Matthew Barriers

Cardiac Pathophysiology. Beautiful!! 😍#cardioTwitter #cardiology #medstudents

Mixing and Streaming in Single Ventricle #1: Why Streaming Matters 👉Single-ventricle physiology does not always produce complete mixing; intracardiac flow patterns can create selective streaming. 👉Unfavorable streaming directs systemic venous blood preferentially into the aorta, resulting in more pronounced cyanosis. 👉Favorable streaming directs pulmonary venous blood preferentially into the aorta, improving systemic arterial oxygen saturation.

心外術後ICU管理の基礎を学びたくて探してたらめちゃくちゃ良いの見つけた。10年前だけど、二部構成でかなりわかりやすくまとまってる。初学者でもとても読みやすくてありがたい....！次は成書でも読んでみようかな。 ・Part1 pubmed.ncbi.nlm.nih.gov/2596… ・Part2 pubmed.ncbi.nlm.nih.gov/2613…

Compressions are only as good as the pressure they generate. Here's how the arterial line, capnography, and echo tell you whether your CPR is working. We should be practicing beyond the ACLS guidelines. 🎩 tip to the authors, including @intensivaev. eddyjoemd.com/foamed

Subphenotypes of Acute Respiratory Distress Syndrome: From Biological Heterogeneity to Precision Medicine CCR Journal Watch criticalcarereviews.com/late…

Comprehensive Echocardiographic Assessment of Right Ventricular Afterload and Right Ventricular–Pulmonary Arterial Coupling in the Intensive Care Unit CCR Journal Watch criticalcarereviews.com/late…

El deterioro de función renal observado al descongestionar con diuréticos no sería debido a la depleción de volumen, se explica mejor por los mecanismos intrarrenales que se originan. Aquí la compleja explicación Hypertension 2026 10.1161/HYPERTENSIONAHA.126.27712

Falla cardíaca derecha, de la Heart Failure Society of America (HFSA, 2026). Puntos importantes: 🔵 Si tienes catéter de arteria pulmonar: obtén, PAPi = presión de pulso pulmonar / PVC. <1.0 en choque obliga a escalar soporte; >1.5 es favorable. Aurícula derecha/presión en cuña ≥0.63 sugiere falla predominantemente derecha. 🔵 PVC alta con cuña normal no contraindica diurético. Meta PVC <12 mmHg; si hay resistencia, combina asa + tiazida. 🔵 PAM 70–75 mmHg para perfundir la coronaria derecha (opinión de expertos). Preferir norepinefrina a dosis baja y vasopresina. Dobutamina si PAS <100; milrinona si hay hipertensión pulmonar o betabloqueo previo. 🔵 Evitar PEEP alta y volúmenes corrientes grandes: aumentan la resistencia pulmonar. Preferir ventilación no invasiva; si hay que intubar, etomidato sobre ketamina (debatido) 🔵 Óxido nítrico >10 ppm no reduce más la resistencia pulmonar.

Los diuréticos de asa intravenosos a dosis muy altas (ej, bumetadina y furosemida), NO se asociaron a ototoxicidad👂, los pocos cambios auditivos son temporales y totalmente reversibles Olvidemonos ese mito viejo y obsoleto JAMA Cardiol 2026 10.1001/jamacardio.2026.4913

Today's Paper of the Day is: Optimizing postoperative pain management in children: evidence, pitfalls, and practical recommendations criticalcarereviews.com/late… Join us to read 1 paper per day and stay up-to-date as we cover the spectrum of critical care across 2026

🫁 Ventilar al asmático crítico en UCIP: ¿qué es evidencia y qué es consenso? Serie de 13 láminas con citas 🧵 La guía AARC/PALISI 2025 hace 11 recomendaciones: todas condicionales, con certeza baja o muy baja. Ninguna es sobre ventilación invasiva. (1/4)

PULMONARY HYPERTENSION: IS THE PROBLEM UPSTREAM OR IN THE PULMONARY VESSELS? Pulmonary artery pressure can rise because of elevated left-heart filling pressure, increased pulmonary vascular resistance (PVR), or both. A. Normal hemodynamics Normal LV filling pressure and normal PVR are associated with normal pulmonary artery pressure. B. Pulmonary hypertension due to left-heart disease Elevated LV filling pressure, as in left-sided heart failure or mitral stenosis, raises left atrial and pulmonary venous pressures. Pulmonary artery pressure rises largely through backward transmission of pressure. C. Pre-capillary pulmonary hypertension PVR is elevated while left-heart filling pressure remains normal. This pattern is typical of pulmonary arterial hypertension, although other pre-capillary causes must also be considered. D. Combined post- and pre-capillary pulmonary hypertension Left-heart filling pressure is elevated, and pulmonary vascular remodeling or vasoconstriction also increases PVR. Pulmonary artery pressure rises beyond what elevated left atrial pressure alone would explain. 2022 ESC/ERS hemodynamic definitions - Pulmonary hypertension: mean pulmonary artery pressure (mPAP) greater than 20 mmHg. - Pre-capillary PH: mPAP >20 mmHg, PA wedge pressure (PAWP) ≤15 mmHg and PVR >2 Wood units. - Isolated post-capillary PH: mPAP >20 mmHg, PAWP >15 mmHg and PVR ≤2 Wood units. - Combined post- and pre-capillary PH: mPAP >20 mmHg, PAWP >15 mmHg and PVR >2 Wood units. Clinical pearl: Echocardiography estimates the probability of PH; right-heart catheterization confirms the diagnosis and distinguishes these hemodynamic patterns. RVSP alone cannot determine the cause. Reference: 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension.

🫀 CardioNugget™: Why does BBB sometimes appear when HR changes? The key is to think about WHEN the next impulse reaches the bundle branch. 🏃 Tachycardia-dependent BBB = Phase 3 block FAST → WIDE Next impulse comes too soon → the bundle is still refractory from the last beat → cannot conduct → BBB. ➡️ Slow the HR → more time to recover → QRS may narrow. 🐢 Bradycardia-dependent BBB = Phase 4 block SLOW/PAUSE → WIDE This one is counterintuitive: shouldn't more time = more recovery? In diseased His-Purkinje fibers, a long pause can cause abnormal phase-4 depolarization → membrane becomes less negative → Na⁺ channels become less available → fiber becomes less excitable → BBB. ➡️ Increasing HR can prevent this abnormal phase-4 drift and restore conduction. 🪗 Ashman phenomenon = LONG → SHORT → WIDE A long RR prolongs bundle refractoriness → the suddenly short RR arrives while the bundle is still refractory → aberrant conduction, classically RBBB in AF. Phase 3 block: the bundle didn't get enough time to recover. Phase 4 block: the diseased bundle got so much time that its membrane potential drifted, making it less excitable. #CardioNuggets #Cardiology #Electrophysiology #ECG

New on pulmonarypocus.com: a free, interactive M-mode Lab :pulmonarypocus.com/mmode-lab🫀🫁 Move the M-line and watch the trace change: EPSS and reduced EF Mitral stenosis Lung sliding vs barcode sign TAPSE and MAPSE IVC Any feed back is appreciated reply here or at [email protected]

🩸 Línea arterial en UCIP (1/2) No interpretes solo PAS/PAD/PAM. Antes valida nivel, cero, tubuladura y prueba de lavado. Un desnivel de 10 cm cambia ≈7,4 mmHg. La morfología solo orienta cuando la señal es confiable.

ノルアドレナリンが循環動態を良くする機序は動脈での血管収縮だけではありません。実は静脈に作用して、前負荷を増やす効果もあるんです。 このことを説明するのに毎回紹介している文献がこちら。ノルアドレナリンの作用機序が一枚で図示されていてお気に入りなんです。link.springer.com/article/10…

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