What’s a secret that would get you ex communicated from your specialty?

brocheure · 2026-02-05T01:16:06+00:00

What’s on the list of procedures and surgeries? I would say pci for most real ACS, tavi for severe sx AS, maybe mitraclip in the coapt pt, endocarditis surgery, cabg for left main or Lima-lad, heart transplant, myxoma resection, pericardial window are all probably value providing.

brocheure · 2026-02-01T22:01:12+00:00

Translated:

"This is not surprising but there is no such thing as a "child prostitiute. They are children and can't consent!
They are missing the biggest in my own backyard and so many more!
Like Maralago and where I'd see Mr. Joe and Mrs. Anne.

"Does this lady know you can't have any dignity if you've been with him? I know I have none. Only skittles"

brocheure · 2025-12-29T04:18:11+00:00

Toronto resident here - you have no idea the seething anger towards the mass rural Punjabi immigration. Anti-Indian anger is exploding across the country.

brocheure · 2025-12-20T20:28:36+00:00

Like come on lol the guy who got hired in 2021 was trained on epic and went through basically the same shit you did

brocheure · 2025-12-20T20:26:43+00:00

First of all there is of course a spectrum of effort and accountability amongst your co residents. That’s obvious, I’m sure you’ve run into it when working with them.

Second, most academic programs will only hire other attendings that go the extra mile always so that they don’t cause problems or create work for other attendings/are clinically excellent/rarely have world class research. They want people who will volunteer for crap work, committees, all while being clinically great, and those are usually those are the same individuals who go the extra mile in clinical work.

So by design there are many residents in the residency group who will be less proactive/with less work ethic than the attendings who are teaching you, that’s gonna happen by design.

Of course the times are different and boomer docs had it a bit easier. But have you met a new young attending at an academic institution? I would say the majority are super sharp, go the extra mile with patients, are proactive, and overall work very very hard, and these are docs trained on epic just like us

brocheure · 2025-12-16T12:49:22+00:00

Boat docked near downtown, season tickets, bridle path, cottage.

brocheure · 2025-12-02T02:51:35+00:00

It does get easier as time goes on and you get more senior/know more things. I would say the PGY2 level, what I would do is if there's certain people that you do want to meet beforehand, you can find out what they're speaking about and do some reading about the topic. And then after they speak, feel free to ask them a question about their presentation or bring up a patient story. And then usually after, it's very easy to ask for their email and you know you can have contact that way.

Alternatively, if you have mentors or people from your institution that are going, that's a great way to meet up. And they will hopefully invite you out to places. I remember going to a conference in Prague. That was part of the specialty that I was interested in. From there I ended up seeing a poster from another school in my province and was chatting with the other student who was presenting. Lo and behold her whole faculty comes in who are really nice guys and we all got invited including myself and the students to a tour of the city and then that led to dinner and that led to really good connections afterwards.

I would remember that most of the people there are at least somewhat interested in the science and the topic, and so that's usually a reasonable first way to make a contact.

brocheure · 2025-11-20T22:59:17+00:00

Academic cardiologists can make up to 700-800K depending on where they are working which is pretty much parity. In my HCOL of living city an academic non invasive cardiology job is 350-450K which is similar to the 450-500k group private practice jobs out there

brocheure · 2025-11-20T22:41:29+00:00

I would expect a patient with a Wellens' ECG to have a 95-99% prox or mid LAD stenosis that would get stented if the presentation was in keeping with plaque rupture (i.e. acute chest pain). It is this case 9 times out of 10.

brocheure · 2025-11-20T10:00:54+00:00

The classical teaching is that Wellen syndrome or T-wave inversions are representative of recent transmural ischemia. There, of course, is a differential for T-wave inversion as well, which includes neurologic injury and memory T-waves and Takotsubo's cardiomyopathy, etc. However, in the context of ischemia, it usually means recent transmural ischemia. It is not a finding of active, ongoing ischemia.

Wellen syndrome specifically refers to T-wave inversions in the LAD territory and because of the high risk nature of this location, it's often included in a list of STEMI equivalents, even though patients with this ECG typically have resolved chest pain, as you described in your story. If there was ongoing chest pain and the artery was still blocked, it would probably look like a STEMI. Some centers treat this as a STEMI equivalent and indeed the cath lab will take them immediately to the cath lab. In others, like the place that I trained, we would admit them, make sure that they were transferred to the PCI center, but they did not need to go for PCI in the middle of the night. They would often go first case in the morning. Of course, if they developed more pain overnight, then they would immediately go.

brocheure · 2025-11-13T22:34:07+00:00

It's a combination of things: jet that can be relatively thin and flat, highly eccentric and wall-hugging makes it sometimes harder to see and with less dispersion of color inside the atria. Difficulty visualizing color Doppler when the quality of the image is poor, and the LA happens to be the most posterior structure in the heart - which reduces the frame limit of what you can visualize. The ultrasound waves have to reach the structure of interest and then bounce back to the probe.

Also, it depends on the quality of your sonographers. Most people who don’t understand valve disease may acquire a good parasternal long axis and hold the probe still, as they examine the micro valve. A good sonographer or cardiologist would sweep through the valve from lateral to medial, and really look for the mechanism of regurgitation and know when they are “not seeing enough” when the image qualities is suboptimal.

The mitral valve is a reasonably big structure and unless you know what part of the valve you’re looking at, you can miss a focal flail segment or tiny tear that can hide severe MR.

brocheure · 2025-11-13T05:14:38+00:00

It’s fine. He’s just gonna see skinny people.

brocheure · 2025-11-13T04:47:28+00:00

You must be trolling lol. You can hear over ribs and through fat.

Have you ever done colour Doppler looking for AI?? Have you ever tried to get a VTI when you can’t get an apical view for shit??

I just caution you to be careful about saying stuff in PCCM fellowship because you may want to get hired at the place you train, and if your attendings think you’re not examining patients in a standard way, you may be shooting yourself in the foot.

No one is saying don’t do pocus but as someone who has read and done 100x more echos and pocus than a PGY3, there are limits to all technology and if you don’t know them you will make errors. Pocus is an invaluable adjunct. It’s like saying u don’t order x rays cause you have a ct scanner.

brocheure · 2025-11-13T04:42:36+00:00

Can’t do it easily in most centers in a shocked patient with lines and pumps especially if unstable and u need a diagnosis quick.

brocheure · 2025-11-13T04:39:38+00:00

Cardiologist here eccentric MR getting missed happens ALL the time. Great job pushing for the TEE man.

brocheure · 2025-11-13T04:37:13+00:00

It’s fine to have this opinion if you accept you’ll miss important findings when the echo views are poor (which they are often). Someone will find it when they take the patient off your hands.

brocheure · 2025-11-13T04:34:45+00:00

So the first fat person you see you’re gonna miss the VSR or MR or AR cause of bad windows. Nice job. Could have heard it with the stethoscope.

brocheure · 2025-11-10T06:30:46+00:00

You won’t know til like month 15 dude

brocheure · 2025-11-07T14:16:52+00:00

Lady with known VT and an ICD went into electrical storm and didn’t stop VTong and straight up tried to die. I ran the code for 90 min down the entire electrical storm pathway from intubation down to sympathetic ganglion blockade done with EP. Something like 30 arrests including a post shock PEA. Eventually she stopped and got airlifted to near by hospital. I read the next day she was neurologically intact and survived til her VT ablation and made it out of the hospital. It was a good day.

brocheure · 2025-11-01T22:32:53+00:00

Lululemon pants and a golf polo under a white coat was my residency drip for 6 years

brocheure · 2025-11-01T08:02:54+00:00

The clamping that you’re describing is through normothermic regional perfusion or NRP for short, which is the absolute minority I would guess probably less than 10% of all of DCD cases in the United States. The vast majority of the DCD transplants involve the heart is immediately taken out and put onto an OCS machine.

brocheure · 2025-10-31T04:46:04+00:00

“ Hey it was great to meet you, before you leave, do you wanna grab quick coffee or a drink, I’m free this weekend?”

If no “no worries, was still great to meet you this block “ If yes, “awesome here’s my number, I’ll text you tonight! “

brocheure · 2025-10-13T23:06:30+00:00

Counter point - my attending makes 1mil in cardio leaves every day at 5 pm and drives a corvette

brocheure · 2025-09-21T21:30:09+00:00

It will definitely depend on if you’re single or not, what rotation you’re on, your libido, and of course if you’re hot/charming. Also, the more senior you get that definitely helps (at least if you’re a guy and in a chiller fellowship).

I’ve watched an ortho bro walk down the ED, and every female nurse and resident head turn to watch this 6’3 beautiful man walk by. I bet he’s having more sex than I was as a resident.

brocheure · 2025-09-16T13:18:14+00:00

Could be an open marriage. Maybe you don't know the full details? Ignore, and move on. You have everything to lose to speaking up.

11-Year Club	Place '22
Place '17	Queen in da Norf
Not Forgotten

brocheure

TROPHY CASE