Christian Inchaustegui, MD

“I never thought of that.” That was the most common reaction to our poster at #ACC26. Transportation noise and cardiovascular risk aren’t typically mentioned in the same sentence, but they probably should be 🚗✈️🚆 Transportation noise at the residential level is an underrecognized environmental risk factor, capturing the chronic exposures people experience where they live. In a large U.S. healthcare system cohort (n=1.25M+), we found: • Higher noise exposure → higher MACE risk • Total noise: +17% risk (HR 1.17) • 🚗 Road noise: +17% risk • 🚆 Rail noise: +10% risk 📈 Per 10 dB increase: • 🚗 Road noise → +3% risk • 🚆 Rail noise → +14% risk These findings align with a growing body of literature linking transportation noise to cardiovascular risk through established biological pathways, including chronic stress and sleep disruption. This study has important implications, from how and where we choose our homes, to how we design and build living environments, to how individuals optimize their sleep and reduce noise exposure at home. Looking forward to publishing this work very soon. Grateful to my mentors @Sadeer_AlKindi & @khurramn1 and collaborators for their support.

Looking forward to #ACC26 in NOLA! Lot of great Critical Care Cardiology sessions this year⤵️ #ACCCriticalCare #CardioTwitter

Cardiac arrest versus no cardiac in cardiogenic shock. Combined analysis from all our RCTs. Mortality similar! ⁦@AGIKinterv⁩ ⁦@DGK_AG3⁩ ⁦@SVRaoMD⁩ ⁦@NavinKapur4⁩ ⁦@ACVCPresident⁩

This almost impossible in many parts of the country and in many cities where safety is an issue. And unfortunately those struggling to make ends meet are the ones disproportionately affected by lack of safe neighborhoods or are in rural areas where driving is essential.

I saw responses to this tweet: how walking everywhere is not possible in the USA. While I agree with that sentiment/ I know where Martha is coming from- population health is not personal—it’s engineered by the environments we create around us. Singapore is a perfect example of this. The “newest” (hu)man made blue zone. The government has deliberately made car ownership extremely expensive (>$100K and limited via permits) and invested heavily in public transport—so walking and transit is the way of life. They’ve even built infrastructure like the Park Connector Network—a nationwide system of connected walking and cycling paths Daily movement is built into life—even in a hot, humid climate( yes much worse than Houston) This is essentially a “policy-driven Blue Zone”: not just culture or diet, but environment + incentives shaping behavior of the masses. So Martha my friend- I applaud you for walking everywhere and having the courage to post something futuristic yet inspiring that currently doesn’t look possible in USA! I don’t think Longevity is just about individual choices—it’s about systems, urban design, and political will. Photos from Singapore last visit- walk/hike with family 😎

We need people to get more active not less. This means addressing the global issue of climate change. One thing people can do is stop driving everywhere. Can you walk to the store? Can you walk to an appointment? Can you walk to work? Can you get rid of a car? Or have no car at all? #hearthealth #climatechange (& yes I have no car & walk everywhere to do my part!)

One of the most satisfying “prescriptions” I ever wrote was for a program that matched dogs in need of homes to patients with cancer, but required a doctor’s signature Lots of confounders here, of course, but I can heartily endorse the companionship of man’s best friend

One of the important echo studies highlighting the importance of EARLY systolic notching of RVOT PW Doppler signal in patients with pulmonary embolism. This finding is present in >90% of patients with significant pulmonary embolism but it is uncommon in low risk/low thrombus burden patients. It is more prevalent than other well known echo phenomena, such as McConnell's sign, 60/60 sign, etc onlinejase.com/article/S0894-…

"Researchers found that walkable city design—not personal motivation—was the key factor behind people taking 1,100 more steps per day."

Poor guy died because the doctor had been fooled into the myth of contrast nephropathy. When death is on the Iine, fuck the kidneys.

another patient death due to mythological fears about contrast dye. modern contrast dye for CT scans doesn’t harm the kidneys. definitive imaging saves lives. get a contrast CT, save your patient’s life, don’t get sued. emcrit.org/ibcc/contrast/

A very important imaging study, which a substudy of POET trial, on residual vegetations after non-surgical treatment of left-sided endocarditis. At the end of antibiotic treatment, more than half of patients have residual vegetations on TEE. Among these patients, most vegetations are unchanged in size compared to initial TEE. More importantly, neither the presence nor size of the residual vegetations is associated with adverse outcomes, including embolic events, up to 4 years. jacc.org/doi/10.1016/j.…

Perfect Happy New Year! @NEJM @CHassager

Another round of applause to our current 3rd Year Fellows who have matched into their subspecialty fellowships!! 🎉🎊 We are so proud of your hard work paying off!! @OHSUCardio

Wake up and smell the arrhythmia risk reduction

If systemic hypotension was the sole cause of ischemic hepatitis, every patient in the MICU would have ALT >500 But the incidence is 1 in 50 You need right heart failure, congestion, that exceeds portal pressure. Then the systemic bp drop can be transient or relative

Minimizing emissions through minimally invasive valve replacement academic.oup.com/eurheartj/adva…

DOCTOR: "I want you to walk around your neighborhood at least once a day." PATIENT: "I'll try."

Wow ! Metoprolol reduced pvo2 Aficamten increased pvo2 Significant treatment effect Reflects our practice with metoprolol but amazing to have an RCT First line recommended BB therapy has detrimental effect on patients

New car technology is designed to make corporations money. Pedestrian infrastructure is designed to improve lives.