Doctor T

Pagingdoctort.com has officially launched!!! Our goal is to promote health literacy, resulting in improved health, decreased health care costs, and a better world! The website is designed to be guideline-based and evidence-based - a place where physicians would feel

@Umair2017 @DrJuergenSch @HadyLichaaMD @JuneKPickett @wilzawall @BCMHeart @BaylorCardio @ShariqShamimMD @minhaskh @BigMaqMD @JingLiu_MD @hrs_journal @ACCinTouch @Dr_Mike_Fradley @JasneetDevgun @LearningEPeeps @netta_doc @CarinaHardy4 @KTamirisaMD @DrMarkMills @majazayeri @ReddyEPS @sachinjv Disagree. You can see the absence of pacing spikes in the other lead. Also, no reasonable pacing setting would allow for pacing so soon after that previous beat.

@DrJuergenSch @HadyLichaaMD @JuneKPickett @wilzawall @BCMHeart @BaylorCardio @ShariqShamimMD @minhaskh @BigMaqMD @JingLiu_MD @hrs_journal @ACCinTouch My thought was the 2nd beat in white circle is also paced (pacing on previous beat's T wave to start VF), and it's spike is outside field of view .... As seen in the blue circle a lot of pacing spikes are up and down on the telemetry... would love to hear other thoughts for VF

Patient w/ 7 ICD shocks for true VF ⚡️ Telemetry captured one of the episodes 👇 What’s the etiology? (Known cardiomyopathy, EF 30%, normal coronaries, normal lytes) #Epeeps #CardioTwitter #MedTwitter #ACCFIT

@anais_dahoumane Interesting that so many here recommend surgery, whereas the ACC/AHA guidelines do not. Class IIb at best if there have been three echoes demonstrating progression of LV dilation. Can certainly do a treadmill stress to document that he is asymptomatic.

I think this is the most severe Aortic Regurgitation I’ve seen till now. 68 YO, Patient says He is completely asymptomatic ! Ascending Aorta 45mm on TTE LV : EDLVD ~ 67 - 70mm ESLVD 45mm LVEF 62% How would you manage this case?

@JSpitz_MD @DLBHATTMD @JAHA_AHA When a patient comes to you and tells you their co-pay is $100/month, and then you quote them the data that there is a 97.8% chance this medication will not help them over the next 4 years, what do you think they will do?

@DLBHATTMD @JAHA_AHA Very exciting new data to quote patients. As curves continue to separate, excited to see even longer term data to see impact of sustained low LDL-c!

#cardiology #cardiotwitter #prevention #lipids #cholesterol @JAHA_AHA

@gcfmd @NMHheartdoc @JavedButler1 @MKIttlesonMD @SJGreene_md @mvaduganathan @texhern @HFSA @BiykemB @jteerlinkmd @AHAScience Is there more recent data suggesting the limited impact in the community. The data posted would not take into account GLP-1s or SGLT2s and does not fully take into account ARNIs.

Fantastic to admire/applaud the RCT success in heart failure over the past 2-3 decades Devastating to lament the limited impact on HF clinical outcomes in the community/clinical practice Substantial opportunity to innovate and improve implementation

@skathire The survey may have been more helpful if it asked people who have ASCVD. Once people are already seeing their cardiologist twice a year, it is not much of a burden to get a shot at those visits.

For several high-conviction ASCVD targets now, multiple modalities emerging as options (daily pills, intermittent injections of varying frequency, & maybe even once-and-done) What might patient preferences be? One look, evaluating PCSK9 target from LifeSci Capital Options!

@gcfmd This makes sense if there is no alternative. But beta-blockers have very strong dose-dependent benefits. Focus should be on titrating these to max first, and then titrating ARNI.

@PagingDoctorT The RCTs were intention to treat for 🎯 dose, so long as tolerated No dose response trial for outcomes On treatment dosing analyses confounded, but suggest at each dose ARNI has similar relative efficacy vs ACEI Guidelines recommend to aim for 🎯 dose, as well tolerated

HFrEF newly diagnosed or recognized* ✨ARNI, 1st line Rx, best if started <24hr ✨BB, 1st line Rx, best if started <24hr ✨MRA, 1st line, best if started <24hr ✨SGLT2i, 1st line, best if started <24hr Rapid additive benefits, well tolerated in combo *hemodynamically stable

@DLBHATTMD @JACCJournals @gabrielsteg @cpcannon @SubodhVermaMD @MkosiborodMD @RenatoDLopes1 @gcfmd @umichmedicine @umichCVC @MountSinaiHeart @RahulAggarwalMD @AmDiabetesAssn So, we have moved beyond the era of evidence-based medicine to the era of extrapolation-based medicine? Shouldn’t the FDA and the academic community hold this drug to a higher standard (instead of a lower standard) when we have two SGLT2 inhibitors already?

@PagingDoctorT @JACCJournals @gabrielsteg @cpcannon @SubodhVermaMD @MkosiborodMD @RenatoDLopes1 @gcfmd @umichmedicine @umichCVC @MountSinaiHeart No, but @RahulAggarwalMD presented data from SCORED and SOLOIST at the @AmDiabetesAssn 2023 annual sessions showing consistent benefit across baseline HgA1c, and the FDA labeling does allow use in patients with heart failure even without diabetes.

#Cardiology #CardioTwitter #HeartFailure @JACCJournals @gabrielsteg @cpcannon @SubodhVermaMD @MkosiborodMD @RenatoDLopes1 @gcfmd @umichmedicine @umichCVC @MountSinaiHeart

@brendonneuen @ValleAlfonso @drpatrickholmes @mvaduganathan @CristobMorales @hswapnil @Nephro_Sparks @AmarPut @georgeinstitute So, a decline in GFR is good?

First in human RCT of SGLT2 inhibition in non-diabetic kidney disease. In this cross over trial, 6 weeks of dapagliflozin did not lower albuminuria, but did induce acute & reversible declines in GFR Fascinating data whilst awaiting DAPA-CKD thelancet.com/journals/landi…

@venkmurthy Presumably, most people who died were at one time on oxygen and eventually intubated. This is generally not a sudden death syndrome. Certainly, some patients may have been debilitated to begin with and aggressive care may not have been opted for...

@PagingDoctorT Hard to extrapolate unfortunately as it seems RRR depends on clinical status in this case with bigger effects for those who are oxygen dependent or ventilated. Will be tricky to assess what RRR to use when the details of how many people died under what circumstances are unknown.

Very few drugs have an absolute risk reduction for DEATH of 4% (O2 requiring pts non-vented) or 12% (vented pts). If this result holds up, dexamethasone in severe COVID is as big a breakthrough as any non-vaccine in any part of medicine.

@NicolasMead2 @MasriAhmadMD Looks like a mid-ventricular takotsubo variant? Had one a few months ago. Supposedly 14 percent of cases, but less in my experience.

I saw one of these prior to last month in my 8 years, I’ve seen 3 in the last month

@jelevenson CyBorD - but I don’t understand why they couldn’t manipulate it to become CyBorG

What’s your favorite sounding chemo regimen? Mine is G-CLAM .

@eemoin Is nystatin also widely disparaged on the Internet?

@VPrasadMDMPH In other locations, health care utilization decreased as a result of fear of Covid. That would not have been the case in China when Covid was unknown.

Wow preprint covered by ABC news uses cars in parking lot of Wuhan hospital to claim virus may have been spreading earlier but kept secret What a claim! Do cars increase in parking lots with COVID? Seems a simple test is ask that in other locations abcnews.go.com/International/…

@jelevenson That may be a scaling issue. Do the liver and spleen look big to you?

@PagingDoctorT Dose problems w the rest ?

Anyone have any thoughts on this stress nuc? #medtwitter #nuclearcardiology #cardiotwitter

@JavedButler1 Does it say “EBL: minimal”?

Op report of the first heart transplant. History of medicine at University of Mississippi.

@venkmurthy Have you read Freakonomics?

Is fraud common and we just don't find it?