endocarditis. Great review of how to orient yourself to leaflets of TV. Proper axis allows you to be more sure of what leaflet you are looking at.
#echofirst
Hemodynamics review with third-year interventional fellow
@JosephWangMD
this morning going through the greatest hits of notable waveforms. 1️⃣ constrictive pericarditis with discordance of RV and LV pressure tracings due to ventricular interdependence.
Third-year fellow
@AshleyBeecy
(along with Jiwon Kim) tackle RV function assessment using machine learning. A fully automated machine learning model of tricupsid annular displacement performs well compared to traditional 2D echo indices.
Morning report with third-year fellow
@JosephWangMD
on antiplatelet therapy after PCI for patients with an indication for anticoagulation. Data shows that in many cases, reasonable to continue OAC alone after 1 year of double therapy. Great summary below!
#cardiotwitter
First-year
@jaya_kanduri
presents case of severe aortic stenosis and cardiogenic shock at Clinical Case Conference. Great discussion on need for accurate assessment of hemodynamics to guide management. Nitroprusside, while not often used, may be useful in high SVR states.
Phenomenal lecture with superstars Dr. Horn and Dr. Singh on Hemodynamics! Cardiogenic shock from MI with RV involvement can present as low SVR state (inflammatory cytokines, gut ischemia) and tailored therapy may require mechanical circulatory support
#CardioTwitter
Phenomenal talk about nuclear by the great
@DrAMcCullough
! In addition to diffuse subendocardial ischemia, TID can occur in the setting of malignant hypertension, differential heart rates during rest and stress images, and technical factors
#CardioTwitter
🔑 pearls from Master interventionalist Dr. Feldman: ticagrelor & prasugrel inhibit platelets faster and more effectively compared to clopidogrel. Ticagrelor binds reversibly to P2Y12 receptor as opposed to clopidogrel/prasugrel, so can be given anytime during cangrelor infusion
Another great CCC by 2nd year Dr. Jeff Abrams about SCD from VF arrest thought to be electrically mediated by early repolarization syndrome (EPS) triggered by short-coupled PVCs originating from RV moderator band, degenerating into TdP. EPS can be treated w/ quinidine
#EPeeps
Important and informative article by our very own first-year fellow
@doctornavjot
on increased incidence of fatal MI during the holiday season. Important for patients to know the warning signs! (Featuring
@SimranSinghMD
and
@HornEvelyn
of
@WeillCornell
)
Hemodynamics 201 with
@SimranSinghMD
and
@HornEvelyn
; below a case of mitral stenosis. Key point: the Gorlin equation in aortic stenosis uses systolic ejection period while in mitral stenosis uses diastolic ejection period.
#CardioTwitter
Excellent CCC by 3rd year Dr Steitieh on a pt with a large aneurysmal coronary artery fistula from LCx to the coronary sinus who presented with a pericardial effusion & syncope. This patient was surgically intervened on but can close these fistulas percutaneously
#CardioTwitter
Clinical Case Conference with first-year fellow
@nickysinghmd
on an interesting case of endocarditis complicated by STEMI. Great imaging review of differentiating valvular densities on echocardiogram below.
#EchoFirst
#Cardiotwitter
Recent Cornell Cardiology graduate
@DrNupoorNarula
in
@JACCJournals
on pregnancy-associated aortic complications in women w/Marfan syndrome. Large single-center study showed women w/aortic root < 4.5cm pre-partum had stable dimensions throughout pregnancy.
Cornell 🫀fellows attend
@AHANewYorkCity
’s Controversy Dinner! All-star
#Cardiology
panel explored complex cases- including the mgmt of refractory
#MINOCA
. In addition to invasive measures of
#CMVD
(e.g., IMR), Stress PET can assess for endothelial-independent microvascular dz.
Amazing Intro to Echo lecture by Dr Roman! Can calculate PA diastolic pressure with a pulmonic regurgitation signal [4x(PR end diastolic velocity)^2]+CVP
#Cardiotwitter
Echo conference with Dr. Mary Roman on aortic valve disease with review of bicuspid aortic valves. Most common fusion pattern is R-L cusp fusion encompassing 70-80% of all BAVs.
#cardiotwitter
#echofirst
Fantastic grand rounds with Dr
@ParagGoyalMD
who educated us about his extensive work on clinical innovations to improve outcomes in older adults with heart failure!
#HFpEF
Terrific Echo conference by our very own 2nd/3rd year 🫀fellows on
#Diastology
. By reducing preload & manipulating transmitral flow, the Valsalva maneuver may help differentiate pseudonormal from normal LV filling patterns by revealing a subsequent E/A ratio < 1
#EchoFirst
Discussing mechanical circulatory support in cardiogenic shock for fellows bootcamp with Dr. Luke Kim. IABP not augmenting appropriately? Good review of troubleshooting waveforms to look for early / late inflation / deflation.
#ACCFIT
#CardioTwitter
2nd yr 🫀fellows leading this wk’s fellow research day!
@nickysinghmd
’s project explores neighborhood-level social determinants of health & outcomes after HF hospitalization while
@dolshanMD
studies the assoc b/w PVCs & RV dysfunction before/after catheter ablation
#Cardiotwitter
ACHD conference with
@SimranSinghMD
on simple shunt lesions. PFO are doors 🚪, while ASDs are windows 🪟 without window panes. PFOs can be open or closed pending loading conditions, while ASDs will always be open.
#cardiotwitter
Pretending to be surgeons for a morning. Annual pig 🫀dissection with EP attending Dr. Christopher Liu to get familiar with cardiac anatomy
#GrossDissectionFirst
Clinical Case Conference with second-year fellow
@doctornavjot
on an interesting case of decompensated mitral regurgitation. Great illustration of pressure volume dynamics with chronic MR causing chamber dilation and normal pressures in compensated state.
#cardiotwitter
Morning conference with electrophysiologist Dr. Christopher Liu on Wolff-Parkinson-White syndrome. Delta waves seen in WPW can be thought of as fusion wave between conducted beats through AV node and accessory pathway.
#EPeeps
#CardioTwitter
Kicking off bootcamp with Hemodynamics 101 with Dr. Singh! If you don’t see a dicrotic notch after the systolic peak on a PA waveform, be concerned about overdampening (may need to flush the line) or being too deep in the PA
#cardiotwitter
Clinical conference by 🫀fellow
@doctornavjot
on
#SCAD
! While the majority of SCAD lesions heal by 30-35 days & w/medical mgmt, high risk features that may necessitate revascularization include ongoing ischemia, HD instability, VT/VF, LM dz or poor TIMI grade flow
#Cardiotwitter
IVC filter teaching in the
#CathLab
! First pioneered in the 1960s, IVC filters serve as an important therapeutic option in select patients with
#DVT
/
#PE
, who are unable to tolerate anticoagulation - such as those w/bleeding diatheses or upcoming
#surgery
.
#Cardiotwitter
#simlab
Cath board review with one of the eminent board writers himself, Dr. Dmitriy Feldman! Good review of PCI of nonculprit lesions after ACS. Guidelines evolving with recent data showing benefit to complete revascularization.
#cardiotwitter
Multimodality imaging conference with Dr. Quynh Truong (
@cardioQT
) on Cardiac CTA and calcium score. Calcium score only shows the tip of the iceberg for coronary artery disease. Should be reserved for asymptomatic patients and in some cases low-risk symptomatic patients.
Interesting imaging conference with third year fellow Cindy You with a case of bioprosthetic pulmonic valve stenosis. Important to remember, RVSP does NOT equal PASP in setting of pulmonic stenosis. Need to subtract peak gradient from RVSP.
EP conference with
@DrJCheungEP
on inherited arrhythmias. QTc in normal and long QT syndrome patients are along a normal distribution. 25-50% of patients with documented LQTS 1, 2, and 3 can have resting QTc < 460. Therefore, normal QTc does not rule out long QT syndrome.
#EPeeps
Cath conference with interventional fellow
@nsharmaMD
talking about bifurcation stenting technique. Size and likelihood of side branch occlusion key factors in determining bifurcation method.