Great paper, great thread, we don’t understand HFPEF at all

Lars Mølgaard Saxhaug@load-dependent.eurosky.social · last yr.

Very interesting physiological study of the hemodynamic effect of nitroprusside infusion in HFpEF vs HFrEF. I think this is equally relevant both for the interaction with EF seen with most heart failure therapies, as in the disparate effects seen with IABP in cardiogenic shock 🧵 #cardiosky #emimcc

Thank goodness - question is; does this apply to beer and chocolate intake too?

David Winchester@drdavemd.bsky.social · last yr.

Concentrating your physical activity as a "weekend warrior" has similar benefit to exercise spread across the week www.ahajournals.org/doi/10.1161/... #cardiosky

Couldn’t be more correct!

Dr Rachel Clarke@drrachelclarke.com · last yr.

The job of a doctor is not, necessarily, to be kind or popular or fluffy or liked. It is to do and to say the right thing for your patients. However difficult it may be to do so. However tough you may find it. Many institutions pretend otherwise, including the GMC. Here's why they're wrong 🧵

I can never resist

Hull Images - Dave Wise@hullimages.bsky.social · last yr.

This is the Hand Wash Car Wash on Anlaby Road. I've posted it because virtually everytime I go by, I see someone giving the inflatable a high five. I've seen it happen about 10 times. #hull #yorkshire #travel #photography #sky #carwash #photographersunited #photographersofbluesky #spring

Redefining conditions that make no sense? (How can something that is sinus be an arrhythmia?) excellent! Next, let’s do away with HF with a preserved ejection fraction.

Nature Reviews Cardiology@natrevcardiol.nature.com · last yr.

New online! Redefining respiratory sinus arrhythmia as respiratory heart rate variability: an international Expert Recommendation for terminological clarity #CardioSky

Yes! Stealing this one

Lars Mølgaard Saxhaug@load-dependent.eurosky.social · last yr.

All definitions of p-values are wrong but some are useful

Lower extremity lymphatic flow is associated with diuretic response in acute heart failure In 65 AHF patients, lymphatic flow (via ICG lymphangiography) predicted diuretic response. #AHF #CardioSky #Lymphatics #AHF @shelleyzieroth.bsky.social @escardio.bsky.social @drrajivsankar.bsky.social

So true - why does “this sort of thing” keep being done??

Lars Mølgaard Saxhaug@load-dependent.eurosky.social · last yr.

This study has been shared widely. This is no more a causal study than those using self reported consumption, just a more reliable marker. Still just as confounded as other observational studies. There is no reason to think here is any health benefit from wine consumption.

Fluid restriction associated with trend to worse QoL and greater thirst in stable outpatients with HF. No difference in safety. www.nature.com/articles/s41...

Liberal fluid intake versus fluid restriction in chronic heart failure: a randomized clinical trial - Nature Medicine

While fluid restriction is typically recommended for patients with chronic heart failure, this randomized clinical trial showed no difference in health status, as assessed by patient-reported outcomes...

nature.com

A trial in which the rate of side effects (uro-genital infection) was nearly 2x greater than the rate of the primary driver of the outcome benefit (worsening HF +\- hospitalisation) www.nejm.org/doi/full/10....

Dapagliflozin in Patients Undergoing Transcatheter Aortic-Valve Implantation | NEJM

Sodium–glucose cotransporter 2 (SGLT2) inhibitors reduce the risk of heart-failure admission among high-risk patients. However, most patients with valvular heart disease, including those undergoing...

nejm.org

Whatever you think of Mandrola’s approach…he could not be more correct about critical appraisal of trials in the first 5 mins of this week’s episode. podcasts.apple.com/gb/podcast/t...

Mar 14 2025 This Week in Cardiology

Podcast Episode · This Week in Cardiology · 14/03/2025 · 28m

podcasts.apple.com

I maintain that I only have time to eat chocolate and drink beer; not eat chocolate, drink beer, and exercise.

The Times and Sunday Times@thetimes.com · 2y ago

Healthy habits may slip in a committed relationship, a study suggests, but the effect is much less apparent for women ⬇️

Amazing story in which the Guardian use the first year medical student definition of heart failure….”weakened the heart so that it cannot effectively pump blood through the body effectively”…bless them. www.theguardian.com/australia-ne...

Australian man survives 100 days with artificial heart in world-first success

Sydney surgeons ‘enormously proud’ after patient in his 40s receives the Australian-designed implant designed as a bridge before donor heart

theguardian.com

Hopeless technique

Sky News@news.sky.com · 2y ago

The King visited the Royal College of Nursing and practiced resuscitating a dummy with the guidance of the nursing cadets 👑👩‍⚕️

An IPD analysis of STICHES and REVIVED-BCIS2. Higher risk in the OMT arm in the older CABG trial STITCHES than the more recent PCI trial REVIVED. #cardiosky academic.oup.com/eurheartj/ad...

Medical therapy and outcomes in REVIVED-BCIS2 and STICHES: an individual patient data analysis

AbstractBackground and Aims. In the Surgical Treatment for Ischaemic Heart Failure Trial Extension Study (STICHES), coronary artery bypass grafting (CABG)

academic.oup.com

Argh!!!!!!

Medlife Crisis (Rohin)@medcrisis.bsky.social · 2y ago

I’ve missed the clashes of US vs UK medicine that used to happen on twitter. Someone sent me this one today and oh boy does it demonstrate one of the many reasons I’m glad I won’t need to rely on American healthcare when sick. A “wild” cardiac arrest being posted online

Presence of congestion is central to a diagnosis of HF. There are multiple imaging techniques to identify congestion - are any of them better than a stethoscope and clinical acumen? pubmed.ncbi.nlm.nih.gov/39998772/

Imaging of Congestion in Cardio-renal Syndrome - PubMed

As an extension of an echocardiographic examination, ultrasound can be used to identify intravascular (inferior vena cava diameter dilation, internal jugular vein distension or discontinuous venous re...

pubmed.ncbi.nlm.nih.gov

Delighted to be joint first author on this work published in @ESC_Journals EHJ academic.oup.com/eurheartj/ad...

Absolutely! Such a wonderful thing

Sky News@news.sky.com · 2y ago

Parkrun should be prescribed on the NHS, charity behind it says

One to pass on to the med students - this is excellent

Johannes Enevoldsen@johsenevoldsen.bsky.social · 2y ago

I wrote a short interactive article👆 It uses simulations to demonstrate how different cardiac arrhythmias can develop. Try it out! (It has defibrillators ⚡️) jenevoldsen.com/posts/excitable-cells #medsky #cardiosky #cccsky #emimcc

Here's an interesting study of atrial pacing in patients with HFpEF, showing how increasing heart rate may decrease LAP until it increases again at higher heart rates. A reason not to give these patients beta blockers without a good indication I think #cardiosky academic.oup.com/eurheartj/ar...

Accelerated atrial pacing reduces left-heart filling pressure: a combined clinical-computational study

AbstractBackground and Aims. Accelerated atrial pacing offers potential benefits for patients with heart failure with preserved ejection fraction (HFpEF) a

academic.oup.com

The beautifully refurbished Montague Burton Building on the corner of Whitefriargate. See #alt-text #alttext for full description. #hull #yorkshire #travel #architecture #artdeco #photography

✨WHEEZING✨

Really pleased to have this published in @jcardfail.bsky.social Natriuresis guided diuresis: barking up the wrong tree. Needless to say, we argue that focussing on natriuresis rather than urine volume may be misguided. onlinejcf.com/article/S107...

This is, surprisingly, the only study I am aware of that compares oral and SC loop diuretic. Tiny difference in diuretic efficacy 7ml/mg driven only by a difference in those with diuretic resistance. Statistically significant yes, but clinically meaningful? onlinelibrary.wiley.com/doi/full/10....

Diuretic efficiency of a single dose of subcutaneous versus oral furosemide after heart failure hospitalization across diuretic resistance strata: A pilot randomized controlled trial

Aims Diuretic resistance (DR) in heart failure (HF) is associated with worse outcomes. Furoscix®, a self-administered subcutaneous (sc) furosemide injection administered via on-body infusor, is appr.....

onlinelibrary.wiley.com

#Diuretic efficiency of a single dose of SC Vs oral #furosemide after heart failure hospitalization across diuretic resistance strata: A pilot RCT onlinelibrary.wiley.com/doi/full/10.... @shelleyzieroth.bsky.social @novitham.bsky.social @anastasiasmihaili.bsky.social @noshreza.bsky.social

Palliative Care (PC) is integral to HF care, but there is little information on how it can be incorporated into comprehensive HF care. Check out the @HFSA Consensus Statement on PC in HF for a practical guide for clinicians caring for these complex patients. 🔗 bit.ly/4fJNz6e

Difficult to translate completely to UK setting due to cost of medications in US but nicely shows that, whatever reason patients aren’t adherent to treatment, it’s not because they have forgotten!

JAMA@jama.com · 2y ago

Text message reminders targeting patients who delay refilling their cardiovascular medications did not improve medication adherence based on pharmacy refill data or reduce clinical events at 12 months. ja.ma/4irtinM

Some excellent threads on Xitter atm re frailty and HF meds. Hawks vs Doves but in a respectful and evidence-related discussion. FWIW - the geriatricians are right, and the cardiologists are wrong (aren’t they always?!) x.com/lucypgeridoc...

Its back! Ten current papers for the curious cardiologist, including BP targets in T2DM, spiro post MI, left atrial appendage occlusion, coronary sinus reducer for angina, device detected AF & tirzepatide in HFpEF #CardioSky 1/11