Structural interventional procedures (e.g., TAVR & TEER) are now standards of care with a 📈 list of indications.
With
#TCT2022
in 4 days, 👇a 🧵 on ⚡️TRANSCATHETER ELECTROSURGERY⚡️; one of the most ingenious & fascinating techniques in the field (& a personal interest of mine)
LV thrombi (LVT)
👉Are associated with systolic dysfunction.
👉Can occur in both ischemic & non-ischemic cardiomyopathy.
👉Carry a significant risk of systemic thromboembolism.
Management is mainly anticoagulation, but would you choose WARFARIN or a DOAC?? A
#tweetorial
🧵
Swan-Ganz catheters can provide valuable diagnostic information as well as guide management.
However, the sheer amount of data can sometimes be 🤯
“VERSION 2.0” of my RHC infographic for
@CardioNerds
Academy!
Scan QR code for references
#CardioTwitter
Recognizing & counseling patients w a family history of premature ASCVD is an often challenging aspect of CVD prevention.
In this infographic for
@CardioNerds
Academy, we address some of the concerns of our patients & aim to guide shared decision making in that setting.
An incredible thread on hemodynamics and troublshooting PA lines!
‼️Remember‼️ that knowing the normal values and equations is NOT ENOUGH!
An absolute must-read!
#Cardiotwitter
#MedTwitter
[1]
#Hemodynamics
Tweetorial
#2
Heart failure pt in ICU is -3.5L after 2d of aggressive diuresis. On day 3, urine output is ⬇️and BUN/Cr is ⬆️
You personally wedge
#PAC
at bedside and obtain a mean wedge 17 mmHg (a normal mean wedge is 6-10 mmHg). Admission wedge was 24
My first in-person ACC has been a dream come true! Theee ACC posters would not have happened without the support and mentorship of
@SaurabhSDani
. Grateful beyond words 🙏🏻
#ACC22
Have you ever 👂 of COCONUT LEFT ATRIUM❓
Its hemodynamic effects❓
why it’s clinically significant❓
Watch my BST Mode video about 🥥 LA for
@CardioNerds
academy
Link to the full video
Teaser trailer⬇️
Special thanks to House Jones chief
@CBlumenthal2
Empagliflozin is the first FDA- approved SGLT2i for treatment of HFpEF!
#Flozinate
Let’s strive for inpatient initiation, not only outpatient!
#tb
to the
#CardsJC
discussing the
#EMPEROR_PRESERVED
Trial!
📣
#LBCT
The SELECT trial
🟢 weekly Semaglutide 2.4 mg lead to a 20% reduction in the primary composite outcome of CV death, non-fatal MI & non-fatal stroke in patients with overweight or obesity, who DID NOT have diabetes!
NNT= 67!!!!
more trial details 👇
@cardionerds
#AHA23
Let’s review!
👉LV thrombi are a RF for strokes & systemic embolization
👉Guidelines (2013/2017): warfarin for 3-6 months (Class IIa, LOE C)
👉Observational data is somewhat conflicting, however DOACs may be reasonable in certain patients
👉Prospective studies & RCT's are needed
Perhaps the best thing I’ve learned from the
@CardioNerds
is that someone like me can BELONG amongst this group of brilliant people.
@AmitGoyalMD
,
@Dr_DanMD
and
@ThomasMDas
: so many emotions, you’ve given us a true family.
My heart is full ❤️
#ACC22
What’s the clinical presentation of adults with VSD?& what’s the pathophysiology behind it?
#ACHD
To answer these questions, I’ve created our first
@CardioNerds
#MedEd
Comic:“A Study in Cyan”
This is, by far, the NERDIEST thing I’ve ever done!
PDF:
(1/2)
Excited to share our work out today
@JAMANetworkOpen
⬇️
#SES
was not only associated w clinically severe strokes (⬆️NIHSS),but also w LARGER strokes
Initial severity(infarct vol&NIHSS) explained ~ 2/3 of the association btwn SES & disability
Highlights👇
The past 5 weeks have been the busiest and most stressful during residency (new interns, fellowship application).
So glad to finally get some free time spend it with my little guy, who also got his first haircut!
Happy
#Thanksgiving2021
from the
@CardioNerds
Academy to all you CardioNerds at heart!
#Thankful
for a great year of learning with my second family and looking forward to next year with our incoming fellows!
CCTA vs Stress testing in patients with stable chest pain; my favorite slide in a high-yield overview of the new chest pain guidelines by
@RonBlankstein
@ACCMass
This is why we need RCT’s!
Although only 79 patients, this important 2021 trial by
@yehiasaleh_MD
et al is the first prospective, randomized clinical trial demonstrating that rivaroxaban was noninferior to warfarin.
Happy 5th anniversary to this strong & brilliant woman. I would not be where I am at today if not for her constant support and sacrifices. It will take me the rest of my life to make it up to you.
Zane & I both love you ❤️
Working with medical students has been on of the highlights of residency , & yesterday I was honored to receive the Annual Excellence in Teaching award, along with my dear friend & GI ⭐️
@Karim_OsmanMD
!
Extremely grateful to the
@TuftsMedSchool
students for nominating us!
In the RED VELVET study (Robinson et al, 2020)
👉514 patients with LVT in 3 centers
👉236 on warfarin, 121 on DOACs & 64 in the “treatment switching” group
👉DOACs were associated with a ⬆️ risk of stroke & systemic embolization
i.e Warfarin more effective ?🤔
I’ve been waiting for this
@CardioNerds
episode and series!! Would definitely pair it with this state-of-the-art review by Jennifer Thibodeau &
@MarkDrazner
! Hands down one of the best resources for physical examination of HF patients!
Incredible “Narratives in cardiology” with
@tavrkapadia
&
@CardioNerds
!!
As an IMG who’s pursuing a career in structural interventions, this was inspirational on so many levels!!!
Don’t worry if you missed it, it will featured soon as a
@CardioNerds
episode, so stay stuned!!
My beautiful date for tonight
Happy 6th anniversary to the smarter, stronger & wiser half of this marriage…and obviously the better looking half
@menna_esaleh
❤️
#AHA2022
was an amazing experience, but nothing beat finally meeting
@PatrickZakka
in real life for the 1st time!
We’ve worked together, we’ve given each other professional & personal advice, & forged a friendship that was made possible only by
@CardioNerds
Love you brother!
Really grateful to
#CardioTwitter
and
@CardioNerds
for the incredible support for this infographic and valuable feedback I got from experts in the field.
I am taking it down to incorporate the feedback we got, VERSION 2.0 COMING 🔜 !!
Confusing evidence?
Observational studies are usually "hypothesis-generating"
🔴prone to bias & confounding
🔴possible loss of follow-up
🔴Can't be used to demonstrate causality
⛔️Caution should be exercised before implementation of their results into clinical practice.
Inspirational cardiology grand rounds
@LaheyHospital
today by
@AnkurKalraMD
: PERSEVERANCE vs PEDIGREE!
He shares his amazing journey as an IMG on a J-visa, a double-hit that very few can overcome to achieve their dreams!
Talks like this one are what help us power through!
The 2013 ACC/AHA & the 2017 ESC STEMI guidelines recommend: WARFARIN for 3-6 months in pts with STEMI and LVT (Class IIa, LOE C).
Unfortunately, no large RCT’s to date have compared warfarin vs DOACs in LVT.
But several recent retrospective studies have addressed this ❓👇👇
High-yield infographic (that also happens to look great) on inotropes that you should all save on your phones and hang up in the CCU!
Awesome work by
@CardioNerds
Academy fellow
@CaliRClark
!
‼️ Excited to release my first
@CardioNerds
infographic on inotropes. 🥳I learned so much while putting this together and I hope you can use this information to help others! 🫀
Shout out to
@EuniceDuganMD
for guiding me! 🙏
(click on the image to get all the info!🤓)
Guess who defended her PhD today?
Can’t be prouder of
@menna_esaleh
after 6 years of field work across 3 countries, back & forth international travel & many sleepless nights; all while being a super-mom, working full-time & a masters
@HarvardExt
along the way!
Menna Saleh, PhD👩🎓
🚨👀 Looking for a way to stay up on the breaking news and info from
#AHA23
?!
Look no further! 😎
Follow the
@CardioNerds
Conference Scholars 🤓⬇️ for live updates and 🔥 important points during the AHA 🫀 Scientific Session this weekend.
It’s official!! I’m honored and super-excited to join this amazing group as a fellow in The CardioNerds Academy! Can’t wait to start learning and teaching!
@cardionerds
@AmitGoyalMD
@karanpdesai
@Dr_DanMD
that email definitely made my heart flutter!❤️
See you all tomorrow at 8pm EST!
@CardioNerds
’ll be discussing the EMPEROR-Preserved trial, arguably the biggest trial of 2021!
Join us in asking, and learning, from the experts about the role of SGLT2i’s in HFpEF!
#Flozinate
Don’t forget to use the hashtag
#CardsJC
Who’s ready for another
#CardsJC
?
TOMORROW, 10/19, 8pm EST!
Incredibly grateful to the experts and
#FITs
joining, awesome learning experience ahead! See you and the rest of the
@CardioNerds
then!
A contrasting study by Ali et al (2020)
👉 110 patients, single center
👉 60 on warfarin, 32 on DOACs
👉 DOACs were associated with a ⬇️ risk of stroke & systemic embolization, & with more thrombi resolving within the 1st month.
i.e DOACs more effective?🤔
Excited to share our work lead by
@AzarRadfar
@ShadyAbohashem
demonstrating that:
⬆️ stress-associated neurobiological activity (Amygdalar activity on FDG-PET CT) ⬆️ risk of development of Takotsubo syndrome.
It was an honor and an amazing learning experience to work on this!
And in between those opposing studies, 4 smaller studies found no difference between warfarin and DOACs in rates of LVT resolution, stroke/systemic embolization, or bleeding.
@tavrkapadia
presenting the results of The PROTECTED TAVR Study (Cerebral Embolic Protection During TAVR) w the Sentinel device
#TCT2022
🔴no difference in ALL peri-procedural strokes
🟢significant differnce in DISABLING strokes
Congratulations to every IM resident who matched today into their dream subspecialty 🎉
And heartfelt congratulations (pun intended) to those who matched into ❤️ fellowship!
I’m on nights but could not get any sleep this morning from my excitement for each & every one of you!
Interestingly, there was no difference between warfarin and DOAC’s in the sub-group of patients with ischemic cardiomyopathy.
Definitely warrants future studies…
After a long break from tweeting, I return today as the proudest husband;
@menna_esaleh
graduated her Master’s degree in Psychology from
@HarvardExt
(which she did in parallel to her PhD
@TUBerlin
, while being the best mother ever for our Zane, and the best sister to
@AE__Saleh
!
Promising results of the Intrepid dedicated transcatheter mitral valve replacement devices.
The fact that these results are for transfemoral (not transapical) access is EXCITING!
@JACCJournals
Congratulations to the most progressive and strategic thinkers I’ll ever meet! Their vision of
@CardioNerds
has revolutionized the fields of medical education AND clinical trials enrollment!
@AmitGoyalMD
&
@Dr_DanMD
🎉🎉🎉🎉
My interview for
@CardioNerds
&
@radcliffeCARDIO
with
@LincoffMichael
discussing the results of the SELECT trial, its impact on clinical practice and potential future directions.
📽️Watch in full here👉
📢Attn CardioNerds!🤓❤️
💌Want to join the
@CardioNerds
Family?
⁉️Are you an IM resident interested in Medical Education, Cardiovascular Disease, and Digital Media?
Consider applying for the CardioNerds Academy!
Applications are due October 15th!
🔗
Shoutout to
@CardioNerds
- who are doing incredible work, bringing cardiology education to social media in a way many others haven’t, and for all of the hard work they do, while in training!
This comic was made possible with the expert review of dr. Keri Shafer
@kerizoz
& my former house chief
@CBlumenthal
, as well as the mentorship of
@karanpdesai
@AmitGoyalMD
&
@Dr_DanMD
, whom I really can’t thank enough for everything they’ve helped me with.
(2/2)
Egypt still has a large number of female patients with rheumatic heart disease and severe valve lesions, Afib & mechanical valves. Managing them during pregnancy was an almost daily part of my training.
Excited to hear the latest evidence in the
@cardionerds
#CardioOB
series!
In this tweetorial, we will explore:
👉 The guideline recommendations for management of LV thrombus.
👉 The most recent evidence favoring warfarin.
👉 The most recent evidence favoring DOACs.
We’re kocking off
#TCT2022
with
@NavinKapur4
Reduction of Infarct Size in Anterior STEMI with LAD Occlusion and LV Unloading using a Micro-axial Pump for 30 Minutes Before PCI: Per Protocol Analysis of the STEMI Door to Unload (DTU) Pilot Study
Outcomes of the 1st yr of the
@CardioNerds
Academy: a digital media &
#MedEd
fellowship
Our amazing Academy PD
@ThomasMDas
presenting
“A digital MedEd fellowship can effectively teach residents and fellows how to create content for the modern educational landscape”
#ACC23
Exactly 10 years ago this month was my first time ever visiting the US. Chicago was my first stop & the first city I ever fell in love with.
So glad I got time today for a nostalgic walk down the
#MagnificentMile
❤️
#AHA22
“We were anything but discon- nected. The community was real & tangible. We felt intense feelings of gratitude & responsibility.”
As usual, no one says it better than
@AmitGoyalMD
and
@Dr_DanMD
❤️❤️
We are proud to share the
@CardioNerds
story in
@CircAHA
2022. (🙏🏽
@MaryjaneFarrMD
)
🔗
@CardioNerds
is Mission-oriented and People-first.
Immense gratitude to countless mentors, collaborators, & mentees.❤️🤓
This is just the beginning...
I have to admit I had very little knowledge about the difficulties in transition from pediatric care to adult care faced by the
#ACHD
patient population.
This was an emotional, eye-opening session!
@CardioNerds
@DeBakeyCVedu
@scfuentesr