Jangan buat janji saat bahagia, dan jangan buat keputusan saat marah.

Pulmonary arterial pressure in VA #ECMO for patients with acute cardiogenic shock? 🔍 @ELSOOrg Registry analysis 🖥️ invasive hemodynamic status assessed at 24h PAC use alone not associated with lower mortality, but helped assess hemodynamic variables associated with lower mortality. Higher PAD at 24h significantly associated with graded increase in mortality, including if concomitant LV mechanical unloading (no significant difference in ealry PAD according to concomitant LVMU modality). Early on-support PAD potentially important hemodynamic marker during VA #ECLS. 🖇️ bit.ly/4hH8ysu

#ArtificialIntelligence in cardiovascular medicine: a practical guide for clinicians and researchers ow.ly/BtJ150ZUN5Z #EHJDigital #MachineLearning @BruiningNico @rafavidalperez @fwasselbergs @rbcasado

This video demonstrates one of the crucial tests used in the evaluation of patients with advanced heart failure. Can you identify the test? A. CPET B. Exercise stress ECG C. Stress echocardiography D. Right heart catheterization

ECG From Scratch #46: Hyperacute T Waves A STEMI does not always begin with obvious ST elevation. Sometimes the earliest ECG clue is a hyperacute T wave (HATW), reflecting acute coronary occlusion before conventional STEMI criteria become obvious. What should you look for? Hyperacute T waves tend to be: ◻️Broad, bulky and disproportionately large relative to the QRS ◼️More symmetric than normal T waves ◻️Prominent in anatomically contiguous leads ◼️Often dynamic, changing rapidly with evolving ischemia The key is not simply a tall T wave. Normal variants, early repolarization, hyperkalemia and other conditions can produce prominent T waves. A major 2025 JACC: Advances study developed and validated an objective HATW score based on two features: 1️⃣ Magnitude: T-wave area relative to QRS amplitude 2️⃣ Symmetry: T-wave peak-to-end time relative to the time from T-wave onset to peak The proposed ECG threshold was 2 contiguous leads with an average HATW score ≥0.70. Among patients without diagnostic STEMI criteria, the score achieved: 98.4% specificity 20.7% sensitivity 47.4% PPV LR+ 12.54 Importantly, among patients without STEMI criteria who had a positive HATW score, 84% had a culprit lesion causing acute MI in this study. But there is an important limitation: HATW is not yet a replacement for clinical assessment, serial ECGs or troponin. The study excluded patients with QRS ≥110 ms, and the sensitivity was low. The score therefore should be viewed as a high-specificity warning sign, not a rule-out test. Current ACS guidance emphasizes that a nondiagnostic initial ECG does not exclude ACS and that serial ECGs are important when suspicion persists. The learner's takeaway: Do not wait for dramatic ST elevation. In a patient with ischemic symptoms, a new, bulky, symmetric T wave in contiguous leads, especially when disproportionate to the QRS, may be the earliest ECG fingerprint of an occluded coronary artery. Recognizing the pattern early can matter because time to reperfusion matters. Reference: jacc.org/doi/10.1016/j.jacad…

✍️🫀Myocardial bridging is increasingly recognized as a cause of ischaemia with non-obstructive coronary arteries. This review provides an updated guide to prevalence, diagnosis, treatment, and key controversies, highlighting areas of uncertainty in clinical management.

Right heart catheterization is recommended in patients with advanced HF, as part of the evaluation for heart transplantation and durable MCS. ESC 2026

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facebook.com/share/r/14rKqEn… ⚡️RBBB vs. LBBB: Anatomy dictates vulnerability. RBBB: a long, thin, unprotected cord—readily disrupted by focal injury (ischemia, trauma). LBBB: a resilient, diffuse fan—usually signals extensive structural disease or dyssynchrony. #EPeeps #Cardiology

♦️عوامل تؤثر على دقة نسبة الألبومين / الكرياتينين في البول ACR و تؤثر على فلترة الكلى eGFR في تقييم وظائف الكلى و شنو الفحص الأدق في مثل هالحالات ؟ 🔺نسبة الألبومين إلى الكرياتينين في البول : _ كتلة العضلات المنخفضة : ممكن ترفع ACR بشكل غير صحيح؛ لأن كمية الكرياتينين قليلة _ كتلة العضلات العالية : ممكن تخفض ACR بشكل غير صحيح _ البول المخفف أو المركز : قد يؤثر على دقة النسبة _ ارتفاع حرارة الجسم ( الحمى ) ، التمارين الرياضية، والتهابات المسالك البولية UTI : قد تسبب ارتفاع مؤقت في ACR 🔺 فلترة الكلى eGFR : _ قد يكون غير دقيق في حالات اختلاف كتلة العضلات، خصوصاً ضمور العضلات المرتبط بالتقدم في العمر sarcopenia _ يتأثر كذلك في حالات تليف الكبد، السمنة، وبتر الأطراف _ بعض الأدوية مثل تراميثوبريم Trimethoprim تقلل إفراز الكرياتينين : فتسبب ارتفاع في الكرياتينين في الدم وانخفاض في فلترة الكلى eGFR دون انخفاض حقيقي مماثل في ال GFR _ في حالات انخفاض كتلة العضلات قد يعطي تقدير أعلى من وظيفة الكلى الحقيقية 🔺سيستين سي Cystatin C : _ يكون أكثر فائدة لما تكون كتلة العضلات غير طبيعية، لكنه مو خالي من العوامل اللي تأثر عليه _ قد يتأثر بـ الالتهاب، التدخين، السمنة، واضطرابات الغدة الدرقية 🔺 إذا كانت النتائج غير متوافقة مع الحالة السريرية : _ ما نعتمد على ACR أو eGFR وحدهم _ نعمل eGFR باستخدام Cystatin C أو المعادلات المدمجة Creatinine + Cystatin C _ وفي الحالات التي نحتاج فيها قياس أدق لوظيفة الكلى، ممكن نعمل directly Measured GFR؛ جمع البول 24 ساعة فيُستخدم في حالات قليلة، لكنه مو شرط يكون أدق من المعادلات الحديثة

✍️Resistant HT/2026 ACC🫀

#WednesdayRead The coronary circulation: pathophysiology, imaging, and role of preventive interventions ow.ly/Ulir50ZUQcH #EHJ

🗞️ Determinants and associations of health-related quality of life with mortality in acute and chronic heart failure: findings from the ESC HF III Registry @ESC_Journals @GiuseppeGalati_ @AmrAbdin10 @HanCardiomd bit.ly/4j5XZBI

🩺 STEPWISE ABG INTERPRETATION (6 STEPS) ( Ref: ATS 2025) ✅ ABG GOLDEN RULES ✔ Always follow the 6 steps ✔ Normal pH ≠ normal ABG ✔ Compensation never over‑corrects ✔ Correct AG for albumin ✔ Use delta–delta routinely ✔ Interpret with clinical settings. Saleem N. Hamilah #RespiratoryCare #respiratorytherapists #respiratorytherapist #respiratorycarespecialist #respiratorytherapy #mechanicalventilation

Recognition of POTS is rising, but gaps in diagnosis, management and access to specialized care remain. During Dysautonomia Awareness Month, explore new survey findings and expert insights in Cardiology magazine: bit.ly/4hE0Y1F #POTS #CardiologyMag

In cardiogenic shock requiring vasopressor support, which agent is preferred according to the 2026 ESC guideline? A. Dopamine B. Epinephrine C. Norepinephrine D. Vasopressin

A patient with long-standing mitral stenosis undergoes ECG evaluation. What's the diagnosis?

🚨 Think all T-wave changes look the same? Think again! 📈 Peaked T waves? Think hyperkalemia. Broad, bulky T waves? Don’t miss early MI!

What’s the future of #CAD #pharmacotherapy? This review details novel lipid‑lowering agents, anti‑inflammatory therapies, metabolic modulators, and precision medicine approaches, charting a path toward safer, more effective CAD treatments. #Cardiology #CVIA #OpenAccess: cvia-journal.org/advances-in…

A lot of #medicalstudents start #ECGs by memorizing patterns before they know where the block actually is. Learn the pathway first: SA node → AV node → His → RBB/LBB → fascicles → Purkinje. Then the ECG starts to make sense. #MedX #MedTwitter

Decompensated HF: High-Yield Numbers to Memorize The 2026 ESC Guidelines contain several important thresholds: 1️⃣ SpO₂ <90% or PaO₂ <60 mmHg: oxygen therapy 2️⃣ RR >25/min + SpO₂ <90% + respiratory distress: consider NIV 3️⃣ uNa⁺ ≥70 mEq/L at 2 h: satisfactory diuretic response 4️⃣ Urine output ≥100 mL/h during the first 6 h: satisfactory response 5️⃣ SBP >110 mmHg: IV vasodilators may be considered 6️⃣ SBP <90 mmHg + hypoperfusion despite standard treatment: inotropes may be considered 7️⃣ 40 mg IV furosemide: usual starting dose in diuretic-naïve patients 8️⃣ 2× usual oral loop-diuretic dose: consider when already taking loop diuretics 9️⃣ After initial stabilization: initiate an SGLT2 inhibitor in hospital Quick memory: 90: oxygen threshold 70: urinary sodium 100: urine output 110: vasodilator threshold Based on the 2026 ESC Guidelines for the management of heart failure.