@eodanielmd

Cardiovascular disease fellow @Wayne cardio | former CMR @ Trinity Health Ann Arbor | Interested in interventional/critical care card + MedEd #cardiorounds

 United States
Joined July 2025
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34Media
Starting a #cardioround series. Will aim for 1-2 tweets per day.
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🫀Ischemia testing in anomalous coronaries •Acute ischemia is mainly 2° dynamic compression during exertion • Exercise/dobutamine reproduces it; vasodilators often miss it • ➕ adenosine FFR is reliable, but a ➖one doesn't r/o ischemia • Perfusion 📷 preferable to WMA
https://www.annalsthoracicsurgery.org/article/S0003-4975%2818%2931837-X/fulltext

ALT https://www.annalsthoracicsurgery.org/article/S0003-4975%2818%2931837-X/fulltext

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Amiodarone & TdP🫀 • Potent class III IKr blocker → marked QT prolongation, yet TdP risk is relatively low • Why? It doesn't ⬆️transmural dispersion of repolarization, the substrate driving TdP with other class IA/III AAD • Also blocks late Na⁺ current → suppresses EAD
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🫀 Persistent ST elevation after STEMI reperfusion? Think LV aneurysm: • Sum ST >4 mm at discharge after primary PCI → LV aneurysm in ~30% • Linked to larger microvascular damage & higher wall-motion score index • Classic chronic pattern:STE + Q waves + small ⬇️/⬆️T waves
https://www.ecgstampede.com/glossary/left-ventricular-aneurysm/

ALT https://www.ecgstampede.com/glossary/left-ventricular-aneurysm/

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🫀Dual AV nodal non-reentrant tachycardia ("double fire") • A single P wave conducts down BOTH fast and slow AV nodal pathways at once → 2 QRS per atrial beat • Requires: big fast–slow conduction gap + retrograde block in both pathways (no reentry) #cardiorounds
Image: JAMA https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2768647?utm_source=openevidence&utm_medium=referral

ALT Image: JAMA https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2768647?utm_source=openevidence&utm_medium=referral

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🫁 Acute vasoreactivity testing in PAH : • Done at RHC in idiopathic/heritable/drug-associated PAH • Use inhaled NO or inhaled iloprost • Positive = mPAP ↓≥10 mmHg to ≤40 mmHg with preserved/increased CO • <10% respond → trial high-dose CCB #cardiorounds
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🫀 Ischemic cascade : Temporal sequence of events with ischemia • Perfusion mismatch • Diastolic dysfunction • Systolic/wall-motion ↓ • ECG 🔺 • Angina (may be silent) Earlier step → more sensitive test: perfusion imaging > stress echo > exercise ECG #cardiorounds
https://www.cardioguide.ca/stable-cad-app/

ALT https://www.cardioguide.ca/stable-cad-app/

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🫀 Adenosine in transplanted hearts (TH) • TH are DENERVATED → loss of vagal/sympathetic tone + upregulated AV-nodal adenosine receptors leads to supersensitivity (3–5x) • So the usual 6 mg can cause profound AV block or asystole • Start 25 μg/kg (max 1.5 mg if ≥60 kg)
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On-X AV🫀 • Only mech valve FDA-OK'd for ↓INR 🎯 1.5–2.0 + low-dose ASA, start 3mo post-op • Allows laminar, low-turbulence flow • High-risk/+RF: keep INR 2–3 • PROACT (Ao): ↓intensity warfarin → ↓🩸, no ↑TE • PROACT Mitral: failed NI → MV On-X needs std INR
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🫀 ATTR diagnosis: r/o AL first • AL is a plasma-cell CA — a missed diagnosis can be fatal (untreated survival <6 mo) • AL lights up on PYP too (~20% of scans) • So grade 2–3 uptake confirms ATTR only if the AL screen is negative. • ➕ IFE/FLC→ biopsy + mass-spec
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🫀 Suicide LV after TAVR •Afterload drops → small, hyperdynamic LV obliterates its cavity → dynamic obstruction + shock. •At risk: women, small LV, septal LVH, high EF/gradient. •Treat: fluids, phenylephrine, β-blocker. STOP inotropes.
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Emmanuel Daniel retweeted
Ron Filipkowski
@RonFilipkowskiOct 1
The reason why Trump is president is because the US has way too many people like this.
Aaron Rupar
@atruparOct 1
Trump fans in Oklahoma: "He's gonna fix it. Believe in him, stand strong ... all the abortion, it's evil. That's one thing that Trump stands for is us Christians. We're being killed everywhere. I want to see two people -- Trump and Jesus ... we do not want Muslims taking over ... I have horrible thoughts. I don't think they should be here. This isn't their country ... they need to pack up their stuff and go back to where they came from."
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Why we don't graft directly to the LCx🫀 • It's buried deep in the AV groove, hard to expose • Sits mm from the coronary sinus & mitral annulus — injury risk • Awkward 📐->kinking. OM is usually targeted • Small LCx? Often skip it —competitive flow can threaten LIMA-LAD
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Some additional insights
George Tolis@georgetolisjrSep 30
Replying to @CristianRosuMD
Completely empty/drained heart, counterclockwise rotation and gentle traction toward the diaphragm. Paradoxically, the circumflex looks like it is headed toward the left pleura (not north/south like the OMs or the LAD). Make sure it is perfectly hemostatic-you won’t see it again.
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