Benigno Valderrábano Salas @MDBeni

GLP-1 receptor agonists are increasingly used to treat type 2 diabetes and obesity, and trials have shown reductions in cardiovascular risk and slowing of kidney failure. Adverse events are mostly gastrointestinal. Read the full review: nej.md/4sUFlys

We've not understood why SGLT2 drugs (like empagliflozin, Jardiance) have marked protective heart benefit. Today @ScienceMagazine a mechanism unraveled for improving cardiac metabolism and fuel efficiency science.org/doi/10.1126/sc…

🫁 Mechanical ventilation is easier when we stop thinking in “modes” Modern ventilators offer an increasing number of modes, acronyms, algorithms, and manufacturer-specific names. At the bedside, every mechanical breath can be reduced to four questions: 1. What starts inspiration? The breath may be initiated by time or by the patient's own inspiratory effort, detected through pressure, flow or even diaphragmatic electrical activity with NAVA. 2. What does the ventilator control during inspiration? In volume control, we determine flow and tidal volume while pressure becomes dependent on respiratory mechanics. In pressure control, we determine inspiratory pressure while flow and tidal volume become dependent on resistance, compliance and patient effort. 3. What ends inspiration? Cycling may occur according to time, volume or flow. 4. What happens during expiration? Usually nothing active: expiration is driven by elastic recoil against airway resistance and PEEP. But when expiratory time is insufficient relative to the respiratory time constant, incomplete emptying produces gas trapping and intrinsic PEEP. This simple framework makes many apparently complex ventilator problems easier to understand. Peak inspiratory pressure contains both the pressure necessary to overcome resistance and the pressure required to distend the respiratory system. During an inspiratory hold, flow becomes zero, the resistive component disappears, and plateau pressure approaches the static elastic recoil pressure of the respiratory system. One step further separates the pressure decay during an end-inspiratory occlusion into P0, P1 and P2. P0 − P1= airway resistance P1 − P2 = viscoelastic stress relaxation P0 − P2 = total respiratory system resistance This is a physiological reminder that the pressure waveform contains considerably more information than simply “peak” and “plateau.” The same principle applies to compliance. Airway pressure distends both lung and chest wall. In obesity or intra-abdominal hypertension, a greater fraction of airway pressure may be transmitted to the chest wall. In another patient with a compliant chest wall and severely injured lung, the same airway pressure may generate a much higher transpulmonary pressure. Same ventilator pressure. Different lung stress. Different physiology. And perhaps the most useful concept for understanding obstructive ventilation is the time constant: High resistance or high compliance means slower emptying. If expiratory time becomes shorter than the time required for the respiratory system to empty, the next breath begins before the previous one has finished. The result is dynamic hyperinflation and intrinsic PEEP. Once these principles are understood, ventilator modes become much less intimidating. Reference 📚 Wattley B, Camporota L. (2026). JICS education: mechanical ventilation – physiology, mechanism and modes. Journal of the Intensive Care Society. doi.org/10.1177/175114… #

EchoBridge Pearl 19 Differentiating True vs False Lumen in Aortic Dissection #POCUS #AorticDissection

There is a hierarchy in diastolic function parameters. Not all parameters have the same power. E/A < 0.5 is always grade 1 with NL DFP. E/A around 0.6 most likely NL DFP. E/e' of 8 says normal diastolic filling pressure. Since the patient has SOB, I would exercise him with filling pressure assessment. PV Doppler pattern wins over LARS when there is a discordance.

Brian Wood @bwoody58

2 months ago

A diastology case. 81 F SOB with SOA. LV EF normal no LVH in SR. BMI 44 e’ lateral 9 & septal 6 E/e 8 PV S/D=1.37 E/A=0.62 TR 2.85 LARS 20% Biplane LAVI 36 ml/m2 Normal IVC If i correct LAVI to BSA for BMI 30 its 44 ml/m2 Whats the LAP normal or high 🤷‍♂️ if i put in

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📢 New in the European Heart Journal #EACVI/@escardio Council of Cardiology Practice Clinical Consensus Statement on cardiac CT in everyday practice. 🫀 This is particularly for the non-CT expert — a practical guide to help clinicians understand: 🔍 What can cardiac CT detect and assess? 📊 How can CT help with patient risk stratification? 📝 What clinical question/information should be included in the referral? 📄 What should you look for in the CT report? And importantly, cardiac CT is much more than coronary imaging — with applications across valvular disease, cardiomyopathies, cardiac masses, the great vessels and congenital heart disease. The aim: to make cardiac CT findings easier to understand and translate into everyday clinical decision-making and patient care. 🔗 academic.oup.com/eurheartj/adva… #CardiacCT #CardiacImaging #Cardiology #EACVI #ESC @gpontone1 @StefanoNistri @drkharabish @JRodriPalomares @Sarah_Moharem @denisamuraru @s_e_petersen @VictoriaDe32503 @ehj_ed academic.oup.com/eurheartj/adva…

Today’s #echofirst illustration: RVOT Doppler (pulsed wave). In #POCUS #NephPearls practice, we use RVOT VTI to assess forward flow instead of LVOT VTI when apical views are suboptimal, and RVOT Doppler can also give us a sense of pulmonary vascular resistance. See the thread below 👇🏼for more pearls and pitfalls on acceleration time and systolic notching.

A very good thinking! Mayo Clinic Echo Lab now recommends measuring a single highest velocity of aortic valve and LVOT to determine AV gradient and AVA. Hope this will become a part of future VHD guideline @ottoecho

Leili Pourafkari @leilii

4 days ago

@JaeKOh2 @alsidawimd I’ve been thinking a lot about this. To me using highest gradient makes more sense as AF by itself brings down the cardiac output, in low flow we give dobutamine to increase flow and gradient. Here long R-R cycle could serve as such

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An outpatient with dyspnea for the past 3 months, no other symptoms. Had 'a heart procedure' 5 years ago. TEE was performed. What are findings and potential explanations?

Natural history of asymptomatic moderate or severe aortic regurgitation: a systematic review and meta-analysis Please read the article and enjoy an in-depth interview between @jhfrudd and the first author, Dr Jwan Naser from The Mayo Clinic in Rochester, Minnesota, USA Paper: bit.ly/4tVHsCM Interview: bit.ly/3R1Tr38

Era previsible. La UNAM acaba de ratificar las trampas en 11 casos de Oaxaca… y entre ellos está Brisa, la de los 120 de 120 en Medicina. Le mostraron las evidencias. No hubo duda. Algunos caerán con los resultados del examen de control. Otros, como ella, ya fueron exhibidos. Da tristeza ver a tantos jóvenes creyendo que se puede engañar sin consecuencias. Y todavía falta que la UNAM transparenté de una vez el contrato con Territorium Life. Lo más grave no es solo el fraude… es que miles lo intentaron. excelsior.com.mx/nacional/joven… #UNAM #ExamenUNAM #TrampaUNAM #ExamenDeControl #TerritoriumLife

🫀HFpEF is not simply “diastolic dysfunction” A preserved ejection fraction does not mean preserved ventricular mechanics. A very elegant review by Fujimoto and colleagues brings us back to one of the most powerful ways of understanding the heart: the pressure volume loop. In HFpEF, the loop allows us to move beyond EF and separate several components of cardiovascular performance: Ees describes end systolic elastance and provides information about intrinsic LV systolic properties. Ea represents effective arterial load. Ees/Ea describes ventricular arterial coupling, showing whether ventricular contractility is appropriately matched to the load against which the heart ejects. EDPVR and β characterize passive LV stiffness. Tau reflects active LV relaxation. And the area enclosed by the loop represents stroke work, connecting pressure generation with the mechanical work required to eject blood. This framework helps explain why two patients with the same EF can have profoundly different cardiovascular physiology. In classic hypertensive HFpEF, excessive arterial load shifts ventricular force toward late systole. The LV continues generating increasing pressure during ejection, producing a narrower, more trapezoidal PV loop. Reducing arterial load with nitroglycerin lowers LV pressure and filling pressure, changes the loading sequence and can improve relaxation. Perhaps even more interesting is what happens when HFpEF patients are stressed. Patients with very high EF may have a steeper ESPVR but also greater LV stiffness and a limited ability to increase end diastolic volume. Under stress, stroke volume can therefore fall despite an apparently “excellent” EF. This is why HFpEF should not be understood through EF alone...Ejection fraction is a ratio, Hemodynamics tells us how the heart actually works. Reference 📚 Fujimoto, N., Omori, T., Moriwaki, K., Nakamori, S., & Dohi, K. (2026). Pressure-volume loop analysis in heart failure with preserved ejection fraction: Implications for cardiac mechanics, diagnosis, and treatment strategy. Journal of Cardiology, 87, 69–76. doi.org/10.1016/j.jjcc…

bit.ly/2PoV3kn For aortic stenosis 🔺measure LVOT diameter 5-10 mm below annulus?? 🔺this UNDERestimates SV/AVA & OVERestimates AS severity & low flow status 🆚 #WhyCMR 🔺Measure LVOT diameter at annulus: agrees best with #WhyCMR SV & AVA #echofirst @JournalASEcho

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@IM_Crit_ POCUS is a more objective tool for recognizing those patterns.

@IM_Crit_ It’s about learning to recognize patterns, even very subtle ones.

Mechanical circulatory support for patients with infarct-related cardiogenic shock: a state-of-the-art review In this episode of the Heart podcast, Digital Media Editor @jhfrudd is joined by Prof. Jacob Eifer Moller from Odense, Denmark. They discuss his review paper on mechanical circulatory support, along with supporting guidelines and papers in this area. Podcast: bit.ly/46fB0vO Paper: bit.ly/4pkR1t5

@ross_prager @pperezde Intraabdominal hypertension. Paracentesis

This image was obtained after ROSC in a person who experienced cardiac arrest during cementation of the prosthesis for total hip arthroplasty. 1️⃣ What #echofirst view is shown, and 2️⃣ what is the likely abnormality❓ #POCUS #CriticalCare Answer and 🔗 to source in thread below.

💡Editors' Insights: Percutaneous closure of an iatrogenic ventricular septal defect complicated by right ventricular pacemaker lead dislocation Don’t miss this engaging clinical vignette in the latest issue of #PolishHeartJournal 🩺✨ journals.viamedica.pl/polish_heart_j… @UR_Rzeszow

Train your 👁️👁️ How many cusps does this aortic valve have? 3⃣ 4⃣ 5⃣❓ #echofirst #POCUS #FOAMed See thread for 🔗to source.