Dr. Mukharjee Madivada

Nice thinking process! Choosing a small OPN is safe and could be effective. The calcium modification it does may extend beyond its diameter. Delivering the OPN in an incompletely dilated vessel is a challenge. Also, OPN may pull the guide wire back along with it. So it’s better to ‘predilate’ to allow the delivery of OPN and also to put a buddy wire, to prevent access-loss to a dissected vessel.

Pre-crack the Plaque!🏋🏻‍♂️ I learnt this from @A_B_Hall last year - and I love it for cases where IVL may not be an option - e.g. distal LM ring when EF is low! Also great for under expanded stent ISR! 👌🏼🤩 doi.org/10.1016/j.crmi…

@realarainmd 4

Another Poll 😳🤔 How long do you keep the DCB up in an UNPROTECTED left main? 1. 30 sec 2. 60 sec 3. 90 sec 4. Until the ECG starts to change? 5. Other → leave a comment!

I agree with @nyalborgesmd! With minor tongue-in-cheek tweak 👉🏼 the vessel you end up with SHOULD not look like the vessel you started off with! 🤔 (If you use IVUS correctly, that is. 😂) Listen to the clip, then weigh in on the poll below if you haven’t already done so. x.com/realarainmd/st…

@mmamas1973 @kamleshkhunti @iamritu @DrMarthaGulati @purviparwani @ShivaniM_KC @ditchhaporia It is Rasamalai Dr. Mamas. Just semantics. But it is delicious!

I went for an indian deconstructed caffee latte - coffee icecream with rasmulli 😜 @kamleshkhunti @iamritu @DrMarthaGulati @purviparwani @ShivaniM_KC @ditchhaporia

@yuripridemd Do you bring down the LDL to less than 55 if the calcium score is 1? Based on data, or is it your own belief, may I ask?

CAC testing has become a big part of my prevention practice. I don't use it to decide whether to look for ischemia - a history can do that for most pts. I use it to decide intensity of therapy. I believe pretty firmly that most pts with CAC >0 should be driven to LDL <55.

Another brilliant piece of writing by @anish_koka making a very difficult to understand topic sound like a children’s fairy tale. He kept his facts straight while firmly taking a side. Wonderful work, dr.

@drkeithsiau Ask him how he got to the figure of four days? No drug in no trial could measure something like this. This is grossly misleading estimate.

Can somebody fact-check this?

@cherviku Please show to a physician. Let him examine and take a call.

@drmssm 2/2- pulse oximetr while keeping it shows 60.dropping to 50-45-35-30 sometimes. When asked he is very active and no other symptoms. At night it shows constant 55-60HR.. what is the cause is that any urgent attention needed on it. Pls advise 🙏🏻@drmssm

A 60 year old patient with left arm pain and giddiness had a differential blood pressure in both arms. He had a normal arterial Doppler (done elsewhere), so got an MRI cervical spine done, which showed mild compression of cervical spinal cord. We did an angio which showed a tight left subclavian ostial stenosis which was stented with a 8mm stent. Please note the complete absence of vertebral artery in the first angio. Also note the negative contrast in the subclavian artery from the vertebral artery. Once stenting is done, the flow in the left vertebral artery is normal. Subclavian steal at its stealthiest best. @DrRajeshG1 @GopalKkoduru @serioustaurean @DrDeepakKrishn1 @evandrofilhobr @nadig_cardio @realarainmd

@ThirumalWnp Whoever used that AI to discover the drug. It is like this: if a man uses a computer to solve a problem, who gets the credit?

@drmssm If AI discovers a drug, who gets the money Sir..? A hypothetical question.

@elonmusk If only “happiness” is a company you could acquire…

Whoever said “money can’t buy happiness” really knew what they were talking about 😔

@aditya_gan3500 He had pain in the left arm and giddiness.

@drmssm I am interested in the diagnostic pathway. Could you please tell me the patient's chief complaints?

@serioustaurean Omnilink (Abbot) 8 x 29 sir

@drmssm Nice! What stent doc?

@sirishtummala 😀

నట్టు కేసు ముందు ట్విట్టు చేయగనేల అరవ ఫిలిపు ముందు అరవనేల ఎన్ను సార్లు చెపిన ఎన్ని సార్లు చెపిన వైద్య జయస నుండు వాయ ముడడు

For the nth time since last night, he works in Hyderabad, Telangana sir.

@ramarao23 @bhatia_nachiket May be he is a U.S. citizen andi. Not sure.

@drmssm @bhatia_nachiket Thanks for intervening and giving info sir. అదే చూపిస్తే సరిపోయేది. USA అని ఎందుకు రాశారు?

Indian doctors are breaking their backs in govt hospitals. 24–36 hr shifts. Violence. No security. No dignity. And Padma awards go to doctors sitting comfortably abroad? Serving which patients? Which system? This isn’t national honour. This is national amnesia. Reward those who stayed. Not those who left. #PadmaAwards #DoctorsOfIndia #MedicalInjustice #HealthcareCollapse #IndianDoctors #AccountabilityNow

@DeviprasadSD You will do well Devi. Thank you for the good words 🙏🏽🙏🏽🙏🏽

వైద్యో నారాయణో హరిః.. 🙏🙏🙏 @drmssm గారు.. మీ అందరికీ ఈ 🧵 ఉపయోగపడుతుందని ఆశిస్తున్నాను. 1/6

@Lightisu At least your version got somethings right. But no, the EF was not more than 50 and no, there was RWMA indeed.

@drmssm Attaching the output screen of my Grok for the same ecg image .

For all the AI enthusiasts out there, I too want AI to work as much as you do. But right now, it is far from perfect, and in medicine, imperfections can cost lives. Here is a real example. The ECG I posted clearly shows a very dangerous heart attack. It is obvious to anyone with basic medical knowledge. Yet #Grok labelled it as normal. You can check the screen shots. If this were an actual patient relying on such an answer, treatment could have been dangerously delayed, and the outcome could have been fatal. So please stop advocating the use of Grok for medical decision-making until it is demonstrably safer and more reliable. @elonmusk

@Sri90234514 It should have told that it is definitely a heart attack.

@drmssm Sir, could you please share your comments on the ChatGPT report for the ECG you provided?

@manishranjan @claudeai That is wrong. It is anterior wall MI

@drmssm @claudeai in Opus 1.ST Elevation in Inferior Leads (II, III, aVF) 2. Reciprocal ST Depression in Lateral Leads (I, aVL) 3. Possible Q Waves Forming in Inferior Leads 4. Tall R Waves in V1-V2 Acute inferior STEMI. Occlusion of RCA