Epilepsy Seizure Types - Generalized vs Focal Generalized Seizures - Absence seizures - Myoclonic seizures - Tonic seizures - Tonic-clonic seizures - Atonic seizures #Generalized #Focal #Seizures #Types #Classification #Neurology #Differential #Diagnosis

Aortic Valve Stenosis • Etiology • Severity and Grading • Management Satyendra Dhar, MD @DharSaty #Aortic #Valve #Stenosis #AS #diagnosis #management #cardiology #aorta

Peripartum Cardiomyopathy - Summary 1. Definition • Towards the end of pregnancy to 5 months postpartum • Usually LVEF <45% with or without LV dilation • Idiopathic LV dysfunction → exclude other causes* 2. Differential Diagnosis • Pre-existing cardiomyopathy (e.g., familial or dilated) • Valvular heart disease • Congenital heart disease • Hypertensive heart disease • Myocardial infarction • Stress cardiomyopathy • Pulmonary embolus 3. Etiology • Actual etiology remains unknown • Final pathway likely an imbalance of angiogenic factors + oxidative stress - Proposed Mechanism: Dysregulation of VEGF (Pro-Angiogenic) through ↑ sFLT1 levels (levels ↑ in pre-eclampsia) - Proposed Mechanism: Altered prolactin processing with ↑ cleavage into a pro-angiogenic fragment • Other: Myocarditis? Genetic predisposition (TTN gene) ? Hemodynamic stressors of pregnancy 4. Risk Factors and Worse Prognostic Markers • Risk Factors: African ancestry, pre-eclampsia, hypertension, multiple pregnancy, maternal age > 30 years, cocaine use • Worse Prognosis: LVEF < 30%, LVEDd > 6.0 cm, LV thrombus, RV systolic dysfunction, Obesity, African ancestry, LGE on MRI 5. Clinical • Under-recognized: sx overlap with normal pregnancy • May have typical HF sx: dyspnea on exertion, orthopnea, PND, LE edema • Minority of Pts: cardiogenic shock and severe arrhythmias 6. Management during Pregnancy • Avoid ARB/ACE-I/ARNI/MRA • Avoid Warfarin and DOAC • Planning for delivery mode and timing with Cardio-OB team 7. Management during Delivery • Stable patients typically deliver vaginally • Account for changes in hemodynamics (e.g., placental auto-transfusion and relief of IVC compression ↑ preload) • A multi-disciplinary team is critical! 8. Management during Postpartum Period • Breast-feeding: no consensus on risk vs. benefit. - Some studies show no ↓ LV function. Avoid ARBs • ICD: Many patients will recover LVEF. Consider waiting ~6 months before 1° prevention. Possible role for wearable defibrillator as a "bridge to recovery" • Contraception counseling should be done on diagnosis or discharge. Avoid estrogen products early post-partum 9. Other Considerations • Thromboembolic complications are relatively common. In patients with LVEF (ESC), suggest prophylactic anticoagulation up to 8 weeks postpartum • Consider early mechanical support for patients clinically deteriorating on medical therapy, including inotropes • Bromocriptine, a dopamine agonist, prevents the release of prolactin. It is an investigative therapy in PPCM. If started, patients should be on a/c. • If no LVEF recovery (e.g., <50%), ESC guidelines recommend against future pregnancy. Risk of recurrence remains even if recovery. • During a future pregnancy, teratogenic GDMT meds (e.g., ACE/ARB) need to be stopped. Serial TTE and close follow-up with Cardio-OB team needed! - Cardionerds - Karan Desai MD, MPH @karanpdesai #Peripartum #Cardiomyopathy #diagnosis #management #cardiology #treatment

Myocarditis on Echocardiogram It is always great to witness the tremendous reversal of severe biventricular dysfunction from myocarditis. Case Resolution: https://twitter.com/i/status/957990786372694018 Ivan Stankovic, MD, PhD @Ivan_Echocardio #Myocarditis #plax #psax #a4c #Echocardiogram #clinical #cardiology #pocus

Myocarditis Diagnosis • Endomyocardial biopsy (gold standard, rarely performed) • Clinical presentation • Cardiovascular MRI Clinical • Excessive fatigue, exercise intolerance • Chest pain, pericarditis • Unexplained sinus tachycardia • S3, S4 or summation gallop • Abnormal ECG, echocardiogram • Dysrhythmia, heart block • Heart failure • Elevated troponin • Cardiogenic shock, sudden cardiac death Management • Supportive • Heart failure therapy as needed • Antidysrhythmics as needed • Antlviral (lymphocytic myocarditis) • Immunosuppressants (chronic myocarditis) • IVIG (Giant cell, eosinophilic) #Myocarditis #Diagnosis #Management #Cardiology