Jonathan Cheung

POCUS, critical care, emergency medicine, anaesthesia

[Rk Jain @drrkhyd]

Post cabg four years ago? Asymptomatic. Patient does not have any details. What’s happening?

[Chirag Bavishi MD, MPH @chiragbavishiMD]

The most stenotic bioprosthetic mitral valve I have encountered. Mean transmitral gradient 31 mmHg at HR 74 bpm, EOA of just 0.2 cm².

The pt was transferred from OSH in pre-shock. Successful TMViV, no valvular or PVL, mean gradient 3 mm Hg.

[Jonathan Cheung @JCHCheung]

@ross_prager A couple of times. Curious what you used for sedation. Ketamine? Midazolam?

[Sudarshan Balla @sudarshanballa]

Sometimes the sonographer has an interesting take. Here SSN view obtained after Definity. Diagnosis? @WvuCvFellows @argulian @CASivaram1 @alex1708ander #echofirst @a_l_bailey @harshi_md

[Carlos El-Tallawi, MD, FACC, FASE @HeartToProve]

Echo contrast in true lumen

[Chittur Sivaram MD MACP MACC @CASivaram1]

#echofirst
✅ For fellows & other early learners
✅ Diagnosis & differential ?
✅ Tagging all experts below mainly for a wider reach to learners. This is too simple for them!
@HeartOTXHeartMD
@iamritu
@DrRajeshG1
@argulian
@purviparwani
@DavidWienerMD
@Hragy
@PWesslyMD
@hvanspall
@jaideeppatelmd

[Benoy Shah MD @dr_benoy_n_shah]

*VALVE CASE OF THE MONTH*

Early 40s, admitted with exertional CP and one episode of syncope

Loud systolic & diastolic murmurs

Here's the first PLAX view on TTE

#echofirst

[Alexander Mladenow MD @alex1708ander]

Thrombus in transit through a PFO AKA “ticking time bomb” 💣 imminent risk for #PE (pulmonary embolism but also for paradoxical embolism) #echofirst male patient with genital cancer

[Dr G Rajesh (Gopalan Nair Rajesh). @DrRajeshG1]

A 25 yr old, known to have small VSD from childhood who has been asymptomatic till 3 weeks back presented with worsening dyspnoea. Likely diagnosis?

[Jonathan Cheung @JCHCheung]

@icmteaching With this afterload=threshold concept, how do you explain the phenomenon that increasing SVR with vasopressor relieves DLVOTO from SAM? Or does it go to the impedance part of the theory?

[Dr G Rajesh (Gopalan Nair Rajesh). @DrRajeshG1]

A 34 yr female was referred to us as Primary PH with R-> L shunt through PFO -> cyanosis.On clinical exam she had long systolic murmur in back which is unusual in PPHN. It finally turned out as Multiple peripheral PS. MESSAGE IS “TR JET VELOCITY GIVES RV PRESSURE NOT PA PRESSURE”

[Alexander Mladenow MD @alex1708ander]

When blindly introducing a Swan Ganz PA-catheter from the left neck side, another dangerous surprise could be the unexpected presence of LSVC (left superior vena cava) #echofirst

⚠️ Inflating the balloon of the catheter can cause a fatal rupture of the coronary sinus ⚠️

[Edgar Argulian @argulian]

Suprasternal view can hide surprises. A patient with known malignancy. What is the finding?

[Alexander Mladenow MD @alex1708ander]

TTE in a patient in PACU after surgery for valve disease. Already extubated. Slightly hypotensive. Abnormal ECG. Elevated CK, CK-MB

👉 what’s most likely the reason?
👉 A-L-P-I-S? #echofirst
👉 which valve was operated on?

[Dr G Rajesh (Gopalan Nair Rajesh). @DrRajeshG1]

Simple echo quiz for fellows.

[Shariq Shamim @ShariqShamimMD]

Rare glimpse of echocardiogram just at the onset of VF, no organized heart activity and....

#cardiotwitter #MedTwitter

[Alexander Mladenow MD @alex1708ander]

Super scary, but not for long 👉 LV clot removed in MIC approach 🔪

Ultra-fast-track-cardiac anesthesia (UFTCA) & enhanced recovery after surgery (ERAS) #echofirst @RootGal210 @ross_prager

Tricenarian with past history of myocardial infarction (10 years ago)

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

4-year-old boy, classic TOF.
@iamritu @CASivaram1 @jeffrey_vinocur @RobertHPass @WGACHDChair @DavidWienerMD @dkthekkoott @WithAScalpel @alexsfelixecho @echoleolopez @loomba_rohit @alex1708ander @SIwa23288585 @CardioNeo @sujithsp

[Dr G Rajesh (Gopalan Nair Rajesh). @DrRajeshG1]

Findings?

[Edgar Argulian @argulian]

A patient in the intensive care 1/2