Melas Ramo

#POCUS #echofirst answer: 1️⃣ Subxiphoid short axis view at the aortic valve level 2️⃣ RVOT Doppler RVOT Doppler is one of the most underused but high yield tools. ● Tracks RV stroke volume and cardiac output SV = CSA × VTI CO = SV × HR VTI alone works well for serial trends ● Estimates pulmonary vascular resistance PVR = (TRV ÷ RVOT VTI) × 10 + 0.16 ● Screens for pulmonary hypertension even when TR jet is absent AccT <105 ms suggests PH AccT ≤60 to 80 ms raises concern for acute PE ● Waveform shape gives physiology Parabolic is normal Early peaking and notching suggest rising PVR and help phenotype disease ● Distinguishes acute PE from chronic PH using AccT and notching patterns ● Provides insight into RV pulmonary arterial coupling RVOT VTI ÷ PASP as a simple coupling metric ● Useful in congenital heart disease Grading RVOT obstruction and serial follow up after repair ● Tracks response to therapy noninvasively over time CWD complements PW when velocities are high ● Grades pulmonic stenosis using peak velocity and gradients Severe if peak gradient >64 mmHg or velocity >4 m/s ● Estimates pulmonary pressures from PR jet mPAP = 4(V peak PR)² + RAP PAEDP = 4(V end diastolic PR)² + RAP ● Identifies multi level RVOT obstruction Double contour envelope suggests infundibular plus valvular disease ● Detects dynamic RVOT obstruction Late peaking dagger shaped signal ● Enables global RV performance assessment Tei index combining TR and RVOT flow ● Monitors conduit or bioprosthetic valve gradients over time

🧵 Why the obsession with p < 0.05 is hurting science. A meme. A truth. A reality check.

Cor Triatriatum: A Rare but Important Cause of Left Atrial Obstruction Cor triatriatum is a rare congenital condition where a fibromuscular membrane divides the left atrium into two chambers. The pulmonary veins drain into the proximal chamber, while the mitral valve and left atrial appendage lie in the distal chamber. The clinical impact depends on the degree of obstruction. Significant obstruction behaves like pulmonary vein stenosis, leading to dyspnea, pulmonary hypertension, and features of heart failure. Atrial arrhythmias such as atrial fibrillation or flutter may also occur. Echocardiography remains the cornerstone of diagnosis. Transthoracic echo can visualize the membrane and assess flow across it, while transesophageal echo provides better definition when needed. Definitive management is surgical resection of the membrane. Intervention is recommended in symptomatic patients or when there is a significant pressure gradient across the membrane.

🫀 #CardioNugget: Types of Interrupted Aortic Arch 👉 Interrupted Aortic Arch = complete break between ascending & descending aorta 👉 Classified based on WHERE the interruption occurs relative to arch branches 🔢 Types 👉 Type A Interruption distal to Left Subclavian Artery (LSA) (All 3 branches arise normally before interruption) 👉 Type B ⭐ MOST COMMON (~85%) Interruption between Left Common Carotid (LCCA) & LSA 🚨 Strongly associated with DiGeorge (22q11 deletion) 👉 Type C (RARE) Interruption between Innominate (brachiocephalic) & LCCA ⚡ Quick memory trick “B = Between carotid & subclavian” → most common 🚨 Clinical pearl 👉 All types are ductus-dependent 👉 PDA closure → neonatal shock, acidosis, ↓ lower body perfusion #EchoBoards #Cardiology #CongenitalHeartDisease #CardioNerdNuggets

@NephroP Subcostal short axis , Rvot signal

#POCUS quiz What #echofirst view is this? And where is this Doppler being sampled? #FOAMed #Nephpearls

@YYCSpartan @ramooo75 it went down ! it was 191 yesterday

What. THE FUCK. is this? I thought the cost of fuel was supposed to drop after removing the fuel tax... and here we are with a $0.20 increase overnight. Unreal.

In the RSI trial involving critically ill patients undergoing intubation in EDs or ICUs, the use of ketamine for the induction of anesthesia did not lead to significantly lower in-hospital mortality than etomidate. Full trial results and Research Summary: nejm.org/doi/full/10.10…

Dr. Sanjiv Shah explains the H2FPEF score used to support clinical decision making. Watch “HFpEF Explained — Prevalence, New Advances, and How to Diagnose,” a new Double Take video, now available on our YouTube channel.

Bicuspid Aortic Valve.

Elderly female known to be had impaired Lt ventricular sys function. Currently have Abd. Bloating and legs swelling.

“What means this throbbing in my breast? This constant search for peace and rest? This loneliness I feel? Even when I mingle with the crowd This aching void is deep and loud; Its cry is real! So real!”

Another very interesting case from now. Refractory septic shock in a young patient. First POCUS was told to be hyperdinamic and thin IVC. Patient had a CRT of 6, cool extremities. I perfomed a new POCUS assessment.

The Difference!!

Kindness

UPDATED: Ford government passes budget bill that lets premier and ministers keep office records secret cp24.com/politics/queen…

The cardiology community mourns the loss of Dr. Eugene Braunwald, a towering figure whose work shaped modern cardiovascular medicine. From foundational discoveries in heart failure to Braunwald’s Heart Disease, his legacy will guide generations to come. A true giant in our field.