🔥The 9th Round of Easy Loan, Earn $40 Reward is in progress❗️ ⏰ Promotion Period: January 15th - Feburary 15th, 2025 👉 Register now and check more details at gate.io/campaigns/358

When clinical suspicion for ACS is high, even if the initial EKG is nondiagnostic, serial EKGs should be performed to evaluate for potential ischemic changes over time (Class I). #CVBoardPearl #MedX

CK-MB is no longer utilized in evaluation of acute myocardial ischemia if troponin is available (Class III). High-sensitivity troponin is the preferred biomarker. It allows rapid detection/exclusion of myocardial injury and increases diagnostic accuracy. #CVBoardPearl #MedX

ETT Contraindications (per chest pain guideline): 1. Abnormal ST on baseline EKG (e,g, WPW, LBBB) 2. Cannot exercise 5 METs / Unsafe for treadmill 3. Active ACS within 2 days 4. Decomp. CHF 5. CHB, VT 6. Sxs Severe AS 7. PE, Aortic Dissection, Myocarditis #CVBoardPearl #MedX

Stress Nuclear Contraindications (Beyond ETT contras): 1. VT, high-grade AV block, sinus brady<45 bpm 2. SBP <90 mmHg 3. Bronchoconstrictive/Bronchospastic dz 4. Caffeine w/in 12 hours 5. SBP ≥200/110 6. If Contraindication to Vasodilator, avoid vasodilator #CVBoardPearl #MedX

Artie’s all packed—are you? 🎒 📱 #ACC25 App ✅ Pro Tip: Make sure to download the app & set ⏰ for your must-attend sessions! 💻 Laptop/Notebook ✅ 👟 Comfy Shoes ✅ 💙 ACC Blue for March 31 ✅ ⚡️ Excitement & Energy! ✅ 4️⃣ days to go! What's your must-have for ACC.25? 🤔

Contraindications to Stress Echo (beyond ETT contras): 1.Poor echo windows 2.Decomp CHF, Resp failure, severe COPD, PE, Severe pHTN 3.BP ≥200/110 -Dobutamine contraindications: severe AS, AV block -Atropine contraindications: MG, narrow-angle glaucoma, etc. #CVBoardPearl #MedX

Contraindications to Stress CMR: 1. GFR (<30 mL/min/1.73 m2) - due to gadolinium 2. If vasodilator contraindicated 3. CIEDs not MR conditional or affecting scan quality/interpretation 4. Significant claustrophobia 5. Caffeine use within past 12 h #CVBoardPearl #MedX

Cardiac CTA Contraindications: 1. Iodine Contrast Allergy 2. Can't follow breath-hold instructions 3. Clinical instability (e.g, decomp CHF) 4. Advanced renal dz (by local protocol) 5. If Beta-Blocker contraindicated & no alt way to lower HR 6. Sig Arrhythmia #CVBoardPearl #MedX

So sad to be missing #ACC25 this year, but I'll see you all at #ACC26 next year! Looking forward to leaning from everyone's tweets this weekend! #CardioX

Okay you asked for a TweetUp or whatever we should call it now. So for those of you that don’t have plans Sunday come and mingle with your friends IRL Please RT and share. All welcome- Just pay your tab & til the bartenders well 👏🏽♥️ Talk to someone you never met before #ACC25

One of the most important trials at American College of Cardiology #ACC25 ! Compared fluid restriction to liberal approach in #HeartFailure. Why? This affects individuals w/HF EVERY DAY! ✨No benefit of Fluid Restriction ✨No HARM for liberal fluid intake ✨Improved QOL in liberal fluid intake

#ACC25 Day 2, here is the summary of today’s trials (I haven’t included the follow-up extensions of Evolut Low Risk, Triluminate, and FAME 3). Today, I counted at least 2 NEJM, 4 Lancet, 1 Nature, 1 JAMA, 1 Circulation, and 1 JACC. 1. MIGHTy-Heart = In-home paramedic visits for

#TipsForNewDocs Before ordering a test, have a plan for a normal, abnormal, or indeterminate result. If this thought experiment demonstrates the test won’t change management, or if you don’t know how to interpret/act upon all possible results, don’t order it. #kittlesonrules

1/ 🚨 NEW #5Pearls: Lp(a) and ASCVD Risk Lp(a) is a lipoprotein similar to LDL but a different entity! Lp(a) has important implications for cardiovascular disease ‼️ 🖥️: coreimpodcast.com/2025/04/02/lpa… Sponsor: Freed AI

In patients whose chest pain or chest pain equivalent symptoms are unchanged, prior testing has a "warranty period" that can reduce unnecessary repeat testing. 🫀 Cardiac CTA: No stenosis or plaque - 2 years 🫀 Stress Testing: Normal stress test - 1 year #CVBoardPearl #MedX

Definition of Low Risk Chest Pain by hs-Troponin: 🫀Initial hs-trop < assay limit of detection or "very low" threshold 🫀Initial hs-trop & both 1h,2h delta < assay “low” thresholds Only rule out with a single negative hs-cTn if sxs started > 3 h before arrival #CVBoardPearl #MedX

HEART PATHWAY is a validated clinical decision score to risk-stratify patients presenting with chest pain: Low: HEART score <3, Neg 0, 3-h cTn, Neg 0, 2-h hs-cTn Int: HEART score 4-6 High: HEART score 7-10 Goal: ↑ ED discharge w/o missing 30-d or 1-y MACE #CVBoardPearl #MedX

🫀 Low-Risk Chest Pain: 30-day risk of death or MACE is <1%. Determine true risk based on a validated clinical decision pathway, e.g. HEART score. 🫀Truly "low risk" patients can be discharged home without admission or urgent cardiac testing (Class IIA). #CVBoardPearl #MedX

Int-risk patients do not have significant troponin elevations and warrant cardiac testing. Consider inpatient or obs monitoring with a chest pain protocol. These patients need a bedside echo to evaluate LV function, valves, wall motion, & pericardial effusion. #CVBoardPearl #MedX

Hi all. I will be taking a brief hiatus from Twitter for the next couple of weeks to focus on my personal life! #CVBoardPearl #MedX