MWHC IM Residency

Overjoyed to welcome these incredible people to our Internal Medicine family! We can’t wait to start this journey together—see you in July!

When cough becomes chronic, structure beats speculation- here’s a quick reference sheet made by one of our residents

This evidence-based guide breaks down the Surviving Sepsis 2026 bundle: from fluids and vasopressors in the first hours to antibiotics, source control, and adjunctive thresholds every clinician needs to know.

We’ve all spent hours debating volume status at the bedside and it’s still one of the hardest things to assess in medicine. A quick visual summary of how physical exam findings, POCUS, and BNP perform for identifying (and ruling out) volume overload #MedTwitter

ATLS has come out with some new key takeaways to help with management of massive hemorrhage. A key difference is the x-ABCDE focus on stabilization that emphasizes stopping the “eX-sanguinating bleed” first before ensuring an airway.

The Renove Trial was completed to assist in understanding what clinicians should consider for patients with high VTE recurrence risk. It showed low dose DOACs were noninferior to full dose DOACs in preventing future VTEs. 1/2

Delighted to present our clinical case report at the National Kidney Foundation Spring Clinical Meeting 2026! Inspired by the ground breaking research transforming kidney care! #NKFSCM2026 @nkf

A quick infographic to review the new PE guidelines 🫀

Cardiogenic + vasodilatory shock, a complex, high-stakes phenotype requiring careful hemodynamic assessment and tailored management. Key concepts and clinical approach informed by JACC's State-of-the-Art Review. A quick, high-yield review #MedTwitter #CardioTwitter

MHRI symposium #research #Gastroenterology #GI #fellowship

Autoimmune hepatitis can masquerade as many things! Recognizing the clues early matters. A tweetorial on diagnosis, pitfalls, and management pearls. 🧵 #MedTwitter #LiverTwitter #Hepatology

Initiation of NB therapy during index HM3 LVAD implant associated with improved survival, a finding that needs to be prospectively studied @FlaviaTejadaF @fsheikh22 @RichaGuptaMD @MedStarHealth @GTCardFellows @IMMWHC onlinelibrary.wiley.com/doi/abs/10.111…

Excellent grand rounds by one of our General Internists Dr. Mueller!

Such a fun morning report!!

🏠 Take-home:     1.    Echo gives a PASP estimate, not a diagnosis     2.    Use ESC probability (Low/Intermediate/High)     3.    Normal echo does NOT rule out PH if suspicion is high     4.    RHC is required to confirm dx, measure PVR, and classify hemodynamic profile

PH is classified into 5 WHO Groups: 1️⃣ PAH (idiopathic, CTD, drugs) 2️⃣ Left heart disease ← common 3️⃣ Chronic lung disease/hypoxia 4️⃣ CTEPH 5️⃣ Multifactorial Why does this matter? Because Group 2 & 3 do NOT get PAH therapy. Getting the group right changes everything

🫁 Your patient has dyspnea on exertion. The echo report says "PASP 52 mmHg - consider pulmonary hypertension." But does that mean they have PH? Not necessarily. Here's what echo can (and cannot) tell you. 🧵 #MedEd #Cardiology #Pulmonary

So, what do you do with an abnormal echo? Clinical suspicion → 🔬 TTE → Low prob: look for alternatives → Intermediate/High: V/Q scan → ➡️ Right Heart Catheterization Echo probability guides who goes to cath - not whether PH exists.

The overdiagnosis problem is real. When borderline elevation on echo is compared to invasive mPAP? ~50% correlation. High PASP on echo alone ≠ PH diagnosis. It's an indication to look further - not a diagnosis to hang your hat on. Fisher MR doi.org/10.1164/rccm.2… PMID 19164700

However, Echo lies. Here are some of the ways how: ❌ No TR jet in ~30% of patients → can't calculate PASP (absence ≠ no PH) ❌ IVC-based RAP overestimates by up to 10–15 mmHg ❌ Non-parallel Doppler beam → underestimates TRV ❌ PASP ≠ mPAP - they diverge as PVR rises

Beyond TRV, look for these RV stress signals: 📏 RV/LV basal ratio >1.0 → RV enlargement 🫀 D-shaped septum → pressure/volume overload 📉 TAPSE <17mm → RV systolic dysfunction 💧 Pericardial effusion → poor prognostic sign 📊 Low TAPSE/PASP ratio → RV-PA uncoupling

The 2022 ESC/ERS Guidelines moved away from a single TRV cutoff. Now we use echo probability categories (TRV + signs): ✅ TRV ≤2.8 + no signs → Low 🟡 TRV ≤2.8 + signs OR 2.9–3.4 → Intermediate 🔴 TRV ≥3.4 → High "Signs" = RV dilation, D-septum, TAPSE <17mm, PA dilation

How does echo estimate pulmonary pressure? 📐 PASP = 4(TRV)² + RAP TRV = Tricuspid Regurgitation jet Velocity (measured by CW Doppler) RAP = estimated from IVC size + collapsibility Simple equation. Lots of ways it can go wrong. More on that in a minute 👇