David T Linker

Very excited about publication by Elsevier of my textbook “High Quality Transesophageal Echocardiography” teaching details on how to do the procedure, and tips for an effective, optimized examination. #HighQualityTEE #MindfulEcho #echofirst #echotwitter

Are TAVRs being used too much, or not enough? A new article in Am J Cardiol has some clues as explained in my editorial: authors.elsevier.com/a/1hmUfgQkyr80

Excited to chair ASE 2023 Scientific Session on Echo Heard Round the World. #ASE2023 @ASE360

I am speaking at ASE 2023 Scientific Sessions. Please check out my talk if you're attending the event! #ASE2023 @ASE360 - via #Whova event app Note new time

@DavidLBrownMD I am not a proponent of calcium screening, but it seems that there are two directions for use: Advising a statin for someone with otherwise low risk but high CAC, or not giving a statin to someone with otherwise high risk but low CAC. I wonder which direction this study leans?

Just curious: Do the proponents of calcium screening believe this randomized trial is unethical? Will the results influence your practice? clinicaltrials.gov/ct2/show/NCT03…

Another excellent session at the Future Hub on Jump Starting Your Idea, discussing regulatory issues, funding and more. #ACCInnovation #ACC23 #WCCardio

Excited to be at #ACC #WCCardio #ACCInnovation Great presentations on the way our profession is changing and how should change.

@DurowojuRasheed @AdvancedHFBuddy Good thinking!

@DavidTLinker @AdvancedHFBuddy I was thinking MR as well

Left to right Doppler flow through a PFO on transthoracic echo. This tracing gives us a clear indication of what pathology? #MindfulEcho #echofirst #echotwitter

@Allam93 Significant MR is the answer. The high gradient is ONLY in late systole.

@DavidTLinker Two hypotheses: 1/ Mitral regurgitation 2/ Underlying constrictive pericarditis, with doppler flow recorded during expiration.

@Deya_AlkhatibMD Very good! Shows that the high pressure gradient is ONLY during late systole => Significant MR.

@DavidTLinker @DavidTLinker the timing suggests V wave with a velocity of 2.5 correlating with gradient of 25 mmHg btwn LA and RA. No much pressure gradient throughout diastole. #echofirst

@ArisKaratasakis @AdvancedHFBuddy Could be. But more general answer is significant MR.

@DavidTLinker @AdvancedHFBuddy Prolapse?

@MDBeni @VerwerftJan Yes. At least moderate to severe MR.

@DavidTLinker @VerwerftJan Prominent and late peaking systolic waveform suggestive of a V-wave = severe MR

@VerwerftJan Bingo. Late increase of velocity shows that there is a late increase in LA pressure which can only be due to significant MR.

@DavidTLinker Either low LA compliance, high LA preload (eg MR) or both

Looks like severe tricuspid regurgitation, with systolic flow reversal into hepatic veins. The flow starts before the QRS, just after the P wave. This is due to the atrial kick. RV dysfunction and elevated filling pressure. Only mild to moderate tricuspid regurgitation.

Hepatic venous Doppler shown below. How much tricuspid regurgitation do you think there is? Why? See next post for answers and explanation. #echofirst #MindfulEcho #echotwitter

@Dr_Oubre @safabric @soupmd_ Feel free to. As they say: Plagiarism is the sincerest form of flattery!

@DavidTLinker @safabric @soupmd_ Beautiful 👆 I like that and might steal it. Type 2 NSTEMI is demand infarction.

What should you call that elevated troponin? This is NOT taught well and impacts more than you think. Understand it in 2 minutes:

@Dr_Oubre @safabric @soupmd_ Canadian Cardiovascular Society ccs.ca/app/uploads/20…

@DavidTLinker @safabric @soupmd_ What is this class system?