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Grand Rapids, MI
Joined February 2010
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ProTrainings retweeted
High vs Low gradient severe Aortic Stenosis approach
Check Gradient & Flow status:
●LOW flow,LOW gradient:
EF<50%:DSE to assess Flow Reserve
EF>=50%:CCT to assess AV calcification
CCT also if no Flow reserve after DSE
●Exclude HIGH flow status in HIGH gradient AS
ProTrainings retweeted
Understanding Intracardiac Blood Flow: Laminar vs. Disturbed Flow
Blood flow in the heart follows distinct patterns, influencing hemodynamics and disease progression.
🔹 Laminar Flow (Top Image) – Smooth, parallel streamlines with uniform velocity, seen in normal arteries and heart chambers. This pattern ensures efficient oxygen delivery and minimizes endothelial stress.
🔹 Disturbed Flow (Bottom Image) – Occurs beyond stenotic valves, regurgitant orifices, or intracardiac shunts. Chaotic vortices and eddies increase turbulence, shear stress, and risk of endothelial damage or thrombus formation.
🔹 Clinical Example: In Aortic Stenosis, blood is forced through a narrowed valve, creating a high-velocity jet. This jet remains laminar until it exits the stenotic orifice, where turbulence forms. Doppler echocardiography detects this as increased peak velocity and pressure gradients, helping assess stenosis severity.
🔹 Another Example: In Atrial Septal Defect (ASD), left-to-right shunting of blood through the septal defect leads to disturbed flow, visible as color Doppler turbulence in the right atrium. This abnormal flow pattern can cause right heart volume overload over time.
Recognizing these flow patterns is crucial in echocardiography and hemodynamic assessments. #Cardiology #Echo #Hemodynamics
ProTrainings retweeted
Who needs a morning coffee when you can start your day with a refreshing walk to work? Happy Walk to Work Day everyone! #walktoworkday spr.ly/6017FTgtd
ProTrainings retweeted
SAN (sinoatrial node)
Precisely locating the starting point of each heartbeat is extremely difficult and has been a challenge for 122 years. The reason is that the P-wave onset in traditional ECGs is a curved corner, and a slight difference amounts to 5–10 milliseconds. Therefore, the unit of measurement with a compass can only be in "seconds," while computer measurements cannot pinpoint it accurately either. Up to now, ECG remains at a rudimentary stage of data values, unable to achieve quantitative diagnosis or meet clinical needs. The heart is an organ that conducts electricity, and undoubtedly, ECG is the most direct targeted indicator of the heart. However, since receiving the Nobel Prize in 1924, it has not been revolutionized. What is recorded is merely a high-frequency trace of the heart's surface (P = atrium, T = ventricle, QRS = pulse wave). What we doctors see is only a superficial electrical trace. Signals such as SCT, various membrane potentials, and ion exchange signals are all completely blank. The correlation between ECG and diseases is simply too far apart.
The SAN (sinoatrial node) is the starting point of each heartbeat and is, of course, of utmost importance because the human heart rate of 60–100 beats per minute is determined by the SAN's working frequency. Electrophysiologists and interventional cardiologists both rely on the SAN, as it is the origin of every heartbeat. The blood supply to the SAN comes from two coronary arteries: the LCx (left circumflex artery) and the RCA (right coronary artery).
**Specialized Cardiac Tissue (SCT) was proposed by Great Hoffman in 1964.
SAN = The source of life, the very place where life resides, and the starting point of every heartbeat.
PhysioSign USA
#ecg #ekg #ep #electrophysiology #medtech #cardiology
ProTrainings retweeted
Did you circle the screen? Or zig-zag? It’s important to have a strategy for managing your blood pressure, too. Talk to your doctor about your numbers and how to keep them in a healthy range.
ProTrainings retweeted
🔴STEMI Critics Are Right. We're Missing Too Many Heart Attacks⤵️ #2025commentary #openaccess
🔹journals.lww.com/em-news/ful…
#CardioEd #Cardiology #CardioX #MedEd #Cardiox #medx #Cardiology #ECG #ekg #EKGInterpretation #Cardiotwitter #cardiotwiteros #medx #meded #medtwitter
ProTrainings retweeted
Is Angioplasty Better Than Thrombolysis in MI?
For STEMI patients, strong evidence favors primary PCI (PTCA) over thrombolysis, reducing mortality, recurrent MI, and stroke.
🔹 PAMI Trial: PTCA lowered in-hospital & 6-month death + recurrent MI.
🔹 GUSTO IIb: Lower rates of death, MI, and stroke at 30 days.
🔹 Meta-analysis: PTCA led to 34% ↓ mortality, 65% ↓ stroke, 91% ↓ hemorrhagic stroke.
📌 Who benefits most from primary PCI?
✅ Cardiogenic shock or CHF
✅ Post-CABG patients (SVG thrombosis)
✅ Contraindications to thrombolysis
⚠️ Limitations: Requires high-volume centers, expertise & cost considerations.
Should all STEMI patients get primary PCI if feasible? ( Comment Your opinion 🙏)
Ref: Grines CL et al., PAMI Trial
#CardioTwitter #STEMI #PCI #Thrombolysis
ProTrainings retweeted
Anatomy of the Bundle of His
The bundle of His is a singular, unidirectional structure located at the atrial outlet, acting as a vital conduit between the atrioventricular node (AVN) and the left and right bundle branches. Its distinct anatomical features highlight its essential role in cardiac conduction, a function that traditional electrocardiography (ECG) cannot capture.
#ecg #ekg #cardiology #ep
ProTrainings retweeted
A healthy workout routine is made up of 4 types of exercise: endurance, strength, balance and flexibility. They don’t all need to be done every day, but variety helps keep the body fit and keeps your exercise routine interesting.
ProTrainings retweeted
🔴Comments on the 2024 ESC guidelines for the management of elevated blood pressure and hypertension⤵️ #2025commentary #OpenAccess
🔹revespcardiol.org/en-comment…
#Cardiology #FOAMed #MedEd #medstudent #paramedic #Cardiology #CardioEd #medtwitter #meded
ProTrainings retweeted
Join @American_Heart & @RubenStuddard on April 2 for National Walking Day!
🌤️ Enjoy the fresh air.
👟 Get some extra steps.
😎 Stress less.
Share YOUR view with us! #WalkingDay
ProTrainings retweeted
M-mode echocardiography at the mitral valve level provides crucial insights into LV function.
- It captures the RV, LV, mitral leaflets, interventricular septum, and posterior LV wall motion.
- The E-point represents early diastolic anterior mitral leaflet motion, while the coaptation point in systole moves anteriorly, paralleling the posterior wall.
- E-point to septal separation (EPSS) is a key measurement—normally minimal.
- Increased EPSS suggests LV dilation, systolic dysfunction, or aortic regurgitation in the absence of mitral stenosis.
A fundamental skill for echocardiographers
Reference: Otto, C. M. Textbook of Clinical Echocardiography.
ALT Here’s an alt text description for the image: "M-mode echocardiography at the mitral valve level. The image displays a time-motion graph of cardiac structures, including the right ventricle (RV), left ventricle (LV), anterior mitral valve leaflet (AMVL), posterior mitral valve leaflet (PMVL), interventricular septum, and posterior LV wall. The upper panel illustrates the ECG tracing, anatomical structures, and the movement of mitral leaflets. The lower panel shows an M-mode echocardiographic image with the AMVL labeled. The E-point represents early diastolic movement of the anterior mitral leaflet, and the E-point to septal separation (EPSS) is a key parameter for LV function assessment." Let me know if you’d like any modifications!
ProTrainings retweeted
Ischemia-Reperfusion Injury in Cardiomyocytes: A Double-Edged Sword
1/ During ischemia, oxygen deprivation halts oxidative phosphorylation, leading to ATP depletion. The cell shifts to anaerobic glycolysis, causing acidosis due to lactate accumulation.
2/ Ionic homeostasis is disrupted—Ca²⁺ overload occurs as Na⁺/Ca²⁺ exchangers attempt to compensate for failing ATP-dependent pumps. This sets the stage for mitochondrial dysfunction.
3/ When blood flow is restored (reperfusion), rapid pH normalization, ROS burst, and further Ca²⁺ influx trigger mitochondrial permeability transition pore (MPTP) opening, leading to loss of membrane potential and ATP depletion.
4/ The result? Mitochondrial dysfunction, contractile failure, and cardiomyocyte death—paradoxically, the very process meant to save the myocardium can also cause damage!
5/ Understanding these mechanisms is crucial for developing therapies to mitigate reperfusion injury in STEMI patients. Targeting ROS, Ca²⁺ handling, and MPTP may be key to cardioprotection.
Ref: Ndrepepa et al., Coron Artery Dis, 2017.
#Cardiology #STEMI #ReperfusionInjury #MyocardialInfarction #Cardioprotection
ProTrainings retweeted
Break the sedentary cycle: National Walking Day can kickstart healthier routines
spr.ly/6010Fp4py
ProTrainings retweeted
🔴 Myocardial Strain Imaging: Theory, Current Practice, & the Future @JACCJournals #Cardiology #CardioEd #echofirst #Strain
ProTrainings retweeted
🔴Brugada Syndrome in Sports Cardiology:⤵️ A 2025 SICSport Expert Opinion Statement #OpenAccess
🔹sciencedirect.com/science/ar…
#Cardiology #FOAMed #MedEd #medstudent #paramedic #Cardiology #CardioEd #medtwitter #meded #CardioTwitter #cardiotwiteros #MedX
