Ritika Tuli

Internal medicine residency ✅ Onwards to Cardiology fellowship 🫀

🫁 #CardioNugget: Hypoxemia in Pre-Capillary pHTN In pre-capillary pHTN, hypoxemia isn't just a lung problem—it's a flow and delivery problem. Treat the vascular dysfunction, optimize cardiac output, and support oxygenation. May use PAH-specific therapies (e.g.…

🫀 #CardioNugget: Who Needs 'Infective Endocarditis' Prophylaxis Before Dental Work? ✅ Who Needs Prophylaxis? -Prosthetic heart valve (Mechanical, bioprosthetic, or transcatheter) -Prior history of infective endocarditis -Certain Congenital Heart Diseases (CHD) -Cardiac…

🫀 #CardioNugget: Why HOCM Has a Bifid Carotid Upstroke A bifid (two-peaked) carotid pulse with: -A brisk initial upstroke (the spike) -Followed by a notch or dip -Then a second slower rise (the dome) 🚩 Pro Tip: This bifid upstroke is not seen in fixed obstructions like…

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Milestone achievement! Dr. Candice Lee performed the 100th pulmonary thrombectomy to treat CTEPH. #CandiceLeeMD #AmreshRainaMD #HayahKassisGeorgeMD @barnes_kileigh @AHNtoday Read the full story: ahn.org/newsroom/press…

#CardioNuggets #TrialTuesdays ❤️ ISAR-REACT 5 Trial Prasugrel vs. Ticagrelor in ACS 👥 4,018 patients with ACS (STEMI, NSTEMI, UA) randomized to: 💊 Ticagrelor vs. Prasugrel 📌 Primary Outcome (Death, MI, Stroke) Ticagrelor: 9.3% Prasugrel: 6.9% ✅ Prasugrel superior (HR…

🫀 #CardioNugget: TR & the Giant c-v Wave in JVP In Tricuspid Regurgitation (TR), you’ll spot a prominent, merged c-v wave in the jugular venous pulse — a classic bedside clue! 🔍 Why does it happen? In normal JVP, the c wave (tricuspid valve bulge during systole) and the v…

🫀 #CardioNugget: Mild vs Severe Aortic Stenosis – Murmur Clues 🩺 Pro Tips: Late-peaking + quiet A2 = severe AS. Always check the carotid pulse for delay and diminished upstroke. Don’t be fooled by murmur intensity alone — small LV stroke volume in very severe AS can…

#CardioNugget Here’s how to tell Jugular Venous Pulse (JVP) apart from the carotid impulse: 🪄 Pro Tip: Elevate HOB to 30–45°, use tangential light, and examine right IJ for accurate JVP assessment. #CardioNuggets #MedEd

A new echocardiographic algorithm provides accurate classification of left ventricular filling pressure, reducing indeterminate cases, particularly in patients with preserved ejection fraction. @SNagueh ahajournals.org/doi/full/10.11…

#CardioNuggets ASD Primum: Location: -Inferior portion of atrial septum (near AV valves) -part of the atrioventricular septal defect (AVSD) spectrum. Associated Defects: Mitral valve cleft → MR. Sometimes tricuspid anomalies as well. ECG Findings: Left Axis Deviation (LAD)…

A huge welcome to our incoming Cardiovascular Disease Fellows! We're thrilled to welcome such an impressive group to the @AHN_CVI family! 🫀🩺 @AHNtoday

#CardioNuggets ASD Secundum Why does ASD secundum show RBBB + RAD on ECG? ✅ Left-to-right shunt → volume overload of RA & RV ✅ RV dilation → conduction delay = RBBB ✅ RV dominance → Right Axis Deviation 📍 Located at the fossa ovalis (mid septum) 🚫 No valve…

#CardioNuggets 🫀July tips for new interns! Recognize Cardiogenic Shock Early! Key signs: 💥 Narrow pulse pressure, elevated diastolic BP ❤️‍🩹 Often tachycardic, but not always 🫁 Crackles/JVD/S3 🧠 AMS 🧊 Cold, clammy skin 🚫 Low urine output 🧪 Lactate ↑, LFTs ↑, Cr ↑,…

#CardioNuggets 🫀 Septal Flattening on Echo? Think RV overload! Best seen in PSAX at papillary muscle level. 🔸 Pressure overload (PE, PH): ➡️ D-shaped LV in systole 🔸 Volume overload (TR, ASD): ➡️ D-shaped LV in diastole #CardioNuggets #EchoNerds #FellowsFirst #POCUS

#CardioNuggets 🧠 The CAHP Score (Cardiac Arrest Hospital Prognosis) helps predict neurological outcomes after OHCA with ROSC. ➡️ Score >200: poor prognosis, but NEVER a reason to withdraw ICU care ➡️ Score <150: Patient with active ischemic EKG or high risk EKG changes,…

#CardioNuggets 🧐 Trying to measure LVOT gradient with CW Doppler (HCM, aortic stenosis)? Be careful—you might be measuring mitral regurgitation (MR) instead! Here's how to tell: 🗡️ LVOT — Forward flow — “Dagger-shaped,” late-peaking jet — Mid-to-late systole — Sign of dynamic…

#CardioNuggets 🧠 Q: My patient is complaining of fatigue on beta-blockers. What should I do? A: -Check for bradycardia/hypotension -Avoid highly lipophilic agents e.g., propranolol (they cross the blood-brain barrier) -Consider nebivolol or bisoprolol (better tolerated)…

#CardioNuggets 🫀HALT = Hypo-Attenuated Leaflet Thickening Seen on CT in bioprosthetic valves (TAVR/SAVR) 🔍 Subclinical leaflet thrombus → thickening ± motion restriction ✅ Reversible with anticoagulation ⚠️ Not seen on echo; may affect durability & stroke risk #TAVR…

Apologies for the recent inconsistency with #CardioNuggets — I’m on an exciting journey to becoming a mom soon 🧿, and life’s been a little busier than usual! Still learning and growing every day, and I’ll keep sharing nuggets as often as I can. Thanks for sticking around ❤️…