giorgio.arman2MD/Opinions,not medical advice

@drahmedmohsen85 MR comes first, then LVOT obstruction peaks in mid systole (MR and HOCM)

For Echo experts Dx?

@DrRajeshMAMC Posterior mitral valve leaflet prolapse/flail valve with severe mitral regurgitation directed superiorly-posteriorly along the poster wall of the aorta

42-year-old lady with recurrent palpitation, exertional chest pain and fatigue. What could be the mechanism of severe mitral regurgitation ?

@TrackYourHeart Typical 'flutter' of the anterior mitral leaflet id diastole in aortic valve regurgitation= the sound known as the Austin-flint murmur. Once heard, never forgotten

Can you connect this echo finding to a classic auscultatory sign?

@Frances98392343 Atrial ectopic with aberrant conduction or pre-excitation

Software says "PVC". Do you agree?

@TrackYourHeart Unicuspid

How many cusps does this aortic valve have? 1️⃣ Unicuspid 2️⃣ Bicuspid 3️⃣ Quadricuspid

@DrSamuelBHume Oral PCSK9 inhibitor results mirrors very much the same effect on LDL and Lp(a) that we see with Repatha injection; up to 30% reduction in Lp(a) with the 60%+ reduction in LDL.

These are really really nice data that've gone largely under the radar In people already taking a statin, Enlicitide (an oral PCSK9 inhibitor) was tested head-to-head against other cholesterol medicines — Bempedoic Acid, Ezetimibe, or the combination Enlicitide lowered LDL more than even the combination (and was the only agent to lower lipoprotein(a) too, by ~25%)

@alex1708ander Hyepertorphy and LV wall thickening are NOT the same. Depending on age and family history the DD is wide: Pompe disease. Glycogen storage disease. Danon. MELAS. RASopathy. Fabry. Mitochondrial myopathy. Sarcomeric Hypertrophic cardiomyopathy. Diagnosis please. Tnx

Are we on the same page #echofirst ? How would you report this? Two patients, one pediatric 👶and one adult 👩, with remarkably similar echo findings (seen on TTE & TEE). LV myocardial hypertrophy and LV wall thickening are closely related, but they are not exactly the same.

@nihar_nayak2 Differential: Glycogen storage disease. Danon. AMPK2. RASopathy. MELAS. LAMP2. HCM. Early onset Fabry

9 year old child. Possibilities?

@Hragy RV and RA dilatation with moderate-severe TR and probable PHTN (needs right heart catheter to assess PHTN). CTPA and V/Q scan to exclude PE/CTEPH as a cause of PHTN. If true embolic TIA change from Rivaroxaban to Apixaban.

F 74, DM, HPN &varicose veins and recent syncope that may have been a TIA? Otherwise asymptomatic, slim , active , young for age. AFib, on Rivaroxaban 20 What is this pathology on echo and what more imaging do you recommend and how would you manage?

@MSBBrandao @jesusgmirelis @iamritu @denisamuraru @EACVIPresident @EHJCVIEiC @Giulia_Vinco @DrGEMandoli @saramoscatelli7 @NMerke @argulian LVOT subiaortic gradient 'corrupted' by mild aortic valve stenosis with CW. Excellent echo. Thanks

⏭️ The patient presented a subaortic membrane resulting in fixed subvalvular obstruction. 👀 CW envelope is different from what we would expect in the case of dynamic LVOTO - 🚩late peaking, dagger-shape envelope. Significant MS was also present, likely contributing to HF 🫀

A breathless 👩‍🦰 referred for suspected #HCM with obstruction. Cause of symptoms based on this #echofirst? 👀 #CardioTwitter @jesusgmirelis @EACVIPresident @EHJCVIEiC @denisamuraru @manuelbarreirop @Falmeidasampaio @FGraziani_Grace @Sarah_Moharem @argulian

@MSBBrandao @jesusgmirelis @EACVIPresident @EHJCVIEiC @denisamuraru @manuelbarreirop @Falmeidasampaio @FGraziani_Grace @Sarah_Moharem @argulian Sub-aortic membrane; not HCM

Case-control studies are considered a “low” form of evidence. But they’re also the hardest to manipulate with statistical tricks. Statins cause dementia.

@Hragy Rosuvastatin 40mg + Repatha 140mg every two weeks. LDL-C <0.5mmol/L (previously 3.4). Keep fighting bad genes.

Same here, my LDL consistently below 40 for the last decade or two, Rosuva 40 , no SAMS(muscle side effects) , no side effects of any kind.

@Willis_Kwandou @EACVIPresident @NMerke @denisamuraru @Sarah_Moharem @lpbadano @hrt01a @papadocardio @Hragy Both TV and MV abnormally thickened with disproportionate thickening and deformity of TV. RHD likely but DD carcinoid with PFO or lung carcinoid secondaries

Any Comment About The Tricuspid Valve? #EACVI #EchoFirst #3DEcho

@Wehbs @MichaelAlbertMD Evelocumab/Repatha (monoclonal antibody inhibitor for the PCSK9 system) is the best Rx for lipids so far. Next best is Inclisiran?Leqvio with absolutely no adverse effects. Many more, including oral medications in the pipeline.

@MichaelAlbertMD repatha + ezetimibe… statin made my muscles feel the same as when I’ve been dehydrated. Also tried Nexlizet but the bempedoic acid in that made my joints hurts. No symptoms with this combo, also 36.

I'm 36. I'm a physician. I take a statin—and ezetimibe—every day. No symptoms. No cardiac history. Just an honest read of the evidence. Here's what I found—and why I stopped waiting for a reason to act.

@MichaelAlbertMD Previous ACC/AHA guidelines were clearly WRONG. Most responsible cardiologists have stuck to "Treat to lowest LDL-C/ApoB/Lp(a)/hsCRP etc" no matter what the US advised. Good to see they've woken up.

1/ The 2026 ACC/AHA Guideline just retired 10-year-old guidance and brought back something crucial: explicit LDL-C numeric targets. Not "treat to benefit." Treat to a number. <55 mg/dL for most established ASCVD. <70 for high-risk primary prevention. Eleven societies signed off.

The cholesterol wars are over. LDL won. New guidelines. Four landmark trials. An oral PCSK9 inhibitor that matches injectables. And data proving we should be treating patients we currently aren't. Here's everything clinicians need to know. 🧵

@OungSavly @AEPCcongenital @iamritu @WGACHDChair @CASivaram1 @alexsfelixecho @echoleolopez @loomba_rohit @alex1708ander @SIwa23288585 @WithAScalpel Torrential MR. Urgent MV repair

10y with severe MR,AML appears prolapsed, but it’s false caused by PML tethering👉🏻abnormal coaptation geometry 📌Not all AML prolapse is real! @AEPCcongenital @iamritu @WGACHDChair @CASivaram1 @alexsfelixecho @echoleolopez @loomba_rohit @alex1708ander @SIwa23288585 @WithAScalpel

@vass_vassiliou @TimKambic @PeroneFrancesco @anast_apost @AnastasiaSMihai @DrMarthaGulati @LuchianLuiza @HanCardiomd @EkateriniL @purviparwani @Kipourou_Kon Hi Vass. They seem to have misspelled your name on this trial. It should be called "Vass Vasiliou Trial" surely! Kalo Pasxa.

VESALIUS-CV may mark the moment PCSK9s -> mainstream primary #prevention. jamanetwork.com/journals/jama/… A 25% reduction in first major CV events means no longer waiting for the first MI to justify intensive LDL lowering. Diabetes, high CAC, ApoB, Lp(a), AI risk scores next?

@TrackYourHeart CT uses leading edge-to-leading edge. Echo uses internal aorta dimensions. Why don't the two societies talk to each other to standardize? Enough of the infighting guys!!

Aortic Measurements in Echocardiography Accurate aortic measurements are vital for assessing valve function and diagnosing aortic pathology: LVOT Diameter (A): Measured in mid-systole to calculate transaortic stroke volume or valve area via the continuity equation. Aortic Measurements at End-Diastole: - Sinuses of Valsalva (B) - Sinotubular Junction (C) - Mid-Ascending Aorta (D) Technique Tip: Measurements should be taken using the leading edge–to–leading edge method. In TTE: outer anterior wall → inner posterior wall In TEE: outer posterior wall → inner anterior wall Source: Catherine M. Otto

@cingolani_oscar Pulmonary artery hypertension; if acute then PE

What’s your diagnosis?