1/ Time for #12LeadThursday!

What’s the axis and do you notice anything about the precordial leads? 2/ What do you see on ECG to identify extreme axis deviation?

Negative deflection in lead I + negative deflection in aVF = extreme axis deviation

1/ What better way to end off a week of pacemakers and ICDs than recapping and revisiting our #12LeadThursday series!

🧵 2/ Which patients get pacemakers?

Think of 2 big buckets: conduction disease and heart failure

1/ Atrial Fibrillation: #GrayMatters Series

What do you do with that episode of #Afib when sick or post-op in the hospital?

What type of monitoring is best?

🎧: link.chtbl.com/Afib
🗒️: bit.ly/3QPiLFt
CME: bit.ly/CIMCME
Sponsor: go.amboss.com/CoreIM-E9 2/ When do you start AC for new Afib post-op?

We hope this infographic will be handy for the many times we may be in the gray zone!

From @accpchest guidelines

A few things to consider:
🤔 Patient specific risk
🤔 Blood thinner of choice
🤔 Bleeding risk of the surgery

1/🚨New Episode🚨
The Lipid Panel Reimagined: #MindtheGap Segment

How do you interpret the #lipidpanel to help inform patients' risk for #cardiovascular disease? Do you use #ApoB? 🧐

🎧: link.chtbl.com/Lipids
Sponsor: go.amboss.com/CoreIM-E8 2/ Unfortunately, our patient is stuck in "bumper-to-bumper" #cholesterol traffic 🚗!

See traffic analogy to understand why ApoB can give us information that LDL-C may not:

#Mindblown! 🤯

1/ November 14th is #WorldDiabetesDay

Let’s look back at one of the most influential #RCTs for

how we given insulin in #T2DM?

the #RABBIT2 trial🐰🧵

#Insulin #MedTwitter 2/ The #RABBIT2 study looked at the (1) efficacy and (2) safety of basal-bolus vs. sliding-scale #insulin in non-critical inpatients🏥.

Basal-bolus regimens consisted of a combo of #Glargine (basal) and #Glulisine (mealtime).

The primary outcome was average glucose🍬.

1/ 🚨 #5Pearls on Alcohol-Associated Hepatitis 🚨

Why is it an immune response?

✔️Direct EtOH insult ➡️ inflammation

✔️Disruption of the gut barrier ➡️ bacteria & inflammatory cells go up portal vein ➡️ to hepatocytes

🎧 link.chtbl.com/AlcHep
Sponsor: @Pan_Financial 2/ Now, What else may be going on & what imaging and labs would you send off for ddx for Alc Hep?

Listen to the episode to hear a powerful story from @etapper differentiating Alc hep and worsening #cirrhosis

1/ Today on #StatswithCoreIM, let’s talk about #bias 2/ Let’s get started with a question: What type of bias do you think is present in this example?

1/🚨New Episode🚨
Aspirin for Primary Prevention: #MindtheGap Segment

What do current ACC and USPSTF guidelines say about daily low-dose #aspirin for the primary prevention of #cardiovascular disease?

🎧: apple.co/3VPRCV4
Sponsor: bit.ly/TCChoZ 2/Throwback to medical school pathophysiology!

Remember how the #atherosclerotic process takes place in blood vessels? 🫀

Now, where does #aspirin exert its effect during this cascade? 🤔

1/ Welcome back to #ReadingRoom with Core IM!

Have you ever been confused about what contrast #protocol to order?! 💭

“Protocols” = which phase of contrast is best evaluate the structure you are trying to see 🔎

Keep an eye on the white contrast being injected in this 🧵 2/ What are some different contrast protocols?

Compare and contrast the different protocols below ⬇️ and think about which clinical situations we use them in

1/ 🚨NEW PATIENT!🚨 66 y/o M found in his home unresponsive and hypothermic.

What abnormalities do you see in this EKG? 2/ Did you notice sinus bradycardia? What about intraventricular conduction delay?

Check out this slide with all 5 EKG findings!

🚨Your pager is going off!🚨 80M w h/o CAD on the inpatient medicine floor reporting burning epigastric pain after eating.

Here is his EKG: Take a look…any notable findings on this patient’s EKG?!

1/ What are 3 Qs you can ask yourself when looking at non-inferiority trials?

Q1) Was the trial planned i.e. pre-specified as comparing an intervention which is non-inferior to control?

WHY?

Bc changing the analysis *afterwards* introduces bias #StatswithCoreIM 2/ Q2) was the control treatment administered to the full std of care?

The trial relies on strict adherence to full standard of care for the control arm, otherwise the whole confidence interval shifts with a relative⬆️in benefit of the intervention compared to control

1/ Let’s dive into #noninferiority trials for this edition of #StatswithCoreIM

But first, take a look at this figure for what superiority trials aim to assess: What’s better? 2/ So how are NON-inferiority trials different?

They ask if a treatment is much worse than standard of care.

1/ Welcome back to #StatswithCoreIM !

What would you tell this patient who inquires about lab cancer #screening test to help him “live longer”?

What types of bias can occur in determining whether a cancer screening test reduces mortality? 2/ Take a look at the bolded arrows below that illustrate that early detection doesn’t always mean better outcomes!

Length-time bias applies to slow-growing disease in which patients have a long phase without symptoms.

1/ Welcome back to 12-Lead Thursday #MedTwitter !

Let’s get the juices flowing with an EKG! What are the major abnormalities? 2/ Yes, those are inferolateral ST elevations!

And notice the underlying rhythm of atrial fibrillation

1/ First and foremost, from all of us here at @COREIMpodcast, sincerest greetings for #InternationalWomensDay!

We wanted to use this opportunity to shed light on the discussion on post-menopausal hormone therapy (HT) via highlighting the important yet controversial WHI trial 2/ WHI followed the Nurses' Health Study, a prospective investigation that showed HT was associated with decreased cardiovascular disease (CVD) risk

1/ Good morning #MedTwitter ! It’s time for #12LeadThursday

Let’s jump in– can you decipher the EKG below to find out what’s wrong with this patient’s His-Purkinje system? 2/ If you thought left anterior fascicular block (LAFB), you were right!

What is the formal criteria for LAFB?!
✅Left axis deviation w/o LVH
✅qR pattern in lead aVL
✅R-peak time in lead aVL of 45 ms or more
✅QRS duration less than 120 ms

1/ Good afternoon #MedTwitter and happy #TriviaTuesday :

What part of a plane are you most likely to come into contact with bacteria? ✈️ 2/ And there you have it… the armrest!

Not what you expected? Read on

1/🚨New Episode & Segment Alert🚨

Grey Matters: Because medicine is rarely black and white!

Hosts: Alison Trainor, @FreedoBaggins
Discussants: @PishkoMD, Brett Carroll MD, Jeff Weinstein MD
Graphic: @samwoodworthmd

🎶 bit.ly/35hN1Fd
ACP: bit.ly/3oVhwbI 2/ Let's review some deep dives 👇

Where does the *strong rec* to anticoagulate for PE at least 1 month (if not the full 3 months) come from?!

We have natural history data tells us:

1/ Good morning #MedTwitter and welcome back to #TriviaTuesday

Let’s start with our question of the week👇 2/ And the answer is: Pneumo-Ultra-Microscopic-Silico-Volcano-Coniosis

Say that 5x times fast!

1/ 🚨New Episode! 🚨

What is an “appropriate” Hgb bump?

Why do we usually say 1g/dL for 1 pRBC?

iTunes: bit.ly/coreimpodcast
Show Notes: bit.ly/3eUgyGw

First, let’s figure out how many grams of hemoglobin are donated? 2/ What is the patient’s PRE-transfusion #intravascular volume?

Usually 6.5% of body weight for women 👩
Usually 7.5% of body weight for men👨