Episode Details
Back to Episodes#464 - [🫀 From The Heart] - Right Drugs, Wrong Heart - A TTTS Recipient That Fooled Everyone
Description
In this episode of From the Heart, Dr. Nim Goldshtrom and Dr. Adrianne Bischoff dissect a hemodynamics consult that changes shape twice in 48 hours. A 30-week recipient twin from twin-to-twin transfusion syndrome presents with biventricular dysfunction and suprasystemic pulmonary hypertension, starts on epinephrine and milrinone, and stabilizes. Then overnight, everything falls apart: hypotension, rising lactate, falling urine output. Only on repeat echo does the real diagnosis emerge: hypertrophic obstructive cardiomyopathy (HOCM) with dynamic left ventricular outflow tract obstruction, where the "correct" initial therapy becomes dangerous. Nim and Adrianne unpack why milrinone can worsen outflow obstruction, why vasopressin beats dobutamine, and when esmolol helps or harms. It's a masterclass in resisting anchoring bias and treating evolving physiology, not just numbers.
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Enjoy!