Batman-Echo

@argulian ANF because probable LS endocarditis. Steroids please!

A middle-aged woman with long history of joint pains and recent transient vision loss undergoes TEE. Modified long axis view shown. What tests would you order next?

Bye bye, USA! Rode Duivels razen voorbij gastland naar kwartfinale tegen Spanje sporza.be/nl/matches/voe… #sporza

Agrree, CCMA often dynamic and seld-resolving and asymptomatic cases without embolic complications are usually managed conservatively without a ny anti-clot threapy. We choose anri-platelet here bacuse no real trhomvus seen and possibly just debrus that embolized. Wednesday pet ct and than decision making…

@echo_batman My one was asymptomatic for extrusion. Too frail for surgery. Added DOAC resolved 🤷‍♂️

What’s the diagnosis in 79F?

@CASivaram1 Yes, agreed! Think they can go for MV repair..

@echo_batman It won’t be surprising if the surgical treatment ends up being MVR and not simple debridement. The mobile mass is likely more than caseous material but also overlying thrombus & platelets.🙏

@Hragy But was a doubtfull penalty….

When a penalty was awarded against Senegal by an African ref for Morocco their coach destroyed the game and withdrew his team from the pitch,to return later & win but lose the title months later by CAF. Here he just looked and did not dare repeat his unsportsmanlike behavior.

Just measure P mean and AVA and assure multiple angle assessments for CWD. DVI threshold is indeed dependent on the LVOTd, but flow rate or SVi not affected, rather relative lower LVOT tvi in large annuli.See document (some small errors are being corrected…) where we refer to DVI and the refs you look for! 👉 academic.oup.com/ehjimp/article…

How would you assess AS in a patient with a dilated aortic annulus. What if this was a BAV , How would you comment on SVi and flow rate . Would you use DVI , instead ? @iamritu @CASivaram1 @echoguru @BeardedHeartDoc @rajdoc2005 @NMerke @dr_benoy_n_shah

@EchoSoliman @RBandH @GSTTresearch Congrats, Hatem!💐

I’m so honoured, humbled and grateful for this nomination. 🇬🇧🇬🇧💙 @RBandH @GSTTresearch #MedEd #cardiotwitter #echofirst

@MasriAhmadMD Strange that their index is not collinear with LVOT gradient and emerges as an “independent” variable. Also, the relation with the index and visually septal contact (I call this ‘septal SAM’) is not considered here…

Example on the left is sub LVOT On the right is LVOTO

@CASivaram1 @argulian @ASE360 @EchoSoliman @DrRajeshG1 @iamritu Great guy!!👍🏻

🤝🤝🤝 ✅ A memorable day, finally met IRL @argulian @ASE360 @EchoSoliman @DrRajeshG1 @echo_batman @iamritu

@VincentVandep8 0+1=1 en 1+1=2 is de redenering, namelijk extra stoken (CO2 output) in de zomer wordt niet verwacht, maar wordt in de nabije toekomst nog meer een voldongen feit op grote schaal en een extra katalysator van een serieus probleem in een sneewbal scenario.

“Airco is geen klimaatmisdrijf”… (wat is een ‘klimaatmisdrijf?) Waarom is een airco om te koelen voor sommigen een probleem terwijl een warmtepomp om bij koude te verwarmen, eigenlijk bijna volledig vergelijkbaar is qua ‘verbruik’? Is de ironie hier niet dat miljoenen mensen een lucht-luchtwarmtepomp laten installeren met overheidssubsidies, terwijl exact hetzelfde toestel in de zomer plots “een probleem” moet zijn omdat het koelt? Dus het is ok om te verwarmen naar bv 21 graden maar koelen tot die temperatuur is -net geen?- ‘klimaatmisdrijf’? Zijn de mensen echt gek geworden?

Artificial intelligence applied to electrocardiogram to rule out acute myocardial infarction: the ROMIAE multicentre study. Read more in the @EHJ at doi.org/10.1093/eurhea… #ArtificialIntelligence #Electrocardiogram @ESCardio @ESC_Journals

@purviparwani @DrSharathS @JSlivnickMD Will sent your message to our government…😉

As physicians, our ethical responsibility to our patients is so deeply ingrained that many of us hesitate to speak up about compensation for additional work like this . Advocating for ourselves is perceived as putting money before patients. Caring for physicians is not at odds with caring for patients- It is one of the prerequisites for it- Until the healthcare systems understand this- and put physician wellbeing first- we won’t solve this problem and more and more burden will be placed on us!

And it’s 100% responsible for physician burnout and stress!

@purviparwani @DrSharathS @JSlivnickMD Indeed. Inconvenient truth!

@purviparwani @DrSharathS @JSlivnickMD Fully agrree. This fllow pushed us to do a second job, for free and causing ‘digital stress’ to many of our collegues. As physicians,, we simply have no union to voice our grievances, so we simply have to put up with it.

@DrSharathS @JSlivnickMD It is out of hand.. only in medicine we love to do free work. .

In fact, in grade 5/5 fTR, the Doppler rv-ra gradient is larger than the cath gradient in the tracing you show, whreas pulm pressures are underestimated in these condtions, providing indirect proof that underestimation of RAP with echo is the main problem here. Also, the small differences between Doppler & cath rv-ra curves you show cannot significantly account for the differences.

Yes, agree (also related to inertia term and the use of simplified Bernoulli rather than modified Bernouilli), BUT the impact of inappropiate rv-ra delta P seem limited for the overall pressure and it is mostly the incorrect CVP estimation which causes the biggest error in this condition rather than inappropriate rv-ra estimates. Also, in a previous study, the diffrences in rv-ra between cath and Doppler were limited.

CardioNugget™ 💡 Why can't you calculate RVSP from a torrential TR jet? In torrential TR, the tricuspid valve behaves more like a wide-open conduit than a restrictive orifice. ➡️ Massive regurgitant flow causes rapid RV-RA pressure equalization early in systole. ➡️ The CW Doppler envelope becomes early-peaking and triangular with a low peak velocity. Therefore: ❌ 4V² no longer reliably reflects the true RV-RA pressure gradient ❌ RAP is underestimated because IVC-based estimates do not capture the giant systolic c-v waves seen in severe TR The result is a falsely low calculated RVSP/PASP. Parabolic TR jet = pressure lesion → Bernoulli works Triangular TR jet = flow lesion → Bernoulli fails onlinejase.com/article/S0894-… #EchoBoards #CardioNugget #CardioTwitter #ASEcho #CardiologyFellowship