srikanth seethala

Advanced Heart Failure Cardiologist Opinions are my own and not the views of my employer.

[Eddy J. Gutierrez, MD @eddyjoemd]

We often take circulation for granted, yet it is rarely as simple as it seems. Grateful to these experts for providing fresh insights into hemodynamic management to help us better care for our patients. 🎩 tip to the authors, including @DrMCecconi
https://t.co/Sfr6vCn6le

[Eddy J. Gutierrez, MD @eddyjoemd]

Step up your management of patients with vasoplegia after cardiac surgery. Learn from the greats, including @pwierusz and @SXC71. 🎩 tip to the authors.
https://t.co/Sfr6vCn6le

[Eddy J. Gutierrez, MD @eddyjoemd]

VA-ECMO buys time for the next step. Here's a good review article for beginners.🎩 tip to the authors.
https://t.co/Sfr6vCn6le

[Ritika Tuli @RitikaTuliMD]

#CardioNugget™

Echo-derived PVR on TTE

This is an empiric Doppler formula validated against cath data — the “×10 + 0.16” converts the Doppler ratio into estimated WU.

Think physiologically:

↑ TR velocity = ↑ pressure
↓ RVOT VTI = ↓ forward flow

So:
high pressure / low flow = high resistance.

#CardioNuggets #MedEd #EchoFirst

[CardiovascularCorner @TrackYourHeart]

Echocardiographic Methods Used in the Assessment of AR Severity

[Aravind Palraj @Rheumat_Aravind]

RF vs Anti-CCP vs ANA

Quick recall:

🔹 RF → Associated with RA, but not specific
🔹 Anti-CCP → Most specific antibody for RA
🔹 ANA → Screening test, not a diagnosis

Key pearls:

❌ RF ≠ RA
❌ ANA ≠ Lupus
✅ Anti-CCP predicts erosive RA

Positive autoantibodies must always be interpreted in the clinical context.

#Rheumatology #MedTwitter #RheumatoidArthritis #Lupus #ANA #AntiCCP #MedicalEducation #ClinicalPearls #FOAMed

[Aravind Palraj @Rheumat_Aravind]

Ever seen ESR 100 with a normal CRP? Or CRP 150 with ESR 15?

ESR and CRP measure different aspects of inflammation and often tell different stories.

Understanding when they disagree can prevent diagnostic errors and improve clinical decision-making.

What is the biggest ESR–CRP mismatch you’ve encountered in practice?

#Rheumatology #MedTwitter #InternalMedicine @docakx @IhabFathiSulima #MedicalEducation #ClinicalPearls #FOAMed #ESR #CRP #Inflammation #RheumatologyPearls

[CardiovascularCorner @TrackYourHeart]

Understanding Diastolic Dysfunction, Made Simple with Echo

This visual shows how the heart’s diastolic function (its ability to relax and fill) changes across different stages of dysfunction , from normal to severely restrictive (Grade 3–4).

Here’s what’s being analyzed:

1️⃣ ECG: for timing
2️⃣ Mitral inflow: the E and A waves show how blood enters the left ventricle
3️⃣ Pulmonary vein flow: tells us about left atrial pressure
4️⃣ Tissue Doppler: checks the movement of the mitral annulus
5️⃣ Color M-mode: shows how quickly blood fills the ventricle (Vp = propagation velocity)

🟢 Normal:
E wave > A wave, good tissue movement, healthy filling
🟡 Grade 1 (Abnormal relaxation):
E < A, slowed filling often in older adults
🟠 Grade 2 (Pseudonormal):
Looks normal, but it’s not E > A again, but due to raised LA pressure
🔴 Grade 3–4 (Restrictive filling):
E ≫ A, very poor ventricular compliance and bad prognosis

[CardiovascularCorner @TrackYourHeart]

Common radiographic signs of congestive heart failure include:
◾Enlarged cardiac silhouette
◾left atrial enlargement
◾hilar fullness,
◾vascular redistribution
◾linear interstitial opacities (Kerley’s lines)
◾bilateral alveolar infiltrates, ◾pleural effusions (right > left).

[MedicoNotes @MedicoNotes]

❤️ AORTIC STENOSIS — High-Yield Clinical Guide

Fixed LV outflow obstruction = pressure overload → LV hypertrophy

⸻

1️⃣ Definition

➊ Narrowing of aortic valve → ↓ systolic outflow from LV

➋ Leads to:
• ↑ LV pressure → concentric hypertrophy
• ↓ cardiac output (late)

⸻

2️⃣ Causes & Risk Factors

➊ Degenerative calcific disease (most common, elderly >70)

➋ “Wear & tear” fibrosis (>65)

➌ Congenital bicuspid valve (younger patients)

➍ Rheumatic heart disease (global cause)

📌 Pearl: Bicuspid valve → early calcification + risk of aortopathy

⸻

3️⃣ Pathophysiology (Key Exam Concept)

➊ Pressure overload → concentric LV hypertrophy

➋ ↓ LV compliance → diastolic dysfunction

➌ ↑ myocardial oxygen demand → ischemia (even without CAD)

➍ Fixed obstruction → inability to ↑ CO during exertion

⸻

4️⃣ Clinical Features

➊ Early: asymptomatic

➋ Classic triad (SAD):
• Syncope (↓ cerebral perfusion on exertion)
• Angina (↑ O₂ demand + ↓ supply)
• Dyspnea (heart failure)

➌ Other:
• Fatigue, ↓ exercise tolerance

📌 Pearl: Symptoms = poor prognosis trigger

⸻

5️⃣ Physical Examination

➊ Harsh crescendo–decrescendo systolic ejection murmur
• Best heard at right upper sternal border
• Radiates to carotids

➋ Pulsus parvus et tardus
• Weak + delayed carotid pulse

➌ Soft/absent A2

➍ Sustained, heaving apex beat

➎ Severe AS:
• Late-peaking murmur
• Paradoxical splitting of S2

➏ Maneuvers:
• ↑ with squatting (↑ preload)
• ↓ with Valsalva/standing

⸻

6️⃣ Diagnosis

➊ Transthoracic echocardiography (gold standard)

➋ Severity criteria:
• Valve area <1 cm²
• Peak velocity >4 m/s
• Mean gradient >40 mmHg

➌ ECG: LV hypertrophy

➍ CXR: may show valve calcification

⸻

7️⃣ Management

➊ Definitive: Aortic valve replacement (AVR/TAVI)

➋ Indications:
• Symptomatic severe AS
• Asymptomatic + LV dysfunction (EF <50%)
• Severe AS undergoing other cardiac surgery

➌ Medical:
• No definitive therapy (bridge only)
• Control HTN cautiously
• Avoid excessive vasodilation

———-

📚 GET the Cardiology Book from our website:
🌐 https://t.co/0LCnBhmZT2

⸻

#medicine #Cardiology #doctorsofinstagram #medicaleducation #USMLE

[Bashaer Gheyath MD FACC 🫀👩🏻‍⚕️ @Bgheyath]

Dr Nishimura 🫀✨This slide never gets old.
RHC hemodynamics — RA, PAWP, RA/PAWP &amp; PAPi — remain the backbone for LV/RV/BiV failure assessment before LVAD.
Elegant physiology, real consequences.
#ICSC2026 #CardioTwitter

[Aravind Palraj @Rheumat_Aravind]

📊 LFT Abnormalities - Pattern Recognition Made Simple

A quick, clinical way to decode hepatocellular, cholestatic, and mixed patterns using:
✔ ALT/AST clues
✔ ALP + GGT behavior
✔ R-ratio
✔ Drug-induced patterns
✔ Red-flag situations you shouldn’t miss
✔ A stepwise flowchart for real-world practice

#LiverTests #Hepatology #InternalMedicine #MedTwitter #Rheumatology #FOAMed @DrAkhilX @IhabFathiSulima #ClinicalPearls #MedEd

[Hematology Review @HematologyTweet]

Anticoagulation strategies in hematologic malignancies with thrombocytopenia

Very nice summarised figure
#ASH25
@Ruah_Mahmoud
@dhoughton

[CardiovascularCorner @TrackYourHeart]

Understanding Diastolic Dysfunction with Doppler Echocardiography😍

[Dr. Martha Gulati ♥️🫀❤️‍🩹🇨🇦 @DrMarthaGulati]

🚨10 electrifying Hot Line sessions and 40+ pivotal trials debuting at #ESCCongress 2025 in Madrid!

‼️Trials targeting long‑held theories related to beta‑blockers post MI, digoxin for #HFrEF, antiplatelets & anticoagulants, novel treatments for Chagas, HCM, hypertension interventions.

Unmissable practice‑changing data!

Have we ever had so many important studies released at one meeting? Does anyone know the answer to this?
#LBCT #Cardiotwitter #CVPrev

[Christian L. Horn, MD, DABOM @ChristianLHorn]

FibroScan interpretation guide using FibroScan cutoffs and recent guidelines!

[Keith Siau @drkeithsiau]

How prokinetics work in the GI tract ⏩💡 #4KMedEd

📸: https://t.co/LIjiUn5s3r

[NephroPOCUS @NephroP]

LV segments and coronary distribution #TEE #POCUS #FOAMed #FOAMcc Courtesy: GM Busato from doi: 10.1007/978-3-030-00859-8_30

1⃣ Segments

[Victoria Delgado @VDelgadoGarcia]

📢New Algorithm for Estimating LV Filling Pressure by Echo:
🔴increase in the number of patients in whom LV filling
pressure can be estimated
🟢only 2 cases of indeterminate LV filling pressure and the majority had a definitive LV filling pattern
https://t.co/4yL751yFFo