🧵 Very interesting chest X-ray!!! What could be the story behind such a bizarre CXR for defibrillator ICD system?! #Epeeps
EP was called to interrogate this device. What would you tell the primary team?
💊 Practical algorithm for diuretic resistance in acute HF from #HeartFailure26— this is the slide to save!
Start: Furosemide 120-160 mg
↓ Still congested?
Add Chlortalidone 12.5-50 mg/24h
↓ Still congested?
Tailor to the problem:
• Metabolic alkalosis → Acetazolamide 120-500 mg/24h
• Hyponatremia → Tolvaptan 15-50 mg/24h
• rLVEF + hypopotassemia → MRA 25-100 mg/24h
And running through the whole algorithm:
➕ Add iSGLT2 throughout
➕ Add sacubitril/valsartan if LVEF <49%
➕ Consider parenteral route if oral absorption is the issue
Clean. Practical. Evidence-based. 💯
(Adapted from de la Espriella R et al. Nefrologia 2021)
#CardioTwitter #HeartFailure #Cardiology #Diuretics #HFrEF
🫀 #CardioNugget:
Isorhythmic Dissociation
“Same rate, different pacemakers”
🧠 Concept:
Sinus node slows (↑ vagal tone/meds) while a junctional focus speeds up → both fire at nearly identical rates but independently
🔍 EKG clues:
• P waves present but not consistently before QRS
• Variable PR intervals
• Atrial ≈ Ventricular rate ⭐
• P waves “march through” ± capture/fusion beats
❗Not CHB
#CardioNugget #MedEd
🧵 BREAKING | #CONDUCTAF trial results just presented at #HeartFailure26 by David Žižek (Ljubljana, Slovenia) — a late-breaking science moment! 🫀
1/ The question: Conduction system pacing (CSP/LBBAP) vs. biventricular pacing (BVP) after AV node ablation in HF patients with refractory AF and narrow QRS. First ever RCT on this! (NCT05467163)
2/ Background: CSP via left bundle branch area pacing (LBBAP) offers procedural advantages over His bundle pacing in the AVNA context — but prior evidence comparing CSP to BVP was only observational. Time for an RCT. ✅
3/ Primary endpoint — LVEF change at 6 months:
📊 Mean difference: 0.4% (95% CI: −3.1 to 3.8)
✅ Non-inferiority met (p=0.002, margin 5%)
➡️ CSP was non-inferior to BVP for LV recovery
4/ Key findings:
🔵 Similar structural reverse remodelling
🔵 Similar functional capacity, QoL & clinical outcomes
🔵 LBBAP showed a more favourable procedural profile + narrower paced QRS
5/ Bottom line: LBBP is a viable alternative to BVP in a ‘pace and ablate’ strategy. Whether CSP offers incremental benefit on hard clinical endpoints needs larger, longer RCTs. Watch this space! 👀
#Cardiology #HFchat #HeartFailure #PaceAndAblate #LBBAP #ConductionSystemPacing
The way we are going…the perfectly pattern-recognition ECG read may be the last hurdle conquered by AI. It boggles my mind how bad these reads are. 2026 no different from 1990.
58 year old patient, CKD, on dialysis for 18 years. Presents with abdominal pain suprapubic. Has a history of Aortic stenosis moderate, tachycardia brady syndrome and AFIB. This is his ecg? Would you ask for a troponin?