Jaideep Singh Bhalla

#ACVC 2026: Mixed shock: the reality behind cardiogenic shock An outstanding session by Dr. David Morrow. Morrow highlighting a critical and often under-recognized concept: 👉 Pure cardiogenic shock is rare. Mixed shock is common. 🔍 Key messages: SVR is not always elevated in cardiogenic shock → Wide variability, often with vasoplegia (SIRS component) Mixed shock = low CO + inappropriately low SVR → A combination of cardiac failure + vasodilatory physiology 📊 Epidemiology (SHARC data): .Cardiogenic shock (isolated): ~65% .Mixed shock: ~17% .Mortality highest in mixed shock (~48%) 🧠 Common phenotypes: -Cardiogenic shock → secondary vasoplegia -Cardiac arrest → stunned myocardium + vasodilation -Sepsis + cardiac dysfunction -Toxic cardiomyopathy (e.g., Ca-blockers, BBs) -Post-cardiotomy vasoplegia ⚙️ Pathophysiology: Inflammation (SIRS) plays a central role Microcirculatory dysfunction + iNOS activation Loss of vascular tone despite vasopressors ⚠️ Clinical implication: 👉 Hemodynamics must be interpreted dynamically, not assumed 👉 SVR ≠ always high → avoid “one-size-fits-all” approach 🛠️ Management principles: Phenotype-guided therapy Combine: Vasopressors (norepinephrine first-line) Inotropes when needed Careful fluid strategy Consider: .Methylene blue / hydroxocobalamin in refractory vasoplegia .CIRCI (steroids) in selected patients 📌 Take-home message: Cardiogenic shock is not purely cardiac. Recognizing the vasoplegic component is key to survival. #ACVC26 #CardiogenicShock #MixedShock #CriticalCare #Hemodynamics #ShockManagement

1/9 The 2026 ACC/AHA Dyslipidemia Guidelines are officially here! Replacing the 2018 guidelines, these new updates bring major shifts in risk assessment, novel lipid markers, and cholesterol targets. Here are the most salient features you need to know. 🧵👇 #Cardiology #MedTwitter

1/8: The cardiology world is buzzing! Two major randomized trials—HeartSync-LBBP and PhysioSync-HF—recently compared Conduction System Pacing (CSP) vs. Biventricular Pacing (BiVP) in heart failure patients with LBBB. Surprisingly, they reached opposite conclusions! Let’s break them down. 🧵👇

Excellent video explaining cardiac axis determination

Antimicrobial resistance - #AMR - is no longer a ‘silent pandemic.’ It's reversing decades of progress in safeguarding health in Asia-Pacific. Drug-resistant infections are making common illnesses harder and more expensive to treat, including tuberculosis, one of the world’s leading killers. But we know what countries should do, ever more urgently, to combat AMR – as our @RD_WPRO Dr Saia Ma’u Piukala and @WHOSEARO's @BoehmeCatharina explain in @TheLancet: thelancet.com/journals/lanse…

In patients with type 2 diabetes (T2D), the risk of hospitalization for #heartfailure was significantly lower w/ GLP-1RAs than DPP-4 inhibitors while it was similar compared w/ #SGLT2i. Read the journal scan for more: bit.ly/4leYKaA #CardioX

Presented at #TCT2025: In STEMI with multivessel disease, immediate iFR-guided PCI of nonculprit lesions was not superior to deferred cardiac stress MRI–guided PCI in reducing death, reinfarction, or hospitalization for heart failure at 3 years. Full iMODERN trial results: nej.md/3Llf6QU @CRFHeart

Will A.I. lead to de-skilling of physicians? And if so what can be done to preempt it? @tberzin and I address this in a new @TheLancet piece thelancet.com/journals/lance…

@SaraswatiUshasi, @LarisaTereschenko, @MarilynHeineMD, @jibran_ikram , @TomKMWang, @PaulCremerMD, @AbbateAntonio, @ImazioMassimo & @AllanLKleinMD1

A step closer to empowering clinicians & patients in the fight against this heart-wrenching disease🫀; thanks to the giants in the field of pericarditis! @TomKMWang, @PaulCremerMD, @AbbateAntonio @ImazioMassimo, @AllanLKleinMD1

Despite the revolution following rilonacept's approval in pericarditis, long-term outcomes and optimal duration strategy remained unknown—until now. 👉 doi.org/10.1136/heartj…: we present the largest cohort to date and a tapering roadmap.