Sam

[Davide Capodanno @DFCapodanno]

This State-of-the-Art review provides a comprehensive and practical overview of coronary interventions related to TAVI, encompassing coronary evaluation and physiological assessment, the indications and timing of percutaneous coronary intervention before and after valve implantation, and strategies for managing coronary obstruction. https://t.co/yojhLj5N5p

[CardiovascularCorner @TrackYourHeart]

LV Torsion: A Powerful Marker of Systolic Function

Definition
Left ventricular (LV) torsion (or twist) is the heart’s wringing motion during systole: the apex rotates counterclockwise while the base rotates clockwise (viewed from the apex). This reflects the helical architecture of subendocardial and subepicardial myocardial fibers.

LV systolic mechanics occur in 3 planes:
- Radial (SAX) contraction: contributes to pressure generation
- Longitudinal (LAX) shortening: contributes to stroke volume
- Torsional deformation: enhances systolic efficiency and pressure development

How is torsion measured?
Using speckle-tracking echocardiography, torsion is calculated as the rotational difference between apex and base (degrees). Rotational velocity (deg/sec) can also be measured.

Why does it matter?
Torsion is a sensitive marker of myocardial performance and may detect dysfunction before EF falls.

Seen in:
🔵 Early ischemia
🔵 MI
🔵 HCM / DCM
🔵 HFpEF / HFrEF

[AbdAllah Othman @CardioBeat_]

https://t.co/s2zN6XfaO8
Excellent ECG Cheat Sheet HD @ManualOMedicine
#meded #ecg

[AbdAllah Othman @CardioBeat_]

https://t.co/itEeUHKifn
📉Understanding myocardial infarction (MI) localization.

This chart correlates specific EKG lead ST-elevations with their corresponding occluded coronary arteries- the LAD, LCx, or RCA and the affected myocardial territories.
#Cardiology #STEMI #EKG

[CardiovascularCorner @TrackYourHeart]

Commonly Misunderstood ECG Signs With Drawn-Out Analogies

[CardiovascularCorner @TrackYourHeart]

Beta blockers one pager

[CardiovascularCorner @TrackYourHeart]

Echocardiography in Valve Disease: Simplified Criteria for Daily Practice

[JACC Journals @JACCJournals]

#JACCIMG provides echo-anatomical correlations, identifying key tricuspid valve morphological features to optimize #echofirst #TEER guidance in challenging cases. https://t.co/p1C2sXtaLj

#cvImaging #vhdTR @Cristinabasso64 @hahn_rt @drmaisano

[CardiovascularCorner @TrackYourHeart]

ECG Localization of Myocardial Infarction: Linking Leads to Coronary Occlusion

[CardiovascularCorner @TrackYourHeart]

Echocardiographic assessment of the right ventricle
Credit: @bebulwer

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

🫀In cardiogenic shock, we still focus heavily on MACROcirculation:
📉 blood pressure
📉 cardiac output
📉 LVEF
📉 vasopressor dose

But what if the real battle is happening deeper?

🩸 At the microcirculatory level.

This excellent ATS viewpoint highlights one of the most important evolving concepts in shock physiology:

⚠️ normalization of macrocirculation does not necessarily mean restoration of tissue perfusion.

Despite advances in cardiogenic shock management, mortality remains >40%.

Even more striking, up to 45% of deaths occur in patients with normalized cardiac index.

That disconnect may be explained by persistent:
🩸 microvascular dysfunction
🩸 impaired capillary perfusion
🩸 endothelial dysfunction
🩸 tissue hypoxia despite “acceptable” hemodynamics

The review reinforces that: Microcirculation is not a passive bystander.

It may be a central driver of:
• organ dysfunction
• lactate persistence
• shock progression
• mortality

Particularly interesting is the emphasis on simple bedside tools.

We often think microcirculation requires advanced devices, yet:
📌 capillary refill time (CRT)
📌 mottling
📌 ΔPCO₂
📌 lactate trends

still carry strong prognostic value.

A CRT >3 seconds at ICU admission was associated with worse outcomes, and combining CRT with the CardShock score achieved an impressive AUC of 0.93 for outcome prediction.

The article also reviews modern technologies:
🔬 handheld vital microscopy
🔬 sublingual microcirculation imaging
🔬 NIRS
🔬 laser Doppler assessment

bringing “real time” bedside microcirculatory monitoring closer to clinical practice.

One of the strongest physiological messages:

⚠️ Shock is not only about flow. It is about effective tissue level oxygen delivery.

The review beautifully summarizes the four major mechanisms of microvascular dysfunction:
• heterogeneity
• hemodilution
• congestion
• edema

Particularly relevant for intensivists:
📌 venous congestion itself may worsen microvascular flow
📌 elevated filling pressures impair driving pressure
📌 edema increases oxygen diffusion distance

This is highly relevant in:
• advanced heart failure
• VA ECMO
• mixed shock states
• fluid overloaded patients

Another important takeaway: Persistent microcirculatory dysfunction after VA ECMO initiation was associated with increased mortality, even when macrocirculation improved.

Perhaps the key message of this paper is:

🩸 Microcirculation should no longer be considered a secondary endpoint in cardiogenic shock.

It may become one of the most important physiological targets of the next decade.

📖 Merdji H, American Journal of Respiratory and Critical Care Medicine. 2026, 212(3), 410–413 https://t.co/81Zp3aj274.

[Zain Khalpey, MD, PhD, FACS @ZainKhalpey]

Recognizing lead-to-artery patterns can rapidly localize myocardial infarction and guide urgent intervention when every minute matters.

Bookmark this one.

@MattersoftheH14

#MedTwitter #Cardiology #ECG #STEMI

[Zain Khalpey, MD, PhD, FACS @ZainKhalpey]

Right ventricular failure can rapidly progress from congestion to multisystem dysfunction.

Early recognition of RV strain, rising venous pressures, and worsening hemodynamics is critical in advanced cardiac care.

@MattersoftheH14

#Cardiology #HeartFailure #MedTwitter #CriticalCare

[Ritika Tuli @RitikaTuliMD]

🫀 CardioNugget

Disproportionate vs Proportionate Secondary MR

➡️ LVEDV (size) vs EROA (severity)

🔴 Disproportionate MR (COAPT)
Smaller LV, high EROA
MR out of proportion to LV dilation
👉 MR is a driver of HF
✅ TEER → benefit

⚪ Proportionate MR (MITRA-FR)
Larger LV, moderate EROA
MR matches LV dilation
👉 MR is a bystander
❌ TEER → limited benefit (focus GDMT)

🟢 Key Takeaway
👉 Same EROA ≠ same disease
👉 Always interpret MR relative to LV size

💡 Memory line:
“Out of proportion → fix the valve
In proportion → fix the ventricle”

#CardioNuggets #MedED #TEER #CardioMed

[Abdulla A. Damluji, MD, PhD @DrDamluji]

Efficacy of dual antiplatelet therapy for three months versus 12 months after coronary artery bypass grafting: multicentre, double blinded, randomised controlled trial: @bmj_latest

🥸 Top CABG-collaborative group.

👇👇👇👇

[CardiovascularCorner @TrackYourHeart]

Acute MI is not always STEMI.

A major 2025 review highlights why relying only on classic STEMI criteria can miss dangerous coronary occlusions.

A thread on OMI (Occlusion Myocardial Infarction): 🧵

[CardiovascularCorner @TrackYourHeart]

Pathophysiology of Right Ventricular Failure

[EuroIntervention @EuroInterventio]

Recurrent TR after T-TEER can limit TTVR when central clips obstruct valve delivery. The ELASTA-T technique enables controlled leaflet detachment to facilitate TTVR. Read our step-by-step expert review on this novel strategy. #Cardiology #tricuspidvalve

🔗https://t.co/HwbLBYhn19

@fiorenzofio
@TRheude
@StarneckerF
@XhepaErion
@MichaelJoner3

[Maxinomics @maxinomics]

Here's the full video — why a small town in North Carolina is America's ace in the hole, and the reason China will always depend on the US for chips

[Tony Breu @tony_breu]

1/14
Why can't you use direct oral anticoagulants (DOACs) in patients with mechanical valves (MVs)?

DOACs have been one of the most important advances in my career. And yet, the presence of a MV is one of the few contraindications.

The reason highlights the unique nature of thrombus formation in those with a MV and provides insights into the evolution of human hemostasis.