Key Contraindications to Pacemaker Implantation:
🫀Bradycardias without significant Symptoms (incl. transient/asymp pauses, Neurocardiogenic response w/ vague sxs, Sleep-related Brady)
🫀1° AV Block
🫀Mobitz I, 2° AV Blocks
🫀Reversible Blocks (e.g. Lyme)
#CVBoardPearl #CardioX

Manage POTS w/ ⬆️hydration, ⬆️salt intake (sports drinks, salt tabs, etc.), aerobic exercise, compression socks, and lower extremity tensing exercises to ⬆️venous return.
Meds include BBs, midodrine, fludrocortisone, pyridostigmine dep. on sxs and severity.
#CVBoardPearl #MedX

Use BP during Tilt Testing to Differentiate Orthostatic Hypotension (OH) from POTS!
In POTS, BP stays normal or ⬆️slightly.
In both types of OH (Immediate & Delayed), see ⬇️SBP by 20 mmHg ± ⬇️DBP by 10 mmHg immediately or in 3-5 min, respectively.
#CVBoardPearl #MedTwitter

Are you applying to cardiology fellowship this cycle, or know someone that is?! Join the ACC Cardiology Applicant Mentor Program! An amazing opportunity for mock interviews and help with your overall application. #ACCMedRes #ACCFIT

A brief increase in HR w/in the first 20ish sec of standing is a normal, healthy response in adults >20 years.
In POTS, the HR increase starts at 30-60 sec and often continues to increase with standing. There MUST be orthostatic sxs to dx POTS.
#CVBoardPearl #MedTwitter

In POTS, the normal compensatory mechanisms for ⬇️ 🫀 & 🧠 blood flow (i.e. ⬆️HR, ⬆️peripheral vascular constriction, ⬆️inotropy) are affected, leading to ⬆️HR of at least 30 bpm (for age > 20) within 10 min of standing, NO ⬇️BP, and (+)orthostatic sxs.
#CVBoardPearl #MedTwitter

What is POTS (Postrual Orthstatic Tachycardia Syndrome)?
It is a disorder on the spectrum of autonomic dysfunction, characterized by orthostatic intolerance--worst when upright.
Ddx: orthostatic hypotension, reflex syncope, vasovaval syncope, etc.
#CVBoardPearl #MedTwitter

A Head-Up Tilt Test for syncope is POSITIVE if the patient has complete LOC +/- sxs of dizziness/lightheadedness.
Ddx: Vasovagal, Orthostatic Hypotension, Pseudosyncope.
Sometimes done with EEG to differentiate epilepsy or psych cause.
#CVBoardPearl #MedTwitter #CardioTwitter

Tilt Test Phases:
1) Supine - Monitor horizontal for 5-10 min.
2) Passive - Head-up at 60-70 degrees for ≥20 min on continuous EKG w/ vitals every 3-5 min.
3) OPTIONAL Drug Provocation - Monitor head-up for 15-20 min after SL NTG 400 mcg.
#CVBoardPearl #CardioTwitter #MedTwitter

For #InternationalDayofFamilies we reflect on #familylife in all its forms & relationships we #love & treasure. #Families give #solidarity , protection against hardship & offer identity, love, care, development. To #InspireInclusion means to accept, value & embrace differences! 💜

#DadJoke

When your Doximity fax is about to expire but you don't have anyone to fax so you send the most random things saved in your phone to their support team. . .
Hope that restaurant menu is useful.

Tilt Testing Contraindications:
AVOID Isoproterenol Tilt Testing in ischemic heart disease (Class III).
AVOID tilt testing in pregnancy (hypotension may harm fetus) or those with myocardial/cerebral ischemia that would be exacerbated by hypotension.
#CVBoardPearl #MedTwitter

Two Class I indications for Tilt Testing:
(1) Unexplained single-event syncope in a high-risk setting or recurrent syncope w/o known heart disease after cardiac etiologies are ruled out.
(2) To evaluate susceptibility to reflex syncope.
#CVBoardPearl #CardioTwitter #MedTwitter

Tilt Testing:
Can have poor reproducibility with a false negative rate >25%, dep on pt selection.
Isoproterenol & NTG ⬆️ sensitivity and ⬇️ specificity of a Tilt Test.
Vasovagal syncope CANNOT be ruled out by a negative Tilt Test but still warrants eval.
#CVBoardPearl #MedTwitter

Happy Mother's Day to all Moms--even those of furry, scaled, or feathered children!

POTS:
🫀Abnormal increase in HR to > 120 bpm within the first 10 min of standing.
🫀Syncope is driven not by this abnormal increase in HR but rather by an overlapping condition.
🫀Encourage hydration +/- electrolytes, compression socks, standing slowly.
#CVBoardPearl #MedTwitter

Happy Nurses Week to our partners in patient care! It is hard and often messy work, but it makes all the difference in patient experiences and outcomes. Thank you for everything!

Orthostasis:
💩Splanchnic circ can store ~25% of blood vol.
🫀When 500-800 ccs of blood shifts to the legs/gut, there is ⬇️Venous Return and ⬇️Cardiac Output. Syncope occurs from inadequate compensation.
🫀Common in DM, Parkinson's, chemo, dehydration.
#CVBoardPearl #MedTwitter

Neurally Mediated Syncope:
😵Response to Noxious Stimuli, Baroreceptor Activation, Vagal Reflex
🫀Leads to ⬇️HR +/- ⬇️BP
🧠Usually quick reorientation. If prolonged recovery, consider head injury!
🍔Post-Exercise/Postprandial: vascular bed vasodilation
#CVBoardPearl #MedTwitter