Martin Jouza

Neonatologist on surgical NICU in Brno. Part of neonatologist/obstetrician marriage. Love technology, Apple, news, memes, sports, running, God.

[Ahmed Ata @Ahmedata7777]

TAPSE/PASP ratio

TAPSE/PASP ratio is a simple echocardiographic index used to assess right ventricular (RV)–pulmonary artery coupling.

🔹 Components
● TAPSE (Tricuspid Annular Plane Systolic Excursion) → Measures RV longitudinal systolic function (in mm).
● PASP (Pulmonary Artery Systolic Pressure) → Reflects RV afterload (in mmHg).

🔹 Formula

TAPSE (mm) / PASP (mmHg)

🔹 Normal & Cutoff Values

● Normal / preserved RV–PA coupling:
👉 > 0.31–0.36 mm/mmHg.

● Impaired coupling:
👉 < 0.31

🔹 Clinical Significance
● Integrates:
○ RV contractility (TAPSE)
○ RV afterload (PASP)

● Low ratio = bad sign
○ RV cannot adapt to increased pulmonary pressure
○ Seen in:
▪︎ Pulmonary hypertension
▪︎ Heart failure
▪︎ Severe valvular disease (e.g., MR, TR).

🔹 Prognostic Value
Strong predictor of:
▪︎ Mortality
▪︎ Hospitalization in heart failure
▪︎ Outcomes in pulmonary hypertension
▪︎ Often better than TAPSE or PASP alone.

🔹 Quick Clinical Pearl

👉 A patient can have normal TAPSE but still have RV failure if PASP is very high → ratio unmasks this.

[Petr Pavel @prezidentpavel]

Zdravotnický záchranný tým CZERT je během 72 hodin připraven zasahovat při přírodních katastrofách a dalších mimořádných událostech po celém světě. Spojuje lékaře, zdravotníky a hasiče, kteří dokážou na místě rychle vybudovat mobilní urgentní příjem.

Jejich dosavadní pomoc, například při zemětřesení v Nepálu, ukazuje, že se jedná o tým, na který může být Česká republika opravdu hrdá.

[WithAScalpel - Fumiya Yoneyama, MD, PhD @WithAScalpel]

TAPVR Classification:

1⃣ Type I (Supracardiac): CPV → vertical vein (VV) → innominate vein → SVC (VV compression can cause PVO).
2⃣ Type II (Cardiac/Intracardiac): CPV drains to coronary sinus (IIa) or directly to RA (IIb).
3⃣ Type III (Infracardiac): CPV → descending VV through diaphragm → portal/hepatic veins or IVC (obstruction common).
4⃣ Type IV (Mixed): PV return splits via ≥2 pathways (high anatomic variability—define with detailed imaging).

Appreciate the beautiful images from @OungSavly, as always.🙏

[CardiovascularCorner @TrackYourHeart]

Myocardial Performance Index (Tei Index)= Interesting one 😍

The Tei Index, named after Dr. Chuwa Tei is a Doppler-based, noninvasive measure of global ventricular function, combining both systolic & diastolic performance.

How it’s measured:
⬜ Obtained using pulsed and continuous wave Doppler of mitral inflow (A4C view) and LV outflow (A5C view).
⬜ Key time intervals are measured:
a. IVCT ➡️ Isovolumetric Contraction Time
b. IVRT ➡️Isovolumetric Relaxation Time
c. ET ➡️ Ejection Time
Formula:
Tei Index = (IVCT + IVRT) / ET
or
Tei Index = (a - b) / b
a = time from mitral valve closure to opening
b = aortic ejection time
Normal Values:
LV Tei Index: ≤ 0.40
RV Tei Index: ≤ 0.43
Interpretation:
🔵 Higher Tei Index = Worsening ventricular function
🔵 Sensitive for detecting early dysfunction, even when LVEF is preserved.
Clinical Significance:
- Helpful in evaluating cardiomyopathies, heart failure, congenital heart disease, and transplant rejection.
- Valuable in both pediatric and adult cardiology.

(Ref: Bulwer BE & Solomon SD. In Essential Echocardiography: A Companion to Braunwald’s Heart Disease. Elsevier, 2019)

[Oung Savly MD FACC FASE FESC FAAP FEACVI 🇰🇭 @OungSavly]

Real time echocardiography during adenosine administration showing
👉🏻SVT conversion with adenosine, transient AV nodal block leading to restoration of sinus rhythm. @jeffrey_vinocur @RobertHPass @KaraMotonaga @iamritu
@loomba_rohit @alex1708ander @SIwa23288585 @AEPCcongenital

[Evidence-Based Neo @EBNEO]

New evidence on how to manage a PDA: Laughon et al. publish results of the NRN PDA RCT in @jama_current
https://t.co/rTKfClMDLL
#neoEBM #EBNEOalerts

[Michael Narvey 🇨🇦 @NICU_Musings]

Not using video Iaryngoscopy (VL) to intubate neonates?

Systematic review and meta-analysis now out showing...

VL improves first attempt intubation success rates, 849 intubations (RR 1.46, 95% CI 1.21 to 1.75), with a NNT of 6
https://t.co/Vsa6MoqrAv
#neotwitter

[Michael Narvey 🇨🇦 @NICU_Musings]

Canadian 🇨🇦 study in 24-29+6 weeks GA: use of t-piece resuscitator in delivery room vs self inflating bag
No diff in death or bronchopulmonary dysplasia (BPD) or severe neurologic injury
It's not the tool you use but knowing how to use it that counts!
https://t.co/pmBAgZuOD4

[ERC - European Resuscitation Council @ERC_resus]

🗓️ SAVE THE DATE:
💙 The @erc_resus is excited to announce the launch of the Guidelines on Cardiopulmonary Resuscitation 2025, which will take place on October 22, 2025, in Rotterdam. This event is a collaborative effort between the European Resuscitation Council, the American Heart Association and the @Ilcor_org
❤️ We are pleased to present a comprehensive program that highlights the latest advancements in resuscitation science and applied practice.
💯 All the different sessions will be made available via live-stream in parallel, and at no cost to the viewer.
✅ Check our website for all the live stream links.
👉 https://t.co/ASvMq9lwui
👉 https://t.co/S6CzoNddVK
✅ PLEASE NOTE THAT ALL TIMES ARE LISTED IN CENTRAL EUROPEAN TIME (CET).
✅ NO PRE-REGISTRATION NEEDED.
🙏 We look forward to your participation and encourage you to join the sessions that interest you the most.
@HeartCPR
#ERC #AHA #ILCOR #RESUS25 #ERCGuidelines #Guidelines2025 #savethedate #SaveLives #StrongerTogether #Resuscitation

[Satyan @neosatyan]

What is your first line vasoactive agent to treat hypotension/hypoperfusion in the #NICU ? Are you a #dopamine fan? A review article in @JPerinatology by @CardioNeo @HebertAudrey3 @SBhombalK3 @ShiranSMoore @StephFordNeoPH and Rios - full text at https://t.co/8iE7ZNZX28

[Evidence-Based Neo @EBNEO]

A meta-analysis in @JAMAPediatrics assesses clinical outcomes of active treatment vs expectant management of PDA in preterm infants. https://t.co/LuFvz3CYXV

#EBNEOalerts #neoEBM #neotwitter

[Nathan Sundgren, PhD, MD @natetexsun]

Epinephrine by Laryngeal Mask (LM)? Animal study by @chandrpk et al here gives some proof to concept. Well placed LM with good seal can deliver tracheal epinephrine. Can the chaotic delivery room environment match the lab? We should find out. https://t.co/EY4vwmKWy0 @EBNEO @Research4Babies @neosatyan @NeoAnup

[The Heart @ZHeart11768530]

🔴Approach to Pediatric ECG❤️⤵️ 🔹

#Cardiology #FOAMed #MedEd #medstudent #paramedic #Cardiology #CardioEd #medtwitter #meded #CardioTwitter #cardiotwiteros #MedX #cardiovascular #MedTwitter #medical #medEd #cardiotwitter #medicineball #GDMT #HFrEF

[The Heart @ZHeart11768530]

🔴 Wolff-Parkinson-White Syndrome

WPW is one of several disorders of the electrical system of the heart that are commonly referred to as pre-excitation syndromes

characterized by an abnormal accessory conduction pathway b/n the atria &amp; the ventricle known as the bundle of kent

[The Heart @ZHeart11768530]

🔴Localization of Atrial Flutter (AFL) focus

#EPeeps #MedEd #AFib #CVD #cardiology #EKG #ECG #electrocardiogram #interpretation #CardioEd #Cardiology

[Brian King @BrianKingNeo]

And had a 74% probability of treatment harm, and 86% probability of increased death.

That should be a big part of the take-home message. #neotwitter

[Martin Picard @MitoPsychoBio]

Beautiful animation of metabolic flux in the mitochondrial Kreb (TCA) cycle

The three "CO2" coming off the cycle is how you lose weight: carbon from your material body coming off as gas you end up breathing out

By @janetiwasa

[CardiovascularCorner @TrackYourHeart]

HOW THE HEART BUILDS ITS WALLS: The Fascinating Story of Atrial Septation🫀

The human heart starts as a single primitive atrium. But how does it divide into two separate chambers?
Let’s break down the formation of the atrial septum in a simple way.

A thread

[Ziyad Al-Aly, MD @zalaly]

1. What are the benefits and risks of GLP1?

Our new study in @naturemedicine comprehensively maps all the benefits and risks of GLP-1 receptor agonists (GLP-1) (Ozempic, Wegovy, Mounjaro, Zepbound).

By @Biostayan, Taeyoung Choi and me
🧵

https://t.co/cJR8t1fZU8

[Eric Topol @EricTopol]

Cytomegalovirus (CMV) is the leading cause of infectious birth defects and linked to many other morbidities such as transplantation. For the first time in over 50 years of pursuit, a vaccine is in reach https://t.co/1j5EHVs3nF