Shyam Shankar

[Ryan Feldman (empoisonpharmd.bsky.social) @EMPoisonPharmD]

Every year, America's Poison Centers publishes their annual report, and among the treasure trove of data, is the emerging trends section- This year, they highlighted the roll of ECMO in poisoning

https://t.co/0aigIusbk9

[Gregorio Romero-González @Tubulocentric]

🔍 Detecting Volume Intolerance Through Filling Pressures
Brilliant presentation by Prof. @AleksandarNesk6 at the #PoCUSummit highlighting the value of pulmonary venous Doppler. Patterns such as S/D ≤ 0.67 and prolonged AR–A duration reliably reflect elevated LV filling pressures (LVEDP >15 mmHg), independent of age or LVEF. A powerful, underused window for diastolic and hemodynamic assessment. 🫀🔍 @NephroP @ArgaizR @EchoSoliman @EACVIPresident @ERAkidney @SENefrologia @nefrocat
#PoCUS #CardioRenal #Echocardiography #Hemodynamics

[NephroPOCUS @NephroP]

Recommend #POCUS reading of the day.
Measuring Left Ventricular Outflow Tract Signal Gradient in Hypertrophic Cardiomyopathy.
❓MR Doppler signal vs LVOT ❓
#FOAMed #echofirst
🔗 https://t.co/QQRH0xvJgM

[Ahmed Ata @Ahmedata7777]

Assessment of LVEDP Using AR–A Duration Difference

■ How to measure

Obtain pulmonary venous flow (usually from the right upper pulmonary vein) using pulsed-wave Doppler in the apical 4-chamber view.

■ Identify:

S wave (systolic forward flow)

D wave (diastolic forward flow)

AR wave (atrial reversal)

■ Measure:

AR duration = time from onset to end of the atrial reversal wave.

Compare it with mitral A-wave duration (from transmitral inflow Doppler).

If AR–A duration difference > 30 ms, → elevated LVEDP

If ≤ 30 ms, → normal LVEDP

■ What it indicates

● Normal: In a healthy heart, the PV AR duration is shorter than the mitral A duration, with a small or negative difference.

● Elevated LVEDP/Diastolic Dysfunction: When the left ventricle is stiff or relaxes poorly (diastolic dysfunction), it can't accept blood quickly enough during the A-wave, causing the A-wave to shorten and the PV AR wave to extend later into diastole. This results in a longer PV AR duration and a positive AR/A duration.

》Cutoff: A difference of >30-35 ms suggests elevated left atrial pressure (LAP) and LVEDP.

■ Notes:

Best used in sinus rhythm (needs identifiable A-wave).

Less reliable in AF, significant MR, or pulmonary venous stenosis.

Should be interpreted along with other diastolic indices (E/e’, LA size, etc.).

[Ahmed Ata @Ahmedata7777]

The diastolic pulmonary artery pressure (DPAP) & The mean pulmonary artery pressure (mPAP)

》The DIASTOLIC pulmonary artery pressure (DPAP) can be estimated from the velocity of the END-diastolic pulmonary regurgitant velocity using the modified Bernoulli equation.

DPAP = 4V(END-diastolic pulmonary regurgitation velocity)² + RA pressure.

》The MEAN pulmonary artery pressure (mPAP) can be estimated from the EARLY PEAK pulmonary regurgitation velocity using the modified Bernoulli equation.

mPAP = 4V(early peak pulmonary regurgitation velocity)² + RA pressure.

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

Doppler(CWD) Spotter for fellows.

[Ross Prager @ross_prager]

(1/x) High quality CPR, early defibrillation, and treating the underlying cause saves lives in cardiac arrest, but what else can we do?

Here are 7 advanced therapies for cardiac arrest👇

A🧵

Caution: Bleeding edge - evidence 'light' zone.

[IMCrit @IM_Crit_]

What is the correlation between echocardiographic & invasive assessment of hemodynamics in acute decompensated heart failure-related cardiogenic shock (ADHF-CS)?

[IMCrit @IM_Crit_]

ICU Hemodynamics - Literature Review:

Speaking about fluid responsiveness...

This was my favorite figure from FENICE, a multicenter international observational study of 2,213 pts aiming to evaluate the practice of fluid challenge (FC) in critical care settings (@DrMCecconi):

[Hany Ragy @Hragy]

⁦@EM_RESUS⁩ F70, severe dyspnea, edema LL, gallop, BP 230/100, this ECG, was normal a week ago…

[IMCrit @IM_Crit_]

including a study from this paper's authors, that "impaired RV function and RV-PA coupling are associated with severe pulmonary congestion on admission, and less resolution of pulmonary congestion during hospital stay". This may be due to a number of factors:

[Echo for fellows @BhaskarArora_MD]

CW Doppler signal through the TV in apical window. Why is the signal Bifid?
Clue: see ECG attached

@ASE360 #ACCFIT

[Shyam Shankar @ShyamShankar33]

@khaycock2 Pardon my ignorance, but how do you use pre ejection time and total ejection time to help with your management? Any resources to read about it?