Quickly estimating CVP using IVC ultrasound
#POCUS #Echofirst

IVC diameter + respiratory collapse
🔹<2.1 cm + >50% collapse = 3mmHg
🔹>2.1 cm + <50% collapse = 15mmHg
🔹Other combo = 8mmHg

ACE inhibition in patients with heart failure and reduced ejection fraction? A cornerstone of heart failure management, established by this historic landmark trial. SOLVD Trial, NEJM 1991 ♥️

Mediterranean diet for primary prevention of cardiovascular disease? A diet rich in fruits/legumes/nuts/olive oil, with CV benefit demonstrable against a low fat diet in this landmark trial. PREDIMED Trial, NEJM 2013 ♥️

Recall that CAD is a constantly changing ACTIVE process — with calcification itself dependent on active, regulated osteogenic pathways via osteoblast- and osteoclast-like cells

Plaque can shift to become vulnerable, to stable, and back to vulnerable plaque which can result in MI

A starter breakdown for CABG vs PCI 🤜🤛

🔑 points:
1️⃣ PCI in stable CAD relieves symptoms, but does not improve survival or reduce risk of MI

2️⃣ CABG in stable CAD can improve survival and reduce risk of MI, but is dependent on the severity of CAD, EF and presence of diabetes

Catheter ablation in end-stage heart failure? A population not previously studied in this context, having been excluded from prior large trials. This trial showed the importance of sinus rhythm maintenance in this vulnerable population. CASTLE HTx Trial, NEJM 2023 ♥️

Aging changes 🫀
- E/A reversal
- LV thickness ⬆️
- LA enlargement
- aortic diameter ⬆️
- aortic valve thickening
- MAC
- basal septal hypertrophy

Aging changes 🫀
- E/A reversal
- LV thickness ⬆️
- LA enlargement
- aortic diameter ⬆️
- aortic valve thickening
- MAC
- basal septal hypertrophy

Cardioprotective effects of SGLT inhibition 🫀

Mechanisms of action 📚

Choice of anticoagulation in patients with mechanical valves? DOACs are routinely used in venous thromboembolism and nonvalvular atrial fibrillation – but are proven INFERIOR to warfarin in patients with mechanical valves (or valvular afib☝️). RE-ALIGN Trial, NEJM 2013 ♥️

Colchicine for pericarditis? 3 months of colchicine with 1-2 weeks of high dose NSAID is now standard of care for acute pericarditis, established by this landmark trial. ICAP Trial, NEJM 2013 ♥️

A new standard for cardiac resynchronization therapy? This trial showed both improved EF and symptoms via left bundle pacing when compared to traditional resynchronization (simultaneous pacing RV and coronary sinus). LBBP-RESYNC Trial, JACC 2022 ♥️

Despite the data.. i rarely ever see clinicians do this

Cardiac Trials Dr. Deepak L. Bhatt Gregg W. Stone MD CardioNerds