David Rogers

Adult Congenital Heart Disease Clinical Nurse Specialist 🫀 Nurse representative @scotcardio 🏴󠁧󠁢󠁳󠁣󠁴󠁿

[ScotCardioSoc @ScotCardio]

@StuartWatkins9 New President @ScotCardio opened today’s Annual Spring meeting with a fitting tribute and dedication to the late Prof. Adrian Brady, immediate past president.
‘Well done, keep going’

[Somerville Heart Foundation @HeartSomerville]

Join Trainee Health Psychologist Matthew Tucker from Glasgow Caledonian University for an online session on self-care and stress management.

27th May 4-5pm

Register for this session: https://t.co/qssQ8GS8hX

You must be a member to join these sessions: https://t.co/u38u8asQkN

[Somerville Heart Foundation @HeartSomerville]

Introducing our next Hearts Together Speaker, Dr Eleanor Joy, ACHD Consultant at Leeds General Infirmary.

Join us in Leeds on 6th June to hear Dr Joy speak about Cardiopulmonary Exercise Testing in ACHD

Book your ticket today! https://t.co/d6ICrWxLtE

[David Rogers @davidrogers24]

1 week to go until the Scottish Cardiac Society Spring meeting 🫀
Wednesday 27 May 2026 📅
Held this year at the Surgeons Quarter, Edinburgh in person and online. Registration ✅:
https://t.co/QeNIz4clxe

[David Rogers @davidrogers24]

2 weeks to go until the Scottish Cardiac Society Spring meeting 🫀
Wednesday 27 May 2026 📅
Held this year at the Surgeons Quarter, Edinburgh in person and online. Registration ✅:
https://t.co/bwVMHWa42k

[David Rogers @davidrogers24]

3 weeks to go until the Scottish Cardiac Society Spring meeting 🫀
Wednesday 27 May 2026 📅
Held this year at the Surgeons Quarter, Edinburgh in person and online. Registration ✅:
https://t.co/svYlBzP9V3

[mark davidson @MarkGlasgowPICU]

An opportunity has come up as part of planned service expansion for a congenital cardiac surgeon to come and join our amazing cardiac team here in Glasgow, UK - get in touch & find out more here: https://t.co/dcoV1sni2V
It’s a rather brilliant part of the world.

[PHA UK @PHA_UK]

Great news today - the Scottish Medicines Consortium has accepted the new PAH drug sotatercept for ‘restricted use’ in eligible patients in Scotland.
This is a big step forward. You'll find all the details here: https://t.co/5Ngs2cLqUl

[Dr. Chacón-Lozsán F .'. @franciscojlk]

🫀The failing right ventricle:
the most misunderstood chamber in critical care

For years, we focused on the left ventricle.

But in the ICU, the real killer is often the right ventricle.

->What is acute RV failure?

👉 Not just “weak contraction”

It’s a hemodynamic collapse syndrome:

RV dilation

↓ LV preload

↓ cardiac output

↑ venous congestion

➡️ → multi-organ failure

->The key pathophysiology (the vicious cycle)

1. ↑ Afterload (PE, ARDS, PH)
2. → RV dilation
3. → Septal shift → LV underfilling
4. → ↓ CO → hypotension
5. → ↓ RCA perfusion
6. → RV ischemia

👉 And the cycle accelerates

->The most important concept

👉 The RV does NOT tolerate pressure

Handles preload very well

Fails rapidly with afterload

➡️ Even small ↑ PVR → collapse

->Main causes you MUST think first

🔴 Pulmonary embolism
🔴 RV myocardial infarction
🔴 ARDS / mechanical ventilation
🔴 Decompensated pulmonary hypertension
🔴 Post-cardiac surgery

->Diagnosis is NOT obvious

There is no single sign.

👉 It requires suspicion + integration:

Clinical: congestion + hypoperfusion

ECG + biomarkers

POCUS (your best friend 🤓)

Hemodynamics

->Echo mindset (fast ICU approach)

👉 Don’t overcomplicate

Look for:

✔ RV dilation
✔ Septal shift (D-sign)
✔ TAPSE ↓
✔ Venous congestion

The real ICU mistake

❌ Treating RV failure like LV failure

->Management principles

👉 Think in 4 pillars:

1. Preload — “not too much, not too little”

Hypovolemic → small fluid

Congested → REMOVE fluid

👉 CVP is not a target, it’s a warning

2. Afterload, THE key target

✔ Treat PE
✔ Optimize ventilation
✔ Reduce PVR

👉 If afterload stays high → RV will fail

3. Contractility
Dobutamine
Milrinone
Levosimendan

👉 Choose based on context

4. Perfusion pressure

👉 Norepinephrine is your anchor

✔ Maintains coronary perfusion
✔ Supports RV function

->Ventilation: the silent killer

⚠️ Positive pressure = ↑ PVR

👉 Over-ventilate → worsen RV failure

->When nothing works

👉 Think early:

VA-ECMO

RV assist devices

🤓Key insight

This is NOT just a cardiac problem.

👉 It is a ventriculo–arterial coupling failure

When:
Ees / Ea ↓ → RV collapses

🤓Bottom line

✔ RV failure is preload dependent BUT afterload sensitive
✔ Small mistakes → rapid collapse
✔ Early recognition + physiology-based treatment saves lives

->Clinical mindset

👉 Don’t ask:
“Is the RV failing?”

👉 Ask:
“Why is the RV failing and, what is driving the afterload?”

📃Reference
Giannakoulas G. et al. European Heart Journal (2025) 00, 1–16 https://t.co/gri8ZaHHsI

[David Rogers @davidrogers24]

@linda_lgriffo45 Happy Retirement Linda. Enjoy your well deserved rest and thank you for all your support 😊🫀

[ESC WG on ACHD Chairperson @WGACHDChair]

Today marks the end of Congenital Heart Disease Awareness Week.
#CHD is a lifelong journey.
As the #ESC WG on #ACHD, we advocate for lifelong specialist care, structured transition, and continued research to improve outcomes for ACHD.
Awareness lasts beyond one week.
@escardio

[Heart Failure Hub Scotland @HFHubScotland]

Join us🗓️28 Jan 26 🏛️@rcpsglasgow
Ensuring Success in #HeartFailure: Enhancing the Patient Journey for Lasting Impact
A full day of trials updates, pathways, collaborative care, QI & a keynote on cardiac amyloidosis.
🔗 Register: https://t.co/jUa7ooT6hR

[Somerville Heart Foundation @HeartSomerville]

If you are an ACHD patient on the transplant pathway this online session is a great opportunity to speak to others 🫶

This month the meeting is on 9th Dec at 2pm. Log in to our Members Area and scroll down to Zooms: https://t.co/tFkcF0Ns8C

[Fred Wu, MD 🫀 吳明杰 @FredWuMD]

Dr. Gruschen Veldtman: heart failure with or without ventricular dysfunction is far more common in #CHD and is influenced by the coronary microcirculation which suggests several potential therapeutic avenues in additional to lifestyle measures. #AHA25

[UK Maternal Cardiology Society @theUKMCS]

Less than 3 weeks to go! Don't forget to register for our annual conference 26-27th November in Birmingham: https://t.co/BfZc91l5vk

[Meta Analysis Academy @metaacademy_ofc]

New publication from the Cardiology Experts Team at The Meta-Analysis Academy, and it’s in JACC! Congratulations to Nelson, Guilherme, and all collaborators.
It’s truly rewarding to see The Meta-Analysis Academy alumni achieving such great success!

https://t.co/Cj7fF94oJc

#Cardiology #JACC #MedTwitter

[Cardio-Obstetrics @CardioOb]

#CardioObstetrics #ACCRepOB #ACCCardioOB #PPCM

[Matthew MY Lee @matthewmylee]

🫀Cardiac myosin inhibitors improve symptoms, exercise performance, biomarkers, LVOT obstruction, & promote favourable cardiac remodelling in obstructive #HCM.

🔍Systematic review & comprehensive frequentist + #Bayesian meta-analyses of phase 3 RCTs.

📖https://t.co/ptvHF2YuO8

[Edgardo Alania @Ed_Alania]

🫀 Arrhythmogenic Cardiomyopathy or “Athlete’s Heart”?: A Systematic Approach to Differential Diagnosis @JACCJournals #Cardiology #CardioEd

[ESC WG on ACHD Chairperson @WGACHDChair]

🫀 VSD Surgical Closure: 50 Years of Insight
This study by Sahra Ünlütürk et al. tracks patients decades after ventricular septal defect surgery, revealing that even small repairs can have long-term effects.
📖 Read more on #IJCCHD https://t.co/09BrK1Ehc5
#VSD #CHD #ACHD