augusto uchida

MD, PhD. Non-invasive cardiologist

[European Society of Cardiology Journals @ESC_Journals]

New in #EJPC: In endurance athletes, neither atrial fibrillation nor left atrial dilation was associated with higher exercise blood pressure responses.
📕 Read more: https://t.co/zTJnzUuQTj

@EJPCEiC @AboyansV @SilCastelletti @PTBuketAkinci @PeroneFrancesco @SMosteoru @TimKambic

[KagawaECG @KagawaECG]

Rao, P.S.; Rao, N.S. Diagnosis of Dextrocardia with a Pictorial Rendition of Terminology and Diagnosis. Children 2022, 9, 1977.
CC-BY 4.0
https://t.co/DVHTsuUBWr

[Robert Herman, MD, PhD @RobertHermanMD]

@PowerfulMedical @PMcardioApp Link to the full paper: https://t.co/srP2H2SK49

[Dr. FEVI🫀🩺 @javier20ch]

Miocardiopatía Hipertrófica & Embarazo. 🫀💥🤰
🔷️La mayoría de las mujeres con MCH pueden tener embarazos exitosos, siempre que exista una adecuada estratificación de riesgo y seguimiento por un equipo cardio-obstétrico especializado.
🔷️El momento más importante no es el embarazo, sino la consulta preconcepcional. Antes de intentar la gestación debe evaluarse la presencia de obstrucción del tracto de salida del VI, función sistólica, carga arrítmica, historia de IC y riesgo de muerte súbita.
🔷️La combinación de las escalas CARPREG II y mWHO permite identificar a las pacientes que requerirán vigilancia estrecha o incluso aconsejar diferir el embarazo si presentan FEVI <50%, síntomas NYHA III-IV o gradientes obstructivos severos.
🔷️Tto: los Ɓ-bloqueadores continúan siendo la piedra angular, con preferencia por metoprolol (o propranolol), mientras que debe evitarse atenolol por su asociación con restricción del crecimiento fetal. En MCH obstructiva sintomática debe considerarse miectomía septal o ablación septal antes de la concepción, ya que los inhibidores de miosina (mavacamten y aficamten) están contraindicados durante el embarazo por su potencial efecto teratogénico (se recomienda suspender mavacamten al menos 4 meses antes de buscar embarazo).

📚🆓️⤵️ State-Of-The-Art Review2026 @JACCJournals 💯
https://t.co/QjiDicw1WT
https://t.co/8pQRUjvPoL

[Robert Herman, MD, PhD @RobertHermanMD]

@drmalshehri Should be no doubt here, even meets mm criteria! LCx vs. RCA on the culprit

[Milan Koštek @KostekMilan]

Two different patterns for the premature ventricular complex induction of a long RP supraventricular tachycardia
https://t.co/9Bl9ZECA8j

[Eric Topol @EricTopol]

The first AI to quantify coronary artery inflammation was approved by the FDA yesterday @CaristoHeart
This is an important step forward for preventing heart disease that I've written about
https://t.co/foSaaTYmNw

[Koichi Nagashima@EP Univ. Ablation School @Koichi16423232]

🚨なぜRAO LAOとメンドイview使うの
→ 心臓の立体構造を簡単に見るため💕

前後像だと中隔（紫の平面）が自分に対して斜めだから、正確なカテ位置が把握しづらいけど

✅RAO：中隔を自分と平行に見る
→ 画面の左が心房、右が心室
→ 心房か？心室か？が直感的にわかる

✅LAO：中隔を自分と垂直に見る
→ 画面の左が三尖弁、右が僧帽弁
→ 右心か？左心か？が直感的にわかる

RAOで心房か？心室か？がわかり
LAOで右心か？左心か？がわかると
全てのカテ位置の把握は瞬殺でしょ❤️‍🔥

#医学生 #循環器 #EPS #アブレーション
#EP大学

[うし先生@新アカウント @ushi_sensei]

【左脚ブロックで考えること】

左脚ブロックについてYouTubeでまとめました。同じ波形でも症状(無症状、胸痛、息切れ、失神など)で解釈が変わりますが、右脚ブロックと違って異常所見なので一定の評価は必要です。個人的には右室生検×(右心カテーテルも気をつける)が大事な気もします。

[Alexander Mladenow MD @alex1708ander]

Nice educational tool about the TEE(R) anatomy and spatial relationships of TV leaflets. Though I have to admit, I spent a minute wondering who the “surgent” was… until I realized it must be the upgraded version of the surgeon’s view 😂 #echofirst #TEER

https://t.co/nnrsZVvMWp

[CardiovascularCorner @TrackYourHeart]

Acute Coronary Syndrome: How clinicians rapidly decide who has a myocardial infarction

When a patient presents with chest pain, the diagnosis is never made from a single test. Instead, clinicians combine four key pieces of information to estimate the likelihood of myocardial infarction (MI) and decide whether the patient can be discharged, requires observation, or needs immediate treatment.

The process begins with the clinical assessment.

The patient's symptoms, physical examination, and vital signs provide the first estimate of risk.

Low-risk features include mild or atypical chest discomfort with stable vital signs.

High-risk features include:
- Typical crushing chest pain
- Pain radiating to the arm, jaw, or back
- Diaphoresis, nausea, or dyspnea
- Hypotension or shock
- Cardiac arrest or hemodynamic instability

The next step is the 12-lead ECG.

The ECG provides immediate information about ongoing myocardial ischemia.

Typical findings include:
🟥 Normal ECG: lowers the probability of MI but does not exclude it.
🟥 Mild ST-segment depression: may indicate early ischemia.
🟥 Significant ST-segment depression: increases suspicion for NSTEMI or extensive subendocardial ischemia.
🟥 ST-segment elevation: strongly suggests acute coronary artery occlusion (STEMI) and usually requires immediate reperfusion therapy.

The third component is the cardiac troponin level at presentation (0 hour).

Cardiac troponin is the most sensitive biomarker of myocardial injury.

Importantly, troponin should be interpreted as a quantitative marker.

In general:
- The higher the initial troponin level, the greater the likelihood of myocardial infarction.
- A normal initial troponin does not exclude very early MI.

For this reason, serial testing is essential.

The fourth component is the change in troponin over time, usually after 1–3 hours.

An acute rise or fall in troponin supports ongoing myocardial injury.

The greater the absolute change, the higher the probability of an acute MI.

These four elements are integrated into a triage strategy.

Rule-out MI Patients with:
- Low-risk symptoms
- Normal or non-ischemic ECG • Low troponin
- No significant change on repeat testing

are unlikely to have an acute myocardial infarction. Alternative diagnoses should be considered, including pneumonia, pneumothorax, musculoskeletal chest pain, or gastrointestinal disorders.

Observe Patients with intermediate-risk findings or equivocal troponin results require additional evaluation.

Possible diagnoses include:
- Unstable angina
- Early NSTEMI
- Myocarditis
- Takotsubo syndrome
- Heart failure
- Other cardiac disorders

Further ECGs, repeat troponins, imaging, or coronary evaluation may be needed.

Rule-in MI Patients with:
- Ischemic symptoms
- Dynamic ischemic ECG changes
- Elevated troponin with a significant rise or fall

have a high likelihood of acute myocardial infarction.

Those with persistent ST-segment elevation are treated as STEMI, requiring urgent reperfusion.

Those without ST elevation but with elevated troponin are diagnosed with NSTEMI and managed according to their risk profile.

Patients presenting with cardiac arrest, shock, or severe hemodynamic instability require immediate ECG and bedside echocardiography to identify life-threatening cardiac causes. If the presentation suggests aortic dissection or pulmonary embolism, dedicated diagnostic pathways should be followed rather than assuming acute coronary syndrome.

The key message is simple: Acute MI is diagnosed by integrating clinical presentation, ECG findings, and serial cardiac troponin measurements, not by relying on any single test in isolation.

Reference: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine (Diagnostic approach to acute coronary syndrome; adapted from the 2020 ESC Guidelines for the management of acute coronary syndromes).

[Rhenals acuña @RhenalsMedint]

Este paper es probablemente la mejor síntesis hasta ahora en obesidad. No es una nueva guía. Compara las más recientes EASO (2024), (2025), ACC (2025) y AACE (2025) en un paper.

Obesidad deja de ser definida por IMC y se define ahora por exceso de adiposidad que genera daño.

[KagawaECG @KagawaECG]

▶️ Masquerading bundle branch block（MBBB）
.
胸部誘導が右脚ブロックっぽくて，肢誘導がらしくない（≒ I誘導とaVL誘導でs波がないことで代用されることが多い印象）の波形です（つづく）
https://t.co/fL7S64ksvM

[KagawaECG @KagawaECG]

⏩ Arrudaアルゴリズム（右側自由壁の副伝導路ver）
.
いわゆる顕性WPW症候群の方のKent束の局在推定に用いられるアルゴリズムを参考に，少し立体風の動画にしてみました
.
よかったら参考にして下さい🙇

[HeartRhythm @hrs_journal]

Unravelling the enigmatic morphology of the atrioventricular conduction axis using Hierarchical Phase-Contrast Tomography (HiP-CT) #OpenAccess

@Chloe_Li_ @aaalmehandi @UCL_ICS

https://t.co/YvNpPRyFnL

[د.مها @res_pian3]

الروابط الجديدة لموقع sci-hub لتحميل الابحاث العلمية المدفوعة

👇👇
1- https://t.co/eiMrqZw8bK
2- https://t.co/oQ9tZbFxtB
3- https://t.co/IbdbuwC5OF
4- https://t.co/Q7wdXpAM8J
5- https://t.co/3KsNnDovJe
6- https://t.co/Wi7QTOwER5

[augusto uchida @augustouchida]

@ElNutriDice Com o Vinho tinha essa falacia de beneficios que durou por muito tempo . Isso aí não passa de uma mentira contada com uma roupagem de medicina baseada em evidencias.

[今西純一｜淡路島の循環器内科医 @jun_awaji]

#淡路島心エコー勉強会

僧帽弁の逸脱があれば…
１．まずは逸脱があることを白黒画像で目視する
２．あればどのパターンか識別し、
３．部位を同定
４．最後にカラーで逆流の程度もあわせて考える
という流れに…✌️

[Christoph Burch @ChristophBurch]

Muscle in Fat Trouble: The Rise of IMAT in Metabolic and Musculoskeletal Disease
https://t.co/F3Cr67s2A1

[Radcliffe Cardiology @radcliffeCARDIO]

📚 New #ECRJournal Article: "CARDIOLIPID Plan: A Decision Pathway for Dyslipidaemia Management"

📚 Just Published!

🔓Access it here 👉 https://t.co/zyBrwGGjKp

#MedEd #CardioEd #VascularDisease