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Joe Cuthbert @jjcuthbert.bsky.social · Jul 17

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

Lars Mølgaard Saxhaug @load-dependent.bsky.social · Jul 16

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

Effects of Vasodilation in Heart Failure With Preserved or Reduced Ejection Fraction: Implications of Distinct Pathophysiologies on Response to Therapy

The purpose of this study was to compare hemodynamic responses to vasodilator therapy in patients with heart failure (HF) and preserved ejection fract…

www.sciencedirect.com

Joe Cuthbert @jjcuthbert.bsky.social · Jun 4

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

David Winchester @drdavemd.bsky.social · Jun 4

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

Dual Cohort Insights Into Accelerometer‐Derived Weekend Warrior Physical Activity and Its Impact on Mortality | Journal of the American Heart Association

www.ahajournals.org

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Joe Cuthbert @jjcuthbert.bsky.social · May 18

Couldn’t be more correct!

Dr Rachel Clarke @drrachelclarke.com · May 18

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 🧵

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Joe Cuthbert @jjcuthbert.bsky.social · May 10

I can never resist

Hull Images - Dave Wise @hullimages.bsky.social · May 10

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

This is the Hand Wash Car Wash on Anlaby Road. I've posted this because virtually everytime I go I see someone giving the inflatable a high five. I seen it happen about 10 times..

Joe Cuthbert @jjcuthbert.bsky.social · May 7

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 · May 7

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

Redefining respiratory sinus arrhythmia as respiratory heart rate variability: an international Expert Recommendation for terminological clarity

Nature Reviews Cardiology, Published online: 06 May 2025; doi:10.1038/s41569-025-01160-zThe physiological phenomenon whereby heart rate varies in phase with breathing in vertebrates has been known as ‘respiratory sinus arrhythmia’. In this Expert Recommendation, the authors argue that this terminology is potentially misleading and propose replacing it with the term ‘respiratory heart rate variability’, which avoids pathological connotations.

bit.ly

Joe Cuthbert @jjcuthbert.bsky.social · May 4

Yes! Stealing this one

Lars Mølgaard Saxhaug @load-dependent.bsky.social · May 4

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

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Reposted by Joe Cuthbert

Henry Han @hancardiomd.bsky.social · Apr 9

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

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Joe Cuthbert @jjcuthbert.bsky.social · Apr 6

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

Lars Mølgaard Saxhaug @load-dependent.bsky.social · Apr 6

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.

drbenweitz.bsky.social @drbenweitz.bsky.social · Apr 6

Light and moderate consumption of wine is associated with a 38-50% lower risk of cardiovascular complications, as determined by urinary tartaric acid levels--yet another paper from the PREDIMED project: academic.oup.com/eurheartj/ar...

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Joe Cuthbert @jjcuthbert.bsky.social · Mar 31

#medsky #cardiosky

Joe Cuthbert @jjcuthbert.bsky.social · Mar 31

We need to know more about hospitalised patients. A priori, if your targeting net fluid loss, then restriction makes sense. But the more you drink, the more you pee - might liberal fluid be beneficial in patients with congestion?? Trend toward quicker diuresis here:

onlinejcf.com/article/S107...

Fluid Restriction in the Management of Decompensated Heart Failure: No Impact on Time to Clinical Stability

To examine the clinical effect of fluid restriction in patients admitted to the hospital with class IV heart failure (HF).

onlinejcf.com

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Joe Cuthbert @jjcuthbert.bsky.social · Mar 31

At least liberal fluid does not appear to be harmful if you’re well (except serum natriuretic peptide concentrations tend to be higher - link.springer.com/article/10.1...)

Effects of limiting fluid intake on clinical and laboratory outcomes in patients with heart failure - Herz

Background The guidelines of the Scientific Societies of Cardiology recommend limiting fluid intake as a nonpharmacological measure for the management of chronic heart failure (HF). However, many pati...

link.springer.com

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Joe Cuthbert @jjcuthbert.bsky.social · Mar 31

Open label trial so can’t read to much into the “positive” findings for liberal fluid - if you tell people to limit what they drink, they’re going to want a drink and feel thirsty, and be more discontent generally.

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Joe Cuthbert @jjcuthbert.bsky.social · Mar 31

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...

www.nature.com

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Joe Cuthbert @jjcuthbert.bsky.social · Mar 30

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...

www.nejm.org

Joe Cuthbert @jjcuthbert.bsky.social · Mar 15

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

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Joe Cuthbert @jjcuthbert.bsky.social · Mar 13

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

The Times & Sunday Times @thetimes.com · Mar 13

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

Married men more likely to be obese than singles

www.thetimes.com

Joe Cuthbert @jjcuthbert.bsky.social · Mar 12

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

www.theguardian.com

Joe Cuthbert @jjcuthbert.bsky.social · Mar 11

Hopeless technique

Sky News @news.sky.com · Mar 11

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

Reposted by Joe Cuthbert

Lars Mølgaard Saxhaug @load-dependent.bsky.social · Mar 11

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

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Joe Cuthbert @jjcuthbert.bsky.social · Mar 5

Argh!!!!!!

Medlife Crisis (Rohin) @medcrisis.bsky.social · Mar 3

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

Joe Cuthbert @jjcuthbert.bsky.social · Mar 3

Other opinions are available. And, ultimately, that’s all we have when it comes to diuretics - opinion-based medicine - despite these “positive” urinary Na trials.

onlinejcf.com/article/S107...

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Joe Cuthbert @jjcuthbert.bsky.social · Feb 28

#cardiosky

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Joe Cuthbert @jjcuthbert.bsky.social · Feb 28

That there are so many techniques and so little agreement (rather like different markers of diastolic dysfunction) suggests we have a long way to go before the US probe can replace the stethoscope

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Joe Cuthbert @jjcuthbert.bsky.social · Feb 28

I’m not a POCUS enthusiast but it can be useful when uncertainty reigns…as it so often does in patients presenting with breathlessness.

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Joe Cuthbert @jjcuthbert.bsky.social · Feb 28

Time from discovery of X-rays to first clinical use was ~3 years.

By comparison, lung ultrasound (for eg) as a means of identifying congestion has been around for ~40 years yet is not widely used.

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