Discover and read the best of Twitter Threads about #Hemodynamics
Most recents (11)
Buckle up for the 1st installment of our HF #Tweetorial series w/ help from @AHajduczok on HF #Hemodynamics based on the @JCardFail State of the Art Review by @stevenhsu_md, @JamesCFangMD and #barryborlaug. An absolute must read for ALL (not only HF folks) 🔥
@robmentz @dranulala
@robmentz @dranulala
First, check out this grade A #tweetorial by @AHajduczok who helps de-mystify Pressure Volume (PV) Loops:
(more to come SOON on this Part III: devices and drugs in PV loops cc @RyanTedfordMD @PSullivan000 @BurkhoffMd)
(more to come SOON on this Part III: devices and drugs in PV loops cc @RyanTedfordMD @PSullivan000 @BurkhoffMd)
The Normal LV volume loop relationships illustrate:
⚠️End-Systolic Pressure Volume Relationship (ESPVR)➡️Ventricular Contractility
⚠️End Diastolic Pressure Volume Relationship (EDPVR)➡️Diastolic Compliance
⚠️EDV-ESV=Stroke Volume (SV)
⚠️End-Systolic Pressure Volume Relationship (ESPVR)➡️Ventricular Contractility
⚠️End Diastolic Pressure Volume Relationship (EDPVR)➡️Diastolic Compliance
⚠️EDV-ESV=Stroke Volume (SV)
Part II of the Basics of PV loops: preload, coupling, afterload, ventricular dysfunction, and valvular disorders.
Big thanks to the team who helped put this together: @jayamj94 & @PSullivan000, with guest editor @RyanTedfordMD.
If you missed Part I, check it out ⬇️
Big thanks to the team who helped put this together: @jayamj94 & @PSullivan000, with guest editor @RyanTedfordMD.
If you missed Part I, check it out ⬇️
- Preload is the stretching of cardiac myocytes prior to contraction (related to sarcomere length); it's measurable surrogate: ventricular end-diastolic pressure/volume.
- Δ in preload affect SV (width of PV loop), by the Frank-Starling mechanism. As preload ⬆️, SV (EDV-ESV) ⬆️.
- Δ in preload affect SV (width of PV loop), by the Frank-Starling mechanism. As preload ⬆️, SV (EDV-ESV) ⬆️.
When venous return to the heart is increased, the end-diastolic pressure and volume of the ventricles are increased, which stretches the sarcomeres, increasing their preload. In contrast, hypovolemia (i.e. hemorrhage) leads to less filling and shorter sarcomeres (reduced preload)
A case of low ScvO2 (60%), high PvaCO2 (8.2 mmHg), fluid intolerance (CVP 11) and fluid responsiveness (PPV 17). What's the physiology and what to do?
#FOAMcc #Hemodynamics #ThePeoplesVentricle #FOAMed #Fluidtolerance #Cardiotwitter #CriticalCare
#FOAMcc #Hemodynamics #ThePeoplesVentricle #FOAMed #Fluidtolerance #Cardiotwitter #CriticalCare
Post-cardiac surgery. MAP 70, HR 95, low dose pressor. High CVP (11 mmHg) with pathologic waveform of x < y-descent. PPV > 17 despite low Vt (< 6 mL/kg). Normal blood gasses, normal lactate.
🧵Complex #Hemodynamics in ESRD:
Middle age pt ➡️ 🏥 for syncope
HPI: Low BP during HD sessions. Does not achieve dry weight. Today she has had 6 episodes of syncope!
Last episode happened as she stood up from a chair
BP 88/62, HR 87 🧠 OK, CRT 2 sec
1/8
Middle age pt ➡️ 🏥 for syncope
HPI: Low BP during HD sessions. Does not achieve dry weight. Today she has had 6 episodes of syncope!
Last episode happened as she stood up from a chair
BP 88/62, HR 87 🧠 OK, CRT 2 sec
1/8
On #Echofist you notice this👇
During systole, flow from the LV towards the Aorta should all be blue in color! (Direction away from the probe)
This apparent change in direction (red sphere) is called Aliasing
Aliasing = Very high flow Velocity!
2/8
During systole, flow from the LV towards the Aorta should all be blue in color! (Direction away from the probe)
This apparent change in direction (red sphere) is called Aliasing
Aliasing = Very high flow Velocity!
2/8
Velocity can be quantified!
Use CW Doppler passing through the red sphere 👇
Velocity = 3.8 m/s 🚨🚨🚨 This is very fast!
Whenever you see a very fast flow, think of obstruction (similar to blocking a hose with your thumb👇)
What is causing the obstruction?
3/8
Use CW Doppler passing through the red sphere 👇
Velocity = 3.8 m/s 🚨🚨🚨 This is very fast!
Whenever you see a very fast flow, think of obstruction (similar to blocking a hose with your thumb👇)
What is causing the obstruction?
3/8
[1] #Hemodynamics Tweetorial #2
Heart failure pt in ICU is -3.5L after 2d of aggressive diuresis. On day 3, urine output is ⬇️and BUN/Cr is ⬆️
You personally wedge #PAC at bedside and obtain a mean wedge 17 mmHg (a normal mean wedge is 6-10 mmHg). Admission wedge was 24
Heart failure pt in ICU is -3.5L after 2d of aggressive diuresis. On day 3, urine output is ⬇️and BUN/Cr is ⬆️
You personally wedge #PAC at bedside and obtain a mean wedge 17 mmHg (a normal mean wedge is 6-10 mmHg). Admission wedge was 24
[2]
Question 1. Based on wedge 17 mm Hg (good waveform; no trick), you:
Question 1. Based on wedge 17 mm Hg (good waveform; no trick), you:
1) Welcome to our new #accredited #tweetorial on the Pathophysiology of #DKD in #T2D: Traditional Teaching and New Insights. Our expert author is Hans-Joachim Anders, MD, @hjanders_hans from @LMU_Uniklinikum of @LMU_Muenchen
2) This #accredited #tweetorial series on the foundations of #kidneydisease #DKD through the lens of #T2D is supported by an independent educational grant from the Boehringer Ingelheim/Lilly Alliance and is intended for healthcare providers.
3) This activity is accredited for #physicians #physicianassociates #nurses #NPs #pharmacists. Past programs still eligible for credit can be found at ckd-ce.com. Faculty disclosures & accreditation statement are at ckd-ce.com/disclosures/. FOLLOW US!
#AKIConsultSeries Middle-aged male ➡️🏥 for painful knee and fever. Now in shock 🚨
📂Chart review: PMH EtOH Cirrhosis, right knee arthroplasty.
It is always a good practice review previous PACS images🩻: Nodular liver, colateral vessels and prosthetic right knee
1/11
📂Chart review: PMH EtOH Cirrhosis, right knee arthroplasty.
It is always a good practice review previous PACS images🩻: Nodular liver, colateral vessels and prosthetic right knee
1/11
On exam: BP 72/48, HR 82, O2Sat 95%.
CRT 7 sec, 🧠somnolent, confused. No edema, no obvious ascites.
Warm, swollen and erythematous knee: Tap with obvious purulent fluid🧫
Cr 2.8 mg/dl (baseline 0.5), K 6.7, Urine 🔬: hyaline casts, some urothelial cells
2/11
CRT 7 sec, 🧠somnolent, confused. No edema, no obvious ascites.
Warm, swollen and erythematous knee: Tap with obvious purulent fluid🧫
Cr 2.8 mg/dl (baseline 0.5), K 6.7, Urine 🔬: hyaline casts, some urothelial cells
2/11
Loos like hemodynamic AKI (AKA Pre-renal)
Usual causes in Cirrhosis:
🔷Distributive: Septic, "Hepatorenal physiology" 🔷Hypovolemic: Laxatives, vomiting, large volume paracentesis
🔷Congestive: Porto-pulmonary HTN, Co-existing cardiomyopathy
3/11
Usual causes in Cirrhosis:
🔷Distributive: Septic, "Hepatorenal physiology" 🔷Hypovolemic: Laxatives, vomiting, large volume paracentesis
🔷Congestive: Porto-pulmonary HTN, Co-existing cardiomyopathy
3/11
1) Welcome to a new #accredited #tweetorial on Clinical and Laboratory Manifestations of #DKD in #T2D: From Early Identification to Monitoring Management. Your expert author is @edgarvlermamd.
2a) This activity is supported by an independent educational grant from the Boehringer Ingelheim/Lilly Alliance and is intended for healthcare providers. It is accredited for #physicians #physicianassistants #nurses #NPs #pharmacists. Check out @cardiomet_ce for more🆓CE/#CME.
2b) Past programs are still eligible for credit & can be found at cardiometabolic-ce.com. Faculty disclosures are at cardiometabolic-ce.com/disclosures/.
#FOAMed #medtwitter #diabetesmanagement #kidneydisease #diabetickidneydisease #diabetes @goKDIGO @MedTweetorials @nephondemand
#FOAMed #medtwitter #diabetesmanagement #kidneydisease #diabetickidneydisease #diabetes @goKDIGO @MedTweetorials @nephondemand
1) Welcome to our new #accredited #tweetorial on the Pathophysiology of #DKD in #T2D: Traditional Teaching and New Insights. Our expert author is Hans-Joachim Anders, MD, @hjanders_hans from @LMU_Uniklinikum of @LMU_Muenchen
2) This #accredited #tweetorial series on the foundations of #kidneydisease #DKD through the lens of #T2D is supported by an independent educational grant from the Boehringer Ingelheim/Lilly Alliance and is intended for healthcare providers.
3) This activity is accredited for #physicians #physicianassociates #nurses #NPs #pharmacists 🇺🇸🇪🇺🇬🇧🇨🇦. Past programs still eligible for credit are at ckd-ce.com. Faculty disclosures are at ckd-ce.com/disclosures/. FOLLOW US for regular programs by expert faculty!
(1/22) Acute PE treatment. An ever evolving landscape.
How about a #tweetorial on acute pulmonary embolism (#PE) and how to use mechanical #thombectomy with @InariMedical #FlowTriever?? Lets goooooo!
#InariFellowsEdition #IRad #IC #cardiotwitter
Pic credit @Jonathan_PaulMD
How about a #tweetorial on acute pulmonary embolism (#PE) and how to use mechanical #thombectomy with @InariMedical #FlowTriever?? Lets goooooo!
#InariFellowsEdition #IRad #IC #cardiotwitter
Pic credit @Jonathan_PaulMD
2/ From @CDCgov data one American dies of a blood clot every....? #VTE #PE @PERTConsortium #InariFellowsForum
3/ Acute #PE stats
📊100,000–180,000 PE-related deaths annually in US
📊PE is the most preventable cause of death among hospitalized patients
📊3rd leading cardiovascular cause of death after coronary disease and stroke
⏱ 1 American dies of a blood clot every 6 seconds
📊100,000–180,000 PE-related deaths annually in US
📊PE is the most preventable cause of death among hospitalized patients
📊3rd leading cardiovascular cause of death after coronary disease and stroke
⏱ 1 American dies of a blood clot every 6 seconds
Hypertrophic Obstructive Cardiomyopathy #HOCM🚧
#Symptoms
Profound exertional dyspnea
#Imaging
▪️SAM/LVOT obstruction #whyCMR
▪️Classic #Doppler🗡#echofirst
#Hemodynamics
▪️Brockenbrough-Braunwald-Morrow sign, explained
#Treatment
▪️Alcohol🍷septal ablation #RadialFirst
#Symptoms
Profound exertional dyspnea
#Imaging
▪️SAM/LVOT obstruction #whyCMR
▪️Classic #Doppler🗡#echofirst
#Hemodynamics
▪️Brockenbrough-Braunwald-Morrow sign, explained
#Treatment
▪️Alcohol🍷septal ablation #RadialFirst
🙏 @hopkinsheart @JonResar @RaniKHasan @kman8585 @DoctorLatina for unlocking these concepts for me!
@PushpaShivaram @AnastasiaSMihai @HeartOTXHeartMD
@DavidWienerMD @DrJayMohan @DxRxEdu @MasriAhmadMD @onco_cardiology @NadeenFaza @dr_chirumamilla @mirvatalasnag @TheVeggieMD
@PushpaShivaram @AnastasiaSMihai @HeartOTXHeartMD
@DavidWienerMD @DrJayMohan @DxRxEdu @MasriAhmadMD @onco_cardiology @NadeenFaza @dr_chirumamilla @mirvatalasnag @TheVeggieMD
Question:
Why wouldn’t more filling time⏱ prior to post PVC beat lead to less obstruction, less gradient, & ↑ arterial pressure?
After all, doesn’t ↑LV volume in #HCM ↓gradient and improve symptoms?
Cornerstone tx is hydration/💊s that ↑ diastolic filling time ...
Why wouldn’t more filling time⏱ prior to post PVC beat lead to less obstruction, less gradient, & ↑ arterial pressure?
After all, doesn’t ↑LV volume in #HCM ↓gradient and improve symptoms?
Cornerstone tx is hydration/💊s that ↑ diastolic filling time ...
