Cardiologist, Director Ambulatory HF/HCM/Cardiac Amyloidosis @CorewellHealth | Husband/Dad 🧩✝️ 🇵🇭 | alum @MayoClinicCV @UMNMedEd @NorthwesternU | Tweets=mine
Grand Rapids, MI
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[1/] My son has profound autism and developed an associated comorbidity, agitated catatonia causing severe debility and regression. In med school 20 yrs ago I don't recall learning at all about the agitated subtype which is the polar opposite of how catatonia is usually depicted.
In medicine, clinicians are taught an important principle: when you hear hoofbeats, think horse—not zebra. In other words, start by considering the most likely and common explanations before assuming something obscure.
Catatonia is often treated as a “zebra”—an unusual or unlikely diagnosis—when in reality, it is a horse: a condition that occurs across diagnoses and clinical settings and should be considered early when symptoms fit.
When catatonia is not recognized or is assumed to be obscure, it may be overlooked in favor of other diagnoses. This delay can have grave consequences. Catatonia has specific, effective treatments, and timely recognition can be life-saving.
Public awareness plays an important role as well. When patients and families know that catatonia exists and understand its many presentations, they are better equipped to raise concerns, ask informed questions, and advocate for appropriate assessment.
Catatonia should not be a last consideration.
It should be part of the early differential when symptoms are present.
January 16 is Catatonia Awareness Day—dedicated to improving recognition, diagnosis, and care so no one needlessly suffers or dies from catatonia.
#catatonia #catatoniaawareness #catatoniaawarenessday #maxfink
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Physicians throughout Minnesota bear witness to the devastation that U.S. Immigration and Customs Enforcement is wreaking. They implore physicians everywhere to raise their voices.
Read “We Do Care” by Bernard E. Trappey, MD, for Minnesota Physician Voices: nej.md/4akke1G
ALT Correspondence “When our patients go without medical care, the harm is not theoretical. It is measurable. Fear doesn’t just keep people away from clinics and EDs, it pushes patients into crisis.” “We Do Care” by Bernard E. Trappey, M.D., for Minnesota Physician Voices
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David Fermin, MD retweeted
🫀 Myocarditis & Pericarditis – What’s new in the 2025 ESC vs ACC criteria?
This review from the Italian Society of Cardiology nicely compares the new ESC 2025 guidelines and the ACC consensus on inflammatory cardiac diseases — and some changes really matter for daily practice.
🔍 Myocarditis – Diagnostic criteria
ESC 2025:
• Definite = clinical syndrome + CMR or biopsy confirmation
• Possible = clinical syndrome + ≥1 of: ECG changes, troponin rise, echo abnormality
• Unlikely = symptoms without objective findings
👉 CMR is now the main diagnostic tool; biopsy only in selected/high-risk cases
ACC:
• Similar logic, but introduces 4 stages (A–D) from “at risk” to advanced disease
💢 Pericarditis – New criteria
ACC:
• Chest pain is mandatory
• Plus ≥1 of: rub, ECG changes, CRP rise, effusion, or CMR inflammation
• Definite if chest pain + ≥2 findings
ESC:
• Similar, but allows rare cases without chest pain if strong objective evidence
🔁 Overlap syndromes
• Myopericarditis = pericardial-dominant
• Perimyocarditis = myocardial-dominant
• Troponin-positive pericarditis = higher risk → closer follow-up
🧲 Imaging
• Echo first line
• CMR = gold standard for myocarditis
• CMR in complicated or recurrent pericarditis
💊 Therapy highlights
• Pericarditis: NSAIDs + colchicine first line
• Avoid early steroids if possible
• IL-1 blockers (anakinra, rilonacept) = game changer for recurrent pericarditis
📌 Take-home:
Diagnosis is now more imaging-driven, more structured, and more personalised — with CMR and biomarkers at the centre of decision making.
#Myocarditis #Pericarditis #ESC2025 #ACC #CMR #CardiacImaging #Inflammation #Cardiology #Guidelines 🫀📚
Link:doi.org/10.1016/j.tcm.2026.0…
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David Fermin, MD retweeted
All of the founders of The Catatonia Foundation had loved ones who experienced excited catatonia. Before catatonia was recognized, their loved ones received a wide range of diagnoses and were often given treatments that were unhelpful — and in some cases harmful. Effective care only began once catatonia was identified and treated appropriately.
Since then, new board members have come forward with strikingly similar experiences, as have countless families who have reached out to The Catatonia Foundation seeking help. Again and again, we hear the same story: intense agitation, fear, confusion, and loss of basic skills that do not fit common stereotypes of catatonia — and are therefore missed.
This is why The Catatonia Foundation is so deeply committed to awareness and education about excited catatonia. These are not abstract concepts or rare edge cases. They are lived experiences, shared across families, diagnoses, and systems of care. And lived experiences matter — especially when they reveal patterns that, once recognized, can change outcomes.
#Catatonia #CatatoniaAwareness #CatatoniaAwarenessDay #MaxFink #EarlyRecognition
#ListenToFamilies #MentalHealthAwareness
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[1/] My son has profound autism and developed an associated comorbidity, agitated catatonia causing severe debility and regression. In med school 20 yrs ago I don't recall learning at all about the agitated subtype which is the polar opposite of how catatonia is usually depicted.
In medicine, clinicians are taught an important principle: when you hear hoofbeats, think horse—not zebra. In other words, start by considering the most likely and common explanations before assuming something obscure.
Catatonia is often treated as a “zebra”—an unusual or unlikely diagnosis—when in reality, it is a horse: a condition that occurs across diagnoses and clinical settings and should be considered early when symptoms fit.
When catatonia is not recognized or is assumed to be obscure, it may be overlooked in favor of other diagnoses. This delay can have grave consequences. Catatonia has specific, effective treatments, and timely recognition can be life-saving.
Public awareness plays an important role as well. When patients and families know that catatonia exists and understand its many presentations, they are better equipped to raise concerns, ask informed questions, and advocate for appropriate assessment.
Catatonia should not be a last consideration.
It should be part of the early differential when symptoms are present.
January 16 is Catatonia Awareness Day—dedicated to improving recognition, diagnosis, and care so no one needlessly suffers or dies from catatonia.
#catatonia #catatoniaawareness #catatoniaawarenessday #maxfink
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[2/] Through my son's journey and experts at @umichmedicine I learned about catatonia and its most effective treatment, electroconvulsive therapy (ECT). Awareness/advocacy can lead to earlier diagnosis, treatment access and research into new therapies.
Description: Catatonia experts share stories of remarkable recoveries they have witnessed across different practices and patient populations. They describe individuals who were profoundly ill with catatonia and went on to recover—some with electroconvulsive therapy (ECT), some with lorazepam, and others with barbiturates. While treatment approaches varied, the outcome was the same: recovery became possible once catatonia was identified and treated appropriately.
One catatonia expert describes catatonia and its treatment with benzodiazepines or electroconvulsive therapy (ECT) as one of the most dramatic rescues in psychiatric practice—among the most rewarding, gratifying, and profound changes psychiatrists can witness in their work.
Another expert shares the story of a patient with profound stuporous catatonia whose recovery felt like a resurrection, explaining that experiences like these are deeply motivating and reinforce the importance of continuing to push forward in caring for patients with catatonia.
Dr. Max Fink, a pioneer in catatonia research and treatment, dedicated more than seven decades of his career to this work while witnessing hundreds of remarkable recoveries from catatonia.
This is why The Catatonia Foundation is deeply committed to increasing awareness about identifying, diagnosing, and effectively treating catatonia. Our message is clear: catatonia is serious, but recovery can be profound when it is identified and treated.
#catatonia #catatoniaawareness #catatoniaawarenessday #maxfink
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David Fermin, MD retweeted
The frequently used medical term "heart failure" is awful and needs to be replaced @NEJM @otago nejm.org/doi/full/10.1056/NE…
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David Fermin, MD retweeted
The frequently used medical term "heart failure" is awful and needs to be replaced @NEJM @otago nejm.org/doi/full/10.1056/NE…
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David Fermin, MD retweeted
"Uncommon Will, Far Better World," a $4 billion campaign to drive transformation at @michiganstateu & beyond. With 3 key ambitions: activate talent, imagine synergies, and build futures. #spartanswill
@MSUMD, @MSU_Medicine
farbetterworld.msu.edu/
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David Fermin, MD retweeted
Thank you to BAMF Health colleagues, my neighbors at Doug Meijer Medical Innovations Building in Grand Rapids, for an eye popping tour of their truly innovative & forward looking work in #theranostics! #SpartansWill
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David Fermin, MD retweeted
Mavacamten was associated with reductions in biomarkers of cardiac wall stress and injury, with no sustained reductions in LVEF observed in patients with HFpEF and LVEF of 60% or greater. ja.ma/4k1namN
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David Fermin, MD retweeted
The 8th paper from the
@iStopMM
study was published in @BloodCancerJnl in 2022. This study examines serum free light chain (FLC) reference intervals in kidney disease. We propose new eGFR-based reference intervals to improve accuracy. 📜📷#iStopMM #MGUS
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Interesting 🐀 model study utilizing cardiac myosin inhibitors (mavacamten and aficamten) to reduce infarct size in ischemia-reperfusion, when cardiomyocytes become hypercontractile➡️contraction band necrosis. Future indications beyond #HCM/#HFpEF? 🫀
link.springer.com/content/pd…
ALT Abstract image
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David Fermin, MD retweeted
Excited to share @MayoClinic experience with #amyloid and🫀transplant
📌 Post tx survival #amyloid = non-amyloid pts
📌 ⬇️ wait times for #amyloid after allocation change
📌 ⬇️ multi- organ tx with TTR targeted therapies
@MayoAmyloid onlinelibrary.wiley.com/doi/…
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David Fermin, MD retweeted
#CircAHA24 VALOR-HCM demonstrates sufficient and sustained long-term improvement in obstructive HCM patients to avoid septal reduction therapy. @DesaiMilindY @neallakdawala @AWangDukeU @tikuowens
@S2beri @DavidFerminMD ahajrnls.org/3ZfwThe
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David Fermin, MD retweeted
Join us tomorrow - virtual link below. An excellent meeting organized by @MicheleEmdin et al in Pisa
us02web.zoom.us/webinar/regi…
#CardioTwitter #Amyloidosis
Hi guys please join the meeting on proteomics in cardiac amiloydosis Pisa November 8 2024 @GiusVerg us02web.zoom.us/webinar/regi…
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David Fermin, MD retweeted
Doctor, I feel exhausted ❗️
Answer: 🫀 your engine is to small. #Exercise 🏃♂️
🌟#StephRowe 🌟 showed that small left ventricular size predicts low VO2, performing even better than LAVi!
optimal cut-off 88ml LVEDV
🤔Exercise deficiency syndrome
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David Fermin, MD retweeted
According to @thinkcollegeICI, 2% of students with intellectual disabilities are likely to attend college. But thanks to @SyracuseU's InclusiveU program, our students earn degrees and launch their careers. Discover InclusiveU's profound impact! #Podcast
🎧go.syr.edu/comms/InclusiveU
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David Fermin, MD retweeted
Robust research strategic planning @FM_HVI @CorewellHealth @MSU_Medicine discussions with @RenzoLoyaga @DavidFerminMD @wohnsmd #tomasztimek @AshMansour5 @chaz_hong and many others
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