important #hormones and #second #messengers #secondmessenger #endocrinology #mnemonic

Approach to Adrenal Incidentaloma - Workup Step 1: Image Evaluation Step 2: Hormonal Assessment Dr. Gabriela Pucci @gabifpucci and Dr. Thiago Mendes @mendesthiagob #Adrenal #tumor #Incidentaloma #Workup #diagnosis #endocrinology

HFpEF and CAD Management Algorithm 1. Consider revascularization based on current guidelines for CAD and HFpEF* 2. Statins: all patients unless contraindicated 3. Aspirin: all patients unless contraindicated 4. Clopidogrel (or equivalent antiplatelet): if indicated by current guidelines (eg, recent PCl or ACS) 5. ACE inhibitor: consider in all patients unless contraindicated 6. ARB: if ACE inhibitor contraindicated 7. ß-BIocker: perform exercise testing to evaluate for Cl. If Cl, first consider pacemaker then start vasodilating ß-blocker. If no CI, treat with vasodilating ß-blocker.* 8. Angina: consider ranolazine if angina is not controlled by above medications. Also consider nitrates, calcium channel blockers. * 9. Optimal BP management: if BP is not controlled by ACE inhibitor/ARB + vasodilating ß-blocker, optimize fluid status (hypervolemia may exacerbate hypertension in patients with increased arterial stiffness), add chlorthalidone, consider spironolactone 10. Lifestyle modification: diet, exercise, cardiac rehabilitation, smoking cessation, weight loss (consider bariatric surgery in morbid obesity); treat obstructive sleep apnea 11. Enroll in HFpEF clinical trial #HFpEF #CAD #Management #Algorithm #cardiology

Severe Heart Failure & Cardiogenic Shock - Management Checklist Evaluation - EKG & echocardiography - CBC, Lytes including Ca/Mg/Phos - Troponin, Lactate, Liver function tests if shock is suspected - TSH and/or digoxin level depending on context Rx 1 — Treat the lungs - Consider BiPAP (vS intubation) in cardiogenic pulmonary edema - Large effusion(s) may be drained if causing acute distress - Consider inhaled epoprostenol for intubated patient with right ventricular failure or pulmonary hypertension Rx 2 — Optimize the MAP - HTN/normotension Afterload reduction (nitroglycerine infusion or hydralazine 37.5 mg & isosorbide dinitrate 20 mg q6hr) - Hypotension (severe or w/ organ dysfunction) Norepinephrine (epinephrine is another option in HFrEF with hypoperfusion) Rx 3 — Optimize the volume - Fluid challenge if: hypoperfusion, no pulmonary congestion (no B-lines on ultrasound), assessment suggests total body hypovolemia - Diuresis if: significant systemic/pulmonary congestion, assessment suggests total body volume overload Rx 4 — Consider inotrope (usually dobutamine/milrinone) for HFrEF if: - (a) Normotensive patient with organ hypoperfusion - (b) Refractory cardiogenic pulmonary edema in hypotensive patient - Note: Digoxin may be considered a weak inotropic agent in patients With chronic AF, HFrEF, and refractory heart failure. Rx 5 — Treat underlying etiology - New-onset tachyarrhythmia causing heart failure: cardioversion, antiarrhythmics - Ischemic cardiomyopathy: Revascularization, treatment for acute MI if present Rx 6 — Mechanical circulatory support - Consider for persistent Organ failure — device Of choice is patient/institution specific. Rx 7 — Things to avoid - Nephrotoxins (e.g. NSAlDs, ACE-inhibitors, angiotensin receptor blockers) - Initiation of beta-blocker in decompensated heart failure - Any beta-blocker or calcium channel blocker (eg diltiazem) in a patient with cardiogenic shock #Checklist #CHF #Shock #Cardiogenic #HeartFailure #Cardiology #Management

POCUS Echo of Acute Massive Saddle Pulmonary Embolism Here's a great teaching Echo of a patient I once took care of with Acute Massive Saddle PE. Since it demonstrates all the findings of Right Heart Strain I made it into this educational GIF - Sam Ghali, M.D. @EM_RESUS #Pulmonary #Embolism #AcutePE #Saddle #Echocardiogram #POCUS #Clinical #RightHeartStrain #McConnells #DSign

POCUS Findings in Acute Pulmonary Embolism - McConnell's Sign - TAPSE - D-Shaped Septum - Abnormal RV:LV Ratio #Pulmonary #Embolism #AcutePE #Accuracy #POCUS #Signs #McConnells #Signs #DSign #Diagnosis

Acute Pulmonary Embolism - Labeled POCUS Findings This patient presented with a-fib and shortness of breath. This POCUS illustrates some of the classic findings of sub-massive or massive pulmonary embolus. Dilated RV, McConnell's, and even clot-in-transit are seen here, color optimized for easier comprehension. Eric Abrams, MD @eabramsMD #McConnells #Sign #Clinical #POCUS #Echocardiogram #A4C #Strain #AcutePE #Pulmonary #Embolism

Papillary muscle rupture on POCUS Echocardiogram - A4C - Labeled I colorized this POCUS to make it easier to appreciate the pathology. This patient had sudden onset SOB after an inferior MI 8 days prior. This is a ruptured antero-lateral papillary muscle causing catastrophic mitral valve failure. Original Unlabeled: https://www.grepmed.com/images/6869 Eric Abrams, MD @eabramsMD #anterolateral #Papillary #muscle #rupture #POCUS #Echocardiogram #A4C #clinical #cardiology #Labeled

Papillary muscle rupture on POCUS Echocardiogram - A4C Rare case! 70M recent MI with acute resp failure and pulmonary edema. Papillary muscle rupture on POCUS Labeled Video: https://www.grepmed.com/images/6917 Eric Abrams, MD @eabramsMD #anterolateral #Papillary #muscle #rupture #POCUS #Echocardiogram #A4C #clinical #cardiology

Mitral Regurgitation on POCUS Echocardiogram - Apical 4 Chamber Before blousing fluids, check for LV systolic function and mitral regurgitation on an A4 view to avoid pulmonary edema. Eric Abrams, MD @eabramsMD #Mitral #Regurgitation #POCUS #Echocardiogram #A4c #cardiology #clinical #MR #Color #Doppler