Leadership without proximity is just theater. If you’ve never touched a patient, don’t design a system for those who do. If you’ve never had to make a split-second decision between billing code accuracy and saving a life, don’t tell us how to chart. And if you’ve never

When I talk to doctors who want to leave clinical medicine, it’s never that they hate taking care of patients. They LOVE, taking care of patients. It’s the uncompensated administrative burden, and the Orwellian oversight that deters them away from clinical practice. That’s what

Today in cathlab TOE, CWD in MS. Double envelope signal. What do you think about the faint “MS” signal? Fact or fiction?

I hate to say this. No one is going to care about the financial stresses of physicians. Waiting around for support on an institutional or government level is unwise. Self-advocate. And plan. You can do this. And you have to do this.

A patient with dyspnea. Mitral opening is restricted. Transmitral CW Doppler is obtained.

Another hepatic vein Doppler tracing in a patient with dyspnea. What are the findings?

People think you need an insane resume, credentials, and social proof to stand out. In reality, if you can carry on a normal conversation and you’re willing to show up and do the work, you’re probably ahead of 90% of people. The bar is lower than you think.

A patient with known heart failure. Transpulmonic CW Doppler is obtained. What is the cause of 'biphasic' pulmonic regurgitation as indicated by white arrowheads?

A patient with bioprosthetic aortic valve, now short of breath. CW interrogation across LVOT is shown. Acceleration time 91 msec. What are the implications?

Everyone needs to remember this...

What’s even more wild: the companies that extract the most wealth from the program aren’t even listed on Fortune 500 because they are “non profit” entities.

I’m always cautious with the language of “underutilization” or “overutilization.” Both assume there’s some ideal level of care that we can measure and enforce. But that implies a top-down knowledge we just don’t, and can’t ever have. It turns personal decisions into system

Everyone needs to hear this…

The arterial circle of Vieussens is a rare anatomical variant that can significantly impact cardiac function. This CV Case Journal presents a 21-year-old patient diagnosed w/ classical Hodgkin lymphoma who experienced nonspecific right-sided chest tightness. bit.ly/3HIHD1c

Importance of color Doppler interrogation of the left ventricular cavity: what is the diagnostic clue in this image?

A patient with precapillary pulmonary hypertension and atrial fibrillation. RVOT sampling shown. Why is mid-systolic notching variable?

A patient with dyspnea. History of 'heart surgery' and 'long infection'. What is the characteristic finding?

Does M mode still have a role in hemodynamic assessment? Two elderly patients with dyspnea, mitral M modes shown. What are the findings and implications?

An elderly patient with known severe left ventricular dysfunction is admitted with hypotension. Annular tissue Doppler velocities are low. What are the likely left ventricular filling pressures?

Is M mode still relevant? A patient with history of open heart surgery. M mode obtained in the parasternal short axis view. What is the finding?