Shows
Hu Said: Cardiology Board Review Series2025 Acute Coronary Syndromes GuidelineShould non-culprit lesions be revascularized in STEMI and NSTEMI? Should revascularization of non-culprit lesions occur in a simultaneous or staged manner? How do these recommendations differ when acute MI presents with cardiogenic shock? When DAPT is reduced to SAPT, which P2Y12 inhibitor is favored for monotherapy? When is de-escalation from ticagrelor/prasugrel to clopidogrel reasonable? In post-PCI patients requiring antithrombotic therapy, what should the duration of triple therapy be, and what is the P2Y12 inhibitor of choice? What is the role of Impella, IABP, and VA-ECMO in ACS with cardiogenic shock? Tune in for answers to these...
2025-03-0248 minHu Said: Cardiology Board Review Series11.12 Single VentricleIn this episode, we review congenital single ventricle, including physiology, surgical repair, and long-term management. What are the different types of univentricular heart defects, and how do they affect the systemic and pulmonary circulations? What are the three steps of staged surgical repair for single ventricle, and what are the indications for each? What is the difference between classic (unidirectional) Glenn surgery and bidirectional Glenn surgery? What is the difference between classic Fontan surgery, direct RA-to-PA Fontan, lateral tunnel Fontan, and extracardiac Fontan? What are the common post-repair complications, including arrhythmias, Fontan-associated liver disease (FALD), and thrombosis, and how...
2024-10-2514 minHu Said: Cardiology Board Review Series11.11 Transposition of the Great Arteries and Truncus ArteriosusIn this episode, we review transposition of the great arteries (TGA), including the physiology, imaging, repair strategies, and potential complications. What is the difference between D-TGA (complete TGA) and L-TGA (congenitally corrected TGA), and why are they named D- and L-? How does blood flow through the heart in D-TGA, and why is a shunt necessary for survival? What imaging features help identify what is serving as a right ventricle versus a left ventricle? What do the atrial switch (Mustard, Senning), arterial switch (Jatene), and Rastelli surgeries entail, and what are their complications? In what subset of D-TGA patients...
2024-10-2417 minHu Said: Cardiology Board Review Series11.10 Ebstein’s Anomaly, Double Right Ventricle, Tricuspid Hypoplasia, Pulmonic HypoplasiaIn this episode, we review right side congenital abnormalities, including Ebstein’s anomaly, double-chambered right ventricle (DCRV), tricuspid hypoplasia, and pulmonic hypoplasia. Which condition is characterized by "atrialization" of the right ventricle? How does the apical displacement of the septal leaflet of the tricuspid valve in Ebstein anomaly compare with what occurs in atrioventricular septal defect? What is the significance of an accessory pathway in patients with Ebstein’s anomaly? What are the indications for surgical intervention in Ebstein’s anomaly? How can tricuspid valve dysplasia be distinguished from Ebstein’s anomaly? What is the role of right ventricle-to-pulmonary artery c...
2024-10-2311 minHu Said: Cardiology Board Review Series11.09 Tetralogy of FallotIn this episode, we review Tetralogy of Fallot (TOF), including its pre-repair issues, surgical options, and post-repair complications. What are the four cardinal abnormalities seen in TOF, and how do they impact right-to-left shunting and systemic oxygenation? What are the differences between the Blalock-Taussig shunt, the Waterston or Potts shunts, and complete TOF repair? What surgical strategies are used today? When are temporizing procedures acceptable over complete repair? What are the long-term complications after TOF repair, including pulmonary regurgitation (PR), arrhythmias, and sudden cardiac death, and how are these managed? When is it acceptable to perform pulmonary valve replacement...
2024-10-2215 minHu Said: Cardiology Board Review Series11.08 Coarctation of the AortaIn this episode, we review coarctation of the aorta (CoA), including its epidemiology, presentation, imaging, and management. Which type of VSD is commonly seen in patients with CoA? What proportion of CoA patients have bicuspid aortic valve, and what proportion of bicuspid aortic valve patients have CoA? What key physical exam findings suggest CoA, and how does it present in young patients versus adults? What pattern should you see on PW Doppler of the descending aorta and CW Doppler of the coarctation? What is considered a significant peak-to-peak gradient across a coarctation? What are the criteria for surgical or...
2024-10-2112 minHu Said: Cardiology Board Review Series11.07 Patent Ductus ArteriosusIn this episode, we review the physiology, imaging, and management of patent ductus arteriosus (PDA). What is the classic murmur of PDA, and how does it change with shunt reversal? Why do patients with PDA get left heart enlargement instead of right heart enlargement? How does the differential cyanosis seen in PDA with Eisenmenger syndrome present? How do you calculate pulmonary artery systolic pressure using PDA velocity? How do you distinguish the Doppler CW profile of PDA from pulmonary valve regurgitation? What are the indications for PDA closure, and why are Qp ratios not used as they are for...
2024-10-2007 minHu Said: Cardiology Board Review Series11.06 Anomalous Pulmonary Venous Return, Persistent Left SVCIn this episode, we explore anomalous pulmonary venous return (APVR), including its types, associated conditions, and management. What is the difference between total anomalous pulmonary venous return (TAPVR) and partial anomalous pulmonary venous return (PAPVR)? How do supracardiac, cardiac, infracardiac, and mixed types of TAPVR differ? Which ASD type is most commonly associated with PAPVR? What are the physiologic consequences of right heart overload caused by APVR, and what are the criteria for surgical intervention? How is Scimitar syndrome diagnosed and managed, and when should surgery be considered for this rare condition? Lastly, we will touch upon persistent superior...
2024-10-1909 minHu Said: Cardiology Board Review Series11.05 Atrioventricular Septal DefectsIn this episode, we explore atrioventricular septal defects (AVSD), covering its types, physiology, and when to intervene. How do complete, partial, transitional, and intermediate AV septal defects differ in structure and physiology? What are the anatomic and functional consequences of a primum ASD with cleft mitral valve, and how does this affect the mitral valve's position relative to the tricuspid valve? What challenges do patients with AVSD face post-surgery, including risks of mitral regurgitation, left ventricular outflow tract obstruction, and arrhythmias? When is surgery recommended for AVSD, and what are the key considerations for long-term follow-up? Tune in for...
2024-10-1808 minHu Said: Cardiology Board Review Series11.04 Ventricular Septal DefectsIn this episode, we review ventricular septal defects (VSDs), including their types, physiology, and management. What are the differences between inlet, outlet, membranous, and trabecular VSDs? How do these defects vary in terms of location, association with other cardiac conditions, and suitability for percutaneous closure? Which VSD types tend to have aortic cusp prolapse, leading to aortic regurgitation? If you see a color jet from a VSD in parasternal short axis view, what is the significance of the color jet being adjacent to the tricuspid valve versus being adjacent to the pulmonary valve? What are the physiologic consequences of...
2024-10-1714 minHu Said: Cardiology Board Review Series11.03 Patent Foramen OvaleIn this episode, we review patent foramen ovale (PFO), including its types, physiology, presentation, and when to intervene. How does a PFO differ from an atrial septal defect (ASD), and why does PFO not cause the right heart enlargement and pulmonary hypertension seen in ASD? What is platypnea-orthodeoxia syndrome? What can cause platypnea-orthodeoxia syndrome other than PFO? What features on brain MRI suggest that the etiology of an ischemic stroke is cardioembolic? What features on echocardiography distinguish between PFOs and ASDs? How can PFOs contribute to cryptogenic stroke, and what high-risk features indicate the need for closure? Tune in...
2024-10-1615 minHu Said: Cardiology Board Review Series11.02 Atrial Septal DefectsIn this episode, we review atrial septal defects (ASDs), including their types, imaging, and management. What is the difference between secundum defect, primum defect, sinus venosus defect, and coronary sinus defect? Which is the only ASD defect out of the four that can be percutaneously closed (in addition to surgically closed)? Which ASD type is accompanied by anomalous pulmonary venous return? What are the physiologic consequences of left-to-right shunting in ASDs, and how can these lead to pulmonary hypertension and RV failure? What is Holt-Oram syndrome? What are the criteria for ASD closure? Tune in for answers to these...
2024-10-1513 minHu Said: Cardiology Board Review Series11.01 Congenital Heart Disease Epidemiology, Physiology, AssociationsIn this episode, we review the epidemiology of congenital heart diseases and develop a framework for categorizing them by cyanotic and non-cyanotic disorders, and go over physiologic concepts across congenital conditions. What are the 5 'T' disorders that are characterized by cyanosis? What are the non-T disorders that can develop cyanosis? What is the tipping point for Eisenmenger syndrome to occur? What are the non-cardiac manifestations of Eisenmenger syndrome? Is phlebotomy appropriate in Eisenmenger syndrome? What is the role of bosentan and sildenafil/tadalafil in Eisenmenger syndrome? What Qp/Qs ratio indicates a large left-to-right shunt that requires repair? What...
2024-10-1424 minHu Said: Cardiology Board Review Series10.01 Cardio-ObstetricsIn this episode, we review highlights of cardiovascular considerations in pregnancy. How does pregnancy affect blood volume, systemic vascular resistance, pulmonary vascular resistance, heart rate, and cardiac output? What routine physical exam findings in pregnancy that can mimic heart disease, and what physical exam findings are abnormal in pregnancy? How do LV mass, chamber size, and LV outflow tract velocity time integral (VTI) change in pregnancy? What is the effect of labor and delivery on cardiac output, blood volume, and venous return? What conditions comprise WHO risk class IV pregnancy patients? If a patient with peripartum cardiomyopathy has recovery...
2024-10-0912 minHu Said: Cardiology Board Review Series9.01 Cardiac MassesIn this episode, we review cardiac masses, including primary benign, primary malignant, and secondary (metastatic) cardiac tumors. Are malignant tumors much more likely to occur in the ventricles or the atria? If you see a myxoma in any cardiac chamber other than the left atrium, what syndromic complex should you suspect? What echocardiographic features distinguish benign and malignant cardiac masses? Which type of sarcoma is the most common primary cardiac tumor? What are the most common sources of metastatic cancer to the heart? Which cardiac chamber or junction would you find the moderator band, eustachian valve, crista terminalis, and...
2024-10-0422 minHu Said: Cardiology Board Review Series8.04 Orthostatic HypotensionIn this episode, we review orthostatic hypotension (OH). What criteria define OH? What is a simple way to distinguish neurogenic OH from volume depletion-related OH? What criteria define postural orthostatic tachycardia syndrome (POTS)? What non-pharmacologic measures should be undertaken as first-line measures for OH? How do fludrocortisone, midodrine, droxidopa, and atomoxetine work, and what are their side effects? How is supine hypertension managed? Tune in for answers to these questions.
Difficulty Level: Easy
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2024-09-2910 minHu Said: Cardiology Board Review Series8.03 Renovascular hypertension, aldosteronism, and pheochromocytomaIn this episode, we explore the diagnosis and management of three important causes of secondary hypertension: renovascular hypertension, primary aldosteronism, and pheochromocytoma. Which segments of the renal artery are preferentially affected by atherosclerotic renovascular hypertension versus fibromuscular dysplasia, and which is more likely to be accompanied by disease in other arterial beds? What characteristics suggest that a patient may benefit from renal artery revascularization? What next steps do you pursue if a plasma aldosterone to renin ratio exceeds 20? How do you differentiate between unilateral adenoma and bilateral adrenal hyperplasia? When would you pursue a MIBG scan in pheochromocytoma? Tune...
2024-09-2612 minHu Said: Cardiology Board Review Series8.02 Hypertensive Urgency and EmergencyIn this episode, we review hypertensive urgency and emergency. What counts as "end-organ" damage in hypertensive emergency? What neurological signs are consistent with hypertensive encephalopathy? Which acute conditions require bringing systolic blood pressure (SBP) down to ≤160 mmHg in the first hour, and which require bringing SBP down to ≤140 mmHg in the first hour? Which acute conditions require bringing SBP down to ≤120 mmHg in the first 5 minutes? How does the BP threshold change in acute ischemic stroke depending on whether you plan to give tissue plasminogen activator (tPA) or not? What is permitted hypertension? Tune in for answers to these questi...
2024-09-2516 minHu Said: Cardiology Board Review Series8.01 Chronic HypertensionIn this episode, we review chronic hypertension. How did the the definitions of stage 1 and stage 2 hypertension change in the most recent AHA/ACC/ASH guidelines? What happened to "prehypertension"? Which chronic condition needs control of systolic blood pressure (SBP) to
2024-09-2421 minHu Said: Cardiology Board Review Series7.08 VasculitisIn this episode, we review the large vessel vasculitides, medium-vessel vasculitides, ANCA-associated small-vessel vasculitides, and immune complex associated small-vessel vasculitides. What is the difference in the population of patients affected by Takayasu's arteritis of the aorta and its branches versus giant cell arteritis of the temporal artery? What about subcranial giant cell arteritis, which affects the aorta instead of the temporal artery? Which disease is characterized by corkscrewing, inflammation, and thrombosis of vessels of the upper and lower limbs, leading to reduced pulses and gangrenous ulcers, which cannot resolve without smoking cessation? What are the criteria for diagnosing Kawasaki...
2024-09-2127 minHu Said: Cardiology Board Review Series7.06 Carotid Artery StenosisIn this episode, we review carotid artery stenosis (CAS), including its presentation, diagnosis, medical management, and intervention. Do dizziness, presyncope, or syncope count as symptomatic CAS? What is the definition of nondisabling stroke and transient cerebral ischemic symptoms? What risk factors permit ordering a carotid duplex ultrasound before coronary artery bypass graft surgery? What peak systolic velocity on ultrasound correspond to >=50% and >=70% stenosis of a carotid artery? What antiplatelet regimen is recommended for CAS? In patients with symptomatic CAS, in what time window after the non-disabling stroke or TIA should you perform revascularization? Is there any role for revascularization...
2024-09-1914 minHu Said: Cardiology Board Review Series7.05 Peripheral Artery DiseaseIn this episode, we review limb peripheral artery disease (PAD). What is the difference in management of a marginally threatened limb vs immediately threatened limb? In whom can you order ankle brachial index (ABI) testing on? When do you reach for toe brachial index (TBI) or exercise ABI? Is there a role for cilostazol or pentoxifylline? Who should be given low-dose rivaroxaban therapy? Tune in for answers to these questions.
Difficulty Level: Easy
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2024-09-1821 minHu Said: Cardiology Board Review Series7.04 Aortic Intramural Hematoma, Penetrating Aortic Ulcer, Aortitis and Aortic AtheroemboliIn this episode, we review aortic intramural hematoma (IMH), penetrating aortic ulcer (PAU), infectious aortitis and aortic atheroemboli. What condition is characterized by a crescentic aortic wall thickening and echolucency within the aortic wall with no intimal flap on transesophageal echocardiogram? What percent of IMH progresses to aortic dissection?What imaging findings distinguish IMH from dissection on non-contrast CT, contrast CT, and TEE? What are the criteria for complicated IMH, and when is emergent surgical repair recommended? How does the management of type A IMH differ from that of type B IMH? How are grades 1, 2, 3, 4, and 5 aortic plaques defined...
2024-09-1714 minHu Said: Cardiology Board Review Series7.03 Aortic DissectionIn this episode, we review aortic dissection, its risk factors, presentation, physical exam findings, imaging findings, and management. Other than aortic dissection, what other cardiovascular conditions can present with unequal arterial pulsations? How do gender and age affect the risk of aortic dissection? What are risks for aortic dissection for women, especially during pregnancy, and for patients with conditions such as Marfan syndrome or a bicuspid aortic valve? How do you distinguish between a true and false lumen on imaging studies? What target blood pressure and heart rate should be achieved within 10 minutes of presentation for aortic dissection? When...
2024-09-1620 minHu Said: Cardiology Board Review Series7.02 Abdominal Aorta AneurysmIn this episode, we review abdominal aortic aneurysm (AAA), including its diagnosis, screening, and management. What are the current guidelines for screening and surveillance of AAA, and how do they differ for men and women? At what size does the risk of rupture significantly increase, and what surveillance intervals are recommended based on the size of the aneurysm? What does Laplace's Law say about how the rate of expansion of AAA correlates with its size? What are the key differences between endovascular aneurysm repair (EVAR) and open surgical repair, and what are the long-term complications associated with EVAR? What...
2024-09-1509 minHu Said: Cardiology Board Review Series7.01 Ascending Aorta Dilation + Marfan, Turner, Loeys-Dietz SyndromesIn this episode, we review ascending aorta dilation and ascending aorta aneurysm, including the key syndromes associated. What is cystic medial degeneration? Which diseases cause dilation of the aortic root versus dilation of the ascending aorta? In which diseases is ascending aorta dilation defined by diameter (cm) versus body surface area-indexed diameter (cm/m^2) versus aortic root cross sectional area to height ratio (cm^2/m)? In which diseases is the cutoff for surgical intervention ≥5.5cm, ≥5.0cm, ≥4.5cm, and ≥4.0cm? What is the definition of rapid growth in 1 year and in 2 years? Among the sinotubular junction, sinuses of Valsalva, aorto-ventricular junction...
2024-09-1429 minHu Said: Cardiology Board Review Series6.05 Left Ventricular ThrombusIn this episode, we review left ventricular (LV) thrombus, including its pathophysiology, imaging characteristics, and treatment. How are the components of Virchow's triad disrupted by myocardial infarction, predisposing to formation of LV thrombus? What are the echocardiographic features of LV thrombus? How can LV thrombus be distinguished from myxoma on cardiac MRI and angiogram? Can the chronic versus acute nature of LV thrombus be discerned on imaging? Is there a role for transesophageal echocardiogram for assessing LV thrombus? What anticoagulation agents are allowed in the treatment of LV thrombus? What evidence supports continuing anticoagulation beyond three months, and when...
2024-09-1309 minHu Said: Cardiology Board Review Series6.04 Deep Venous ThrombosisIn this episode, we review deep vein thrombosis (DVT). What are the ultrasound features of a DVT? What counts as a proximal DVT? Why are patients with proximal DVT at higher risk, and how does this impact management? What are the recommended anticoagulation strategies, including the use of DOACs versus VKAs? How long should anticoagulation continue for provoked versus unprovoked DVT? When is indefinite anticoagulation recommended, and in what situations might aspirin be a reasonable alternative? What counts as provoked versus unprovoked? How do you approach testing for thrombophilia, and when is it appropriate? Tune in for answers to...
2024-09-1211 minHu Said: Cardiology Board Review Series6.02 Calculating Pulmonary Artery PressuresIn this episode, we review how to calculate pulmonary artery pressures (PASP) on echocardiography. How does the simplified Bernoulli equation relate the velocity of flow through the tricuspid valve (tricuspid regurgitant velocity, V_TR) to the right ventricular systolic pressure (RVSP)? When is it permissible and not permissible to assume that PASP is equivalent to RVSP? How can the maximal tricuspid regurgitant velocity (V_max TR), maximal pulmonic regurgitant velocity (V_max PR), and end pulmonic regurgitant velocity (V_end PR) be used to calculate systolic, mean, and diastolic pulmonary artery pressure? What are five ways to calculate mean...
2024-09-1008 minHu Said: Cardiology Board Review Series6.01 Pulmonary HypertensionIn this episode, we review the essentials of pulmonary hypertension (PH), including the five groups. What echocardiographic findings allow you to distinguish between pre-capillary and post-capillary PH without information from right heart catheterization? In patients with PH non-vasoresponsive to nitric oxide, how do you decide whether to use phosphodiesterase-5 inhibitors (PDE-5 inhibitors), prostacyclin analogs, endothelin receptor antagonists (ERAs), or soluble guanylate cyclase stimulators (sGCS)? What is the criteria for vasorespose to nitric oxide, and how does the results of that testing change management? In patients with chronic thromboembolic pulmonary hypertension (CTEPH), how do you decide whether to offer pulmonary...
2024-09-0928 minHu Said: Cardiology Board Review Series5.02 Inflammatory PericarditisIn this episode, we dive into the pathophysiology, diagnosis, and treatment of inflammatory pericarditis. How do diagnostic criteria differ for first-time pericarditis and recurrent pericarditis? What is the sequence of ECG changes over the course of pericarditis? How many components would you expect to hear in a pericardial friction rub? Is post-MI pericarditis the same thing as Dressler's syndrome? What medications should be avoided? Can athletes who develop pericarditis play in competitive sports? Tune in for answers to these questions.
Difficulty Level: Easy
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2024-09-0512 minHu Said: Cardiology Board Review Series5.01 Pericardial Effusion and TamponadeIn this episode, we review pericardial effusion and cardiac tamponade. What is the definition of small, moderate, and large pericardial effusion? What is ventricular interdependence? What is pulsus paradoxus? What conditions can cause a false positive or false negative pulsus paradoxus? What comprises Beck's triad? What are seven cardinal findings of tamponade physiology on echocardiography? What common comorbidity can cause RV collapse to be negative in tamponade? How do you distinguish pericardial cysts from pericardial diverticulae and hiatal hernia? What is the appearance of congenital absence of the pericardium on echocardiography? Tune in for answers to these questions.
2024-09-0418 minHu Said: Cardiology Board Review Series4.19 Patient Prosthesis Mismatch and Prosthetic Valve StenosisIn this episode, we review patient-prosthesis mismatch (PPM) and prosthetic valve stenosis. What cutoffs for indexed effective orifice area (EOA) suggest severe, moderate, or mild PPM of an aortic valve prosthesis? What about for mitral valve prosthesis? What are the causes of prosthetic valve stenosis? How do you differentiate PPM from prosthetic valve stenosis using Doppler velocity index (DVI), acceleration time, and jet contour? What factors determine whether prosthetic valve stenosis should be treated with a transcatheter valve-in-valve procedure (ViV TAVR) versus reoperation? What factors determine whether prosthetic valve thrombosis should be treated with anticoagulation only, or additional fibrinolysis...
2024-09-0227 minHu Said: Cardiology Board Review Series4.18 Anticoagulation Targets After Valve ReplacementIn this episode, we review anticoagulant targets after valve replacement. What are the anticoagulation goals for mechanical and bioprosthetic valves? Why does a mechanical mitral valve have a higher INR target compared to a mechanical aortic valve? What are the risk factors that can increase the target INR for a mechanical aortic valve? How does the On-X mechanical valve’s anticoagulation regimen differ? What antiplatelet regimen is used after transcatheter valve replacement? Can direct oral anticoagulants (DOACs) be used in valve replacement patients? What are the guidelines for bridging anticoagulation before surgery? Tune in for answers to these questions....
2024-09-0113 minHu Said: Cardiology Board Review Series4.17 Infective Endocarditis Part 2In this episode, we continue our review on infective endocarditis (IE), covering antibiotic prophylaxis, prosthesis-related endocarditis, and device-related infections. Which are the high-risk cardiac conditions and high-risk procedures that warrant antibiotic prophylaxis for IE? How do the pathogens differ between early and late prosthetic valve endocarditis, and how do these impact prognosis and treatment? What are the common pathogens associated with endocarditis after transcatheter aortic valve replacement (TAVR), and why is diagnosing TAVR endocarditis particularly challenging? When endocarditis occurs in patients with cardiac devices such as pacemakers or ICDs, when is device removal mandatory? Tune in for answers to...
2024-08-3109 minHu Said: Cardiology Board Review Series4.16 Infective Endocarditis Part 1In this episode, we review the epidemiology, diagnosis, and management of infective endocarditis (IE). What five cardinal characteristics lead you to suspect a vegetation on echocardiography? Which heart valves are most commonly affected, and how does the microbial etiology differ between IV drug use and non-drug use-related endocarditis? When is it appropriate to repeat transthoracic echocardiography (TTE) or transesophageal echocardiography (TEE)? What features of left-sided endocarditis and right-sided endocarditis should prompt you to refer to early surgery? What is non-bacterial thrombotic endocarditis (NBTE)? Tune in for answers to these questions.
Difficulty Level: Easy
2024-08-3022 minHu Said: Cardiology Board Review Series4.15 Differentiating the Doppler envelope of AS, MR, TR, HOCMIn this episode, we review how to differentiate the Doppler signals of aortic stenosis (AS), mitral regurgitation (MR), tricuspid regurgitation (TR), and left ventricular outflow tract obstruction (LVOTO) in hypertrophic obstructive cardiomyopathy (HOCM) – as all four of these occur during the systolic phase of the cardiac cycle. Which jets are separated by the isovolumic contraction time (IVCT) and the isovolumic relaxation time (IVRT)? Which jets can blend into each other across cardiac cycles? Which jets are parabola-shaped, and which are dagger-shaped? How can the point of velocity aliasing on color Doppler distinguish between valvular AS from subaortic membrane? Tune in...
2024-08-2908 minHu Said: Cardiology Board Review Series4.14 Common Principles in Valve Regurgitation QuantificationIn this special episode, we sit down and examine the flowcharts for guideline-based quantification of aortic regurgitation (AR) severity, mitral regurgitation (MR) severity, and tricuspid regurgitation (TR) severity, and compare and contrast the differences in the cutoffs used, and the physiologic reasons for these differences. How are EROA and regurgitant volume thresholds the same or different across AR, MR, and TR, and why? Why is pressure half time only used in the algorithm for AR severity, but not MR and TR? Why is the proximal isovelocity surface area (PISA) radius omitted from the algorithm for AR severity, but included...
2024-08-2820 minHu Said: Cardiology Board Review Series4.13 Pulmonic Stenosis and Pulmonic RegurgitationIn this episode, we review pulmonic stenosis (PS) and pulmonic regurgitation (PR). How do you distinguish between the click of pulmonic stenosis, aortic stenosis, Ebstein anomaly, and mitral valve prolapse? What cutoffs in peak velocity and mean gradient define severe, moderate, and mild PS? What is branch PS? Is surgical repair or pulmonary balloon valvuloplasty preferred for the treatment of moderate and severe PS? What echocardiographic findings characterize severe PR? In patients who develop PR as a result of intervention for PS, in what situation is pulmonary valve replacement indicated in the absence of symptoms? Tune in for answers...
2024-08-2709 minHu Said: Cardiology Board Review Series4.12 Tricuspid Stenosis, Tricuspid Regurgitation, Carcinoid DiseaseIn this episode, we review tricuspid stenosis (TS) and tricuspid regurgitation (TR). What are the echocardiographic criteria for diagnosing severe TS, and how does it differ from that of severe mitral stenosis? Which etiology of TR would have diffuse leaflet thickening with restriction of opening due to commisural fusion, chordal shortening, and calcification with characteristic diastolic doming? Which etiology of TR would have short, thick leaflets with systolic and diastolic restriction? Which etiology of TR would have apical displacement of the tricuspid valve septal and posterior leaflets from the atrioventricular ring? What would the jugular venous pressure and central...
2024-08-2621 minHu Said: Cardiology Board Review Series4.11 Mitral Regurgitation ManagementIn this episode, we review the management of mitral regurgitation (MR). How is the management of chronic primary MR, chronic secondary, and acute MR different from each other? What is the relative difficulty of repair for Carpentier type I vs II vs III type MR? In patients with severe primary MR who are asymptomatic, what are the four factors which permit mitral valve surgery? Why does the LV end-systolic diameter (LVESD) matter in MR? Why is the ideal time for surgery for mitral valve regurgitation when LVEF is just dropping below 60% and LVESD is just widened to 40mm? Why...
2024-08-2526 minHu Said: Cardiology Board Review Series4.10 Mitral Regurgitatation QuantificationIn this episode, we review methods to quantify the severity of mitral regurgitation (MR), including the calculation of effective regurgitant orifice area (EROA) and regurgitant volume (RVol) by the proximal isovelocity surface area (PISA) method, and calculation of EROA and RVol using stroke volume by the continuity equation. What numerical cutoffs for EROA, RVol, and regurgitant fraction (RF) indicate severe MR? What does a vena contract width of ≥0.7cm versus ≤0.3cm suggest? What does a PISA radius of ≥1.0cm versus ≤0.3cm suggest? What does an enlarged LV versus a normal-sized LV suggest? What does a regurgitant fraction of ≥50% versus
2024-08-2426 minHu Said: Cardiology Board Review Series4.09 Mitral Regurgitation ClassificationIn this episode, we explore how mitral regurgitation (MR) is categorized based on anatomy, leaflet motion, and acuity. Are the A1, A2, A3, P1, P2, P3 scallops/segments of the mitral valve named from medial to lateral or lateral to medial? What is the difference between primary and secondary MR, and what are the most common etiologies of each? How does the Carpentier classification system categorize MR into types I, II, and III, based on leaflet and chord motion? What distinct features of Barlow disease and fibroelastic deficiency contribute to type II MR, and how do they differ in...
2024-08-2313 minHu Said: Cardiology Board Review Series4.08 Mitral StenosisIn this episode, we review mitral stenosis (MS), including its epidemiology, presentation, imaging features, and management. What are the main causes of MS? What do the the characteristic "fish mouth" and "hockey stick" signs on echocardiography signify regarding the etiology of MS? How do mitral valve area, pressure gradients, and pressure half-time factor into determining the severity of MS, and how are these parameters different from that of aortic stenosis? What are the 4 components of the Wilkins score? At what range of the Wilkins score is balloon mitral valvuloplasty recommended? What are contraindications to performing balloon mitral valvuloplasty? Tune...
2024-08-2222 minHu Said: Cardiology Board Review Series4.06 Aortic Regurgitation Types and ManagementIn this episode, we review the types, presentation, physical exam, and management of aortic regurgitation (AR). What is the difference between types Ia, Ib, Ic, Id, II, and III aortic regurgitation? Why is the murmur of acute AR barely audible compared to the murmur of chronic AR? What are Corrigan's pulse, Muller's sign, Quincke's sign, and De Musset's sign? What is the Austin Flint murmur? Why should vasoconstrictors such as phenylephrine, beta blockers and intra-aortic balloon pumps be avoided in acute AR? , focusing on acute and chronic AR. Why does the LV end-diastolic diameter (LVEDD) and LV end-systolic diameter...
2024-08-2017 minHu Said: Cardiology Board Review Series4.05 Aortic Valve ReplacementIn this episode, we explore the timing and indications for aortic valve replacement (AVR) in aortic stenosis (AS). Is it possible to qualify for AVR if AS is not severe, or if AS is asymptomatic? What are the key considerations when choosing between transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR), and when might palliation be more appropriate? What are the main types of TAVR valves? What are the access approaches for TAVR? What factors make a patient ineligible for TAVR? What are the rates of intra-procedural and post-procedural complications from TAVR? What anticoagulation or antiplatelet...
2024-08-1928 minHu Said: Cardiology Board Review Series4.04 Low Gradient, Bicuspid, Unicuspid, Subvalvular, and Supravalvular Aortic StenosisIn this episode, we explore various types of aortic valve stenosis (AS) other than conventional AS, including low-gradient AS, bicuspid and unicuspid valves, subvalvular and supravalvular AS. What is the difference between classical low flow low gradient AS, paradoxical low flow low gradient AS, and normal flow low gradient AS? What parameters on dobutamine stress echo allow you to and valvular computed tomography (CT) distinguish between true severe low-flow low-gradient AS and pseudo-severe AS? What additional structural heart defects are commonly associated with bicuspid aortic valve? Which are the most common cusps to be fused together in bicuspid AS...
2024-08-1820 minHu Said: Cardiology Board Review Series4.03 Valve Disease Epidemiology, Conventional Aortic StenosisIn this episode, we explore the epidemiology of valvular disease, and then jump in to aortic stenosis, focusing on the presentation, grading of severity, measurement of gradients on invasive and non-invasive modalities, and calculation of valve area. What is Heyde's syndrome? What is the Gallavardin phenomenon? What is pulsus parvus et tardus? What are the cutoffs for mild, moderate, and severe AS in dimensionless index, and what two variables make up the dimensionless index? What are the Gorlin and Hakki formulas for calculating aortic valve area? Why is the aortic stenosis gradient invariably different when measured on invasive catheterization...
2024-08-1728 minHu Said: Cardiology Board Review Series3.21 Post Heart TransplantIn this episode, we review post-heart transplant issues, including immunosuppression, rejection, complications, and long-term monitoring. What are the three phases of immunosuppression? How do calcineurin inhibitors, antimetabolites, and corticosteroids prevent rejection? What are the key differences between hyperacute rejection, acute cellular rejection, antibody-mediated rejection, and chronic rejection? At what frequency should heart transplant recipients undergo surveillance for coronary allograft vasculopathy? What factors increase the risk of post-transplant malignancy and infection? Why do heart transplant patients have a higher resting heart rate, and how does this affect their exercise capacity? Tune in for answers to these questions.
2024-08-1524 minHu Said: Cardiology Board Review Series3.20 Pre-Heart TransplantIn this episode, we review pre-heart transplantation issues, including indications for heart transplant, exclusion criteria for heart transplant, levels of listing for heart transplant, and serial testing while on the wait list. What is the definition of advanced heart failure? What are the indications for evaluation for heart transplant? What are major exclusion criteria for heart transplant? What frequency should serial tests such as right heart catheterization (RHC) and cardiopulmonary exercise testing (CPET) be performed for patients on the transplant waitlist? What steps should be taken to manage patients with HLA and ABO sensitization? What are some reasons for...
2024-08-1427 minHu Said: Cardiology Board Review Series3.19 Cardiopulmonary Exercise TestingIn this episode, we review cardiopulmonary exercise testing (CPET) and its role in heart failure management and transplant evaluation. What term describes the value at which oxygen uptake plateaus despite a continued increase in the intensity of exercise? What term describes the threshold during exercise at which lactic acid begins to accumulate in the blood and carbon dioxide production starts to rise disproportionately compared to oxygen consumption? How is the respiratory exchange ratio defined, and what does it indicate? What is the significance of a VO2 max under 14 mL/kg/min? How can the ventilatory equivalent slope (VE/VCO2...
2024-08-1310 minHu Said: Cardiology Board Review Series3.17 Left Ventricular Assist Devices Part 1In this episode, we review patient selection for left ventricular assist devices (LVADs), LVAD types, components, physiology, and troubleshooting. LVAD evaluation may be reasonable in patients in which INTERMACS profiles? What is the function of the driveline, system controller, pump cable, and rotor of the LVAD? What is a typical fixed speed, and how close should the actual speed be to the fixed speed? What low speed limit should you set relative to the fixed speed? Which parameter is inversely proportional to the difference in left ventricular pressure (P_inflow) and aortic pressure (P_outflow)? What is a normal...
2024-08-1228 minHu Said: Cardiology Board Review Series3.18 Left Ventricular Assist Devices Part 2In this episode, we review the use of imaging in assessing patients before and after LVAD implantation. What are concerning findings on pre-LVAD echocardiogram, other than an overly small left ventricular (LV) cavity? On post-LVAD echocardiogram, what emergency would be suggested by the combined findings of an increased left ventricular internal diameter at end diastole (LVIDd), worsened mitral regurgitation, septal shift toward the right ventricle, and increased aortic valve opening duration or frequency? What concerning development would be suggested by the combined findings of worsened tricuspid regurgitation, right ventricular enlargement, reduced right ventricular fractional area change, and septal shift...
2024-08-1216 minHu Said: Cardiology Board Review Series3.16 Intra-Aortic Balloon PumpsIn this episode, we go over the practical use and management of intra-aortic balloon pumps (IABP) in the cardiac intensive care unit. How does the IABP assist during systole and diastole, and what are the hemodynamic benefits of its inflation and deflation? What physiologic effects does the balloon pump have on cardiac output, coronary perfusion, left ventricular wall stress, pulmonary capillary wedge pressure, heart rate, and urine output? Why is helium used? What are key indications and contraindications for balloon pump placement? Where do you want the IABP to be located on monitoring chest X-ray? What level of diastolic...
2024-08-1018 minHu Said: Cardiology Board Review Series3.15 InotropesIn this episode, we review the use of inotropes in acute decompensated heart failure and cardiogenic shock? What are the effects of activating alpha-1 receptors, beta-1 receptors, and beta-2 receptors? What are the effects of inhibiting phosphodiesterase-5? What is the vasoconstriction-vs-inotropy-plot and where does each inotrope and vasopressor sit on the plot with respect to the intropy=0 vertical line or the vasoconstriction=0 horizontal line? In a patient with pulmonary hypertension with >3 Woods units of pulmonary vascular resistance, is dobutamine or milrinone a more appropriate choice? In a patient with acute kidney injury, is dobutamine or milrinone a more appropriate...
2024-08-0916 minHu Said: Cardiology Board Review Series3.14 Pressure Waveform InterpretationIn this episode, we review central venous pressure (CVP) waveform interpretation. What is signified by the a, c, and v waves, and the x and y descents? What do giant a peaks signify? What do cannon a waves signify? What does absent a peak signify? What does a prominent v peak or merged CV peak signify? What does a diminished v peak signify? What does a merged ACV peak signify? What does a rapid y descent signify? What does a rapid x descent signify? Tune in for answers to these questions.
Difficulty Level: Intermediate
2024-08-0809 minHu Said: Cardiology Board Review Series3.13 Pulmonary Artery (Swan-Ganz) CatheterizationIn this episode, we review pulmonary artery (Swan-Ganz) catheterization. What are indications and contraindications to pulmonary artery catheter placement? What variables make up the oxygen content equation and oxygen delivery equation? What is the difference between mixed venous oxygen saturation (SvO2) and central venous oxygen saturation (ScvO2)? What conditions cause elevated or depressed SvO2? What conditions cause elevated and depressed pulmonary vascular resistance (PVR) and systemic vascular resistance (SVR)? What are the drawbacks and advantages of Fick cardiac output versus thermodilution cardiac output? What is the pulmonary artery pressure index (PAPi) and cardiac power output (CPO), and how can...
2024-08-0728 minHu Said: Cardiology Board Review Series3.12 Right Ventricular FunctionIn this episode, we review the assessment of right ventricular (RV) size and function. What is the normal range of RV basal diameter, mid diameter, and longitudinal diameter? What are the relative advantages and drawbacks of tricuspid annular plane systolic excursion (TAPSE), tissue Doppler peak systolic velocity S’ at the tricuspid annulus, RV fractional area change (RV FAC), and RV index of myocardial performance (RIMP)? How are they calculated? Tune in for answers to these questions.
Difficulty Level: Advanced
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2024-08-0609 minHu Said: Cardiology Board Review Series3.10 Diuretic Resistance and Cardiorenal SyndromesIn this episode, we review the very common issue of diuretic resistance and cardiorenal syndromes. What are the key actions of diuretics along different segments of the nephron? How do factors like hypoalbuminemia, renal perfusion pressure, and competing anions reduce loop diuretic efficacy? What role does chronic RAAS activation play in creating sodium avidity in the distal tubules and collecting ducts? How can sequential nephron blockade help overcome diuretic resistance? What are the five types of cardiorenal syndrome? Why is it that BUN:Cr ratio is >20:1 in pre-renal acute kidney injury? What are situations in which fractional excretion of...
2024-08-0422 minHu Said: Cardiology Board Review Series3.09 Biomarkers and Lab Abnormalities in Heart FailureIn this episode, we review the role of biomarkers and lab abnormalities in congestive heart failure. What are ANP, BNP, CNP, and DNP? What effect does BNP have on glomerular filtration rate, urinary sodium excretion, adrenal aldosterone secretion, and peripheral vascular tone? What is the relationship between BNP and NTproBNP? What are some factors that increase BNP and NTproBNP? What are some factors that decrease BNP and NTproBNP? How should NTproBNP thresholds be adjusted in older adults and patients with obesity? Why does hyponatremia occur in acute decompensated heart failure? Tune in for answers to these questions.
2024-08-0309 minHu Said: Cardiology Board Review Series3.08 Acute Heart Failure DecompensationIn this episode, we review the presentation and management of acute heart failure decompensation (ADHF). Why is venous dilation with IV nitroglycerin beneficial in patients with ADHF? What are the four quadrants of the Forrester-Stevenson classification? What is the relative conversion between oral and IV loop diuretics? When is a right heart catheterization indicated? What is the difference between transferrin, total iron binding capacity (TIBC), ferritin, and transferrin saturation? How are absolute iron deficiency and functional iron deficiency defined? What is the role of oral versus intravenous iron in heart failure? What are the clinical criteria for diagnosis of...
2024-08-0229 minHu Said: Cardiology Board Review Series3.07 Chronic Heart Failure: Pathophysiology and GDMTIn this episode, we review chronic heart failure with reduced, mildly reduced, improved, and preserved ejection fraction (HFrEF, HFmrEF, HFimpEF, HFpEF). What are the stages of HF, and what therapies should be given to patients with pre-heart failure? What does adverse myocardial remodeling involve? While core GDMT for HFrEF is well-known, what constitutes core GDMT for HFpEF and HFmrEF? When should you use adjunctive GDMT such as ivabradine, vericiguat, digoxin, polyunsaturated fatty acids, and potassium binders? Tune in for answers to these questions.
Difficulty Level: Easy
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2024-08-0126 minHu Said: Cardiology Board Review Series3.06 Non-compaction cardiomyopathy, stress cardiomyopathy, and myocarditisIn this episode, we go over the diagnosis and management of non-compaction cardiomyopathy (LVNC), stress cardiomyopathy, and myocarditis. What imaging criteria are used to define LV noncompaction, and how does this differ between echocardiography and cardiac MRI? What are the most common microbes causing myocarditis? Can athletes with LVNC or myocarditis participate in competitive sports? Tune in for answers to these questions.
Difficulty Level: Easy
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2024-07-3116 minHu Said: Cardiology Board Review Series3.05 Dilated CardiomyopathiesIn this episode, we explore various forms of dilated cardiomyopathies (DCM) and their distinct features. What are the hallmark characteristics of idiopathic dilated cardiomyopathy on echocardiogram, and how does the sphericity index predict prognosis? How do we differentiate between dilated cardiomyopathies like sarcoidosis, peripartum cardiomyopathy, tachycardia-mediated cardiomyopathy, and hemochromatosis? How is sarcoidosis diagnosed using FDG-PET, and what are the prognostic indicators in laminopathies and arrhythmogenic right ventricular cardiomyopathy (ARVC)? What are the diagnostic features and treatment options for PVC-mediated cardiomyopathy and peripartum cardiomyopathy? Tune in for answers to these questions.
Difficulty Level: Easy
2024-07-3029 minHu Said: Cardiology Board Review Series3.04 Restrictive Cardiomyopathies, including AmyloidosisIn this episode, we review restrictive cardiomyopathies (RCM), including amyloidosis and hypereosinophilic syndrome. What is the ice-cream cone appearance of the atria? What is the cherry-on-top appearance on strain imaging? What is the difference between AL, SSA, ATTR, and AA amyloidosis – which ones never have cardiac involvement and which ones always have cardiac involvement? Which amyloidosis type is the only one assessed by PyP scan? How do tafamidis and patisiran work? What are the three stages of cardiac hypereosinophilic syndrome? What is Merlon sign? Which restrictive cardiomyopathy has a tendency for developing subvalvular thrombosis, causing entrapment of the mitral va...
2024-07-2917 minHu Said: Cardiology Board Review Series3.03 Other Hypertrophic CardiomyopathiesIn this episode, we explore types of hypertrophic cardiomyopathy (HCM) other than idiopathic HCM and obstructive HCM, including apical HCM, Fabry's disease, and Danon's disease. We also review an HCM-mimic, athlete's heart. What are 10 ways that athlete's heart can be distinguished from HCM on imaging? Which cardiomyopathies will have thinning (echogenecity) of the basal inferolateral wall instead of thinning of the basal septum? What genetic property accounts for why male patients with Danon disease are more severely affected than female patients and have younger onset? Tune in for answers to these questions.
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2024-07-2814 minHu Said: Cardiology Board Review Series3.02. HCM and HOCM Part 2In this episode, we explore the medical and surgical management of hypertrophic cardiomyopathy (HCM) and hypertrophic obstructive cardiomyopathy (HOCM). What cautions should you take with inotropes, vasodilators, diuretics, preload, and afterload in patients with HOCM? Do you initiate and uptitrate therapies based on symptoms, heart rate, QTc, or left ventricular outflow tract (LVOT) gradient? How does mavacamten work? What are the indications for referral to septal reduction therapy? What are the comparative benefits and drawbacks of surgical myectomy and alcohol septal ablation? How do you determine if ICD placement is indicated? Tune in for answers to these questions.
2024-07-2720 minHu Said: Cardiology Board Review Series3.01 HCM and HOCM Part 1In this episode, we review the diagnosis and imaging of hypertrophic cardiomyopathy (HCM) and hypertrophic obstructive cardiomyopathy (HOCM). How does the location of septal hypertrophy differ by age? Why does systolic anterior motion (SAM) of the mitral valve occur? What is the role of crypts in HCM? What is the Brockenbrough-Braunwald-Morrow sign? Tune in for answers to these questions.
Difficulty Level: Intermediate
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2024-07-2615 minHu Said: Cardiology Board Review Series2.19 Pre-operative Risk StratificationIn this episode, we review pre-operative cardiovascular risk stratification for noncardiac surgery. What is considered a low-risk surgery? What does "risk" refer too–risk of what? How are emergent surgery, urgent surgery, time-sensitive surgery, and elective surgery defined? How does functional capacity factor into decisions about preoperative testing? What are the cardinal steps for determining whether additional cardiac testing is needed pre-operatively? When is it appropriate to get a pre-operative echocardiogram, stress test, coronary CTA, or cardiac catheterization? How long must dual antiplatelet therapy (DAPT) be continued for a drug-eluting stent implanted for a presentation of acute coronary syndrome ve...
2024-07-2418 minHu Said: Cardiology Board Review Series2.18 INOCA, SCAD, Cocaine CardiotoxicityIn this episode, we explore ischemia with non-obstructive coronary arteries (INOCA). How is the diagnosis of microvascular angina (MVA) and vasospastic angina (VSA) made? What cutoffs in the index of microvascular resistance (IMR) and coronary flow reserve (CFR) are used to diagnose MVA and VSA? Which medication for treating MVA will worsen VSA? What factors increase risk of spontaneous coronary artery dissection (SCAD)? What is the consequence of cocaine's blockade of sodium channels and potassium channels? Tune in for answers to these questions.
Difficulty Level: Easy
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2024-07-2316 minHu Said: Cardiology Board Review Series2.17 Flow Reserve MeasurementsIn this episode, we explore flow reserve measurements used to determine lesion significance in coronary artery disease. What is the difference between hyperemic and non-hyperemic wire-derived ratios? Which different segments of diastole are instantaneous wave-free ratio (IFR), diastolic pressure ratio (DPR), and diastolic hyperemia-free ratio (DFR) measured at? What are the cutoffs for fractional flow reserve (FFR), Pd/Pa, resting full-cycle ratio (RFR), IFR, DPR, and DFR? What are the non-wire-based flow reserve measurements? Tune in for answers to these questions.
Difficulty Level: Advanced
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2024-07-2211 minHu Said: Cardiology Board Review Series2.16 Normal and Anomalous Coronary ArteriesIn this episode, we review the anatomy of normal coronary arteries and provide a systematic framework for thinking about coronary artery anomalies. How do you define proximal vs mid vs distal RCA, LAD, and LCX? What are the normal lengths of the RCA, LAD, and LCX? Which coronary artery anomalies have no clinical significance, and which are associated with sudden cardiac death? Which types of anomalous aortic origin of a coronary artery (AAOCA) are associated with higher risk of sudden cardiac death? How do the indications for surgery for anomalous right coronary artery from the left cusp (ARCA-L) differ...
2024-07-2112 minHu Said: Cardiology Board Review Series2.15 Complications of MIIn this episode, we explore the complications that can arise following myocardial infarction (MI). What is the Bezold-Jarisch reflex, and which territory of myocardial infarction (MI) predisposes to it? Where are LV aneurysms most likely to occur post-MI, and how can they be distinguished from LV pseudoaneurysms on echocardiography? Does accelerated idioventricular rhythm (AIVR) post-reperfusion carry any prognostic implications? What physical exam findings distinguish between posteromedial papillary muscle rupture and interventricular septal rupture? Does prior MI increase or decrease the risk of LV free wall rupture? Other than DAPT nonadherence, what factors are associated with development of stent thrombosis...
2024-07-2019 minHu Said: Cardiology Board Review Series2.14 FibrinolysisIn this episode, we explore the use of fibrinolysis in managing STEMI when PCI is not immediately available. What is the difference between streptokinase, alteplase, reteplase, and tenecteplase? What is the mandated door-to-needle time for receiving fibrinolytic? What is the window for onset of symptoms for which fibrinolysis is acceptable? What loading dose of antiplatelet should you use when giving fibrinolysis? How long should heparin be continued after fibrinolysis? What are the absolute and relative contraindications to giving fibrinolysis? Tune in for answers to these questions.
Difficulty Level: Easy
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2024-07-1908 minHu Said: Cardiology Board Review Series2.13 Percutaneous Coronary InterventionIn this episode, we explore key aspects of percutaneous coronary intervention (PCI) from the generalist’s perspective. What are the comparative risks of death, stroke, and major vascular complications in diagnostic catheterization versus PCI? What are the relative advantages and disadvantages of radial access over femoral access? What are the mandated durations for first medical contact to PCI, ED to PCI, and onset of symptoms to PCI? When and should a non-infarct artery be revascularized? In a patient with prior CABG, should you pursue PCI of the diseased native coronary artery or the diseased SVG? Tune in for answers to...
2024-07-1819 minHu Said: Cardiology Board Review Series2.12 Coronary Artery Bypass GraftingIn this episode, we explore key aspects of coronary artery bypass grafting (CABG) revascularization. What are the 10-year patency rates of internal mammary artery (IMA) grafts compared to saphenous venous grafts (SVGs), and what accounts for this difference? Is CABG or PCI a better option for revascularizing patients with left main disease? What about triple-vessel disease with reduced ejection fraction, triple-vessel disease with diabetes, triple-vessel disease with preserved ejection fraction, double-vessel disease, and single-vessel disease? How does one identify sternal wound infection, and how can one diagnose peri-CABG MI, given that troponin will be universally abnormal at baseline in...
2024-07-1730 minHu Said: Cardiology Board Review Series2.11 Preventive and Adjunctive Therapies in CADIn this episode, we review preventive and adjunctive therapies in the management of coronary artery disease (CAD). Who qualifies for cardiac rehabilitation (CR)? What are the four phases of CR? What is the difference between the DASH and Mediterranean diets? In which situations are pharmacologic therapies such as GLP-1 receptor agonists appropriate for weight loss in patients with CAD? How can exposure to air pollution and extreme environmental conditions impact cardiovascular health? What is PM2.5? What is the primary metabolite of nicotine, which serves as an effective biomarker of tobacco smoke exposure? How are bupropion, varenicline, and nicotine replacement...
2024-07-1621 minHu Said: Cardiology Board Review Series2.09 Post-MI Medications and Anti-Anginal MedicationsIn this episode, we review long-term medication therapy for CAD, including medications used post-myocardial infarction (MI) and medications used for anginal symptom relief in unrevascularizable CAD. What pathways do colchicine interrupt in the development of CAD? Is dual-antiplatelet therapy (DAPT) primarily for prevention of in-stent thrombosis or in-stent restenosis? How many months should you continue DAPT after percutaneous coronary intervention (PCI) for acute coronary syndrome versus after PCI for chronic coronary disease? In which post-MI patients should beta blockers, ACE inhibitors/ARBs, and statins be added? Among the anti-anginal medications beta blockers, nitrates, calcium channel blockers, and ranolazine, which...
2024-07-1424 minHu Said: Cardiology Board Review Series2.08 Antiplatelets and AnticoagulationIn this episode, we explore the role of antiplatelets and anticoagulants in managing acute coronary syndromes (ACS) and during percutaneous coronary intervention (PCI). How many days off clopidogrel, prasugrel, ticagrelor, and cangrelor is advised prior to proceeding to CABG? In patients not undergoing CABG, how does one decide which P2Y12 inhibitor to use? How do glycoprotein IIb/IIIa inhibitors such as abciximab, eptifibatide, and tirofiban prevent platelet aggregation, and in what situations are they indicated in PCI? What anticoagulant can be used in patients who present with ACS but are unable to take heparin due to allergy, religious...
2024-07-1317 minHu Said: Cardiology Board Review Series2.07 Hibernation and StunningIn this episode, we explore the concepts in myocardial hibernation and stunning. What is the difference between myocardial stunning, hibernation, and scar? What is considered viable and what is not? What cellular adaptations occur in the process of hibernation? What pattern of rest perfusion, stress perfusion, and FDG metabolism on FDG PET imaging would indicate hibernation instead of scar? What would a hypokinetic->better->worse response vs a hypokinetic->better->worse response imply on dobutamine stress echocardiogram? Tune in for answers to these questions.
Difficulty Level: Intermediate
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2024-07-1210 minHu Said: Cardiology Board Review Series2.06 Anatomic TestingIn this episode, we review anatomic testing for coronary artery disease. When can you draw upon coronary artery calcium (CAC) scoring to guide statin therapy? When can you use coronary CT angiography (CCTA) with CT-FFR? What are pitfalls of each? Should you choose anatomic testing or functional stress tests for your patients? Tune in for answers to these questions.
Difficulty Level: Easy
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2024-07-1115 minHu Said: Cardiology Board Review Series2.05 Stress TestingIn this episode, we review the essentials of stress testing, including indications and contraindications of exercise and pharmacologic stress agents, features and pitfalls of imaging-based stress, and a systematic framework for reporting stress test results. What are normal and abnormal ECG changes in response to stress? What baseline abnormalities render exercise ECG uninterpretable? When should you terminate a stress test prematurely? When should you give aminophylline to reverse the effect of regadenoson? Which findings on nuclear stress testing are associated with a >3% risk of annual mortality? Tune in for answers to these questions.
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2024-07-1029 minHu Said: Cardiology Board Review Series2.04 ACS Part 2In this episode, we review the presentation of acute coronary syndromes (ACS) and the Fourth Universal Definition of Myocardial Infarction (MI). What is the difference between myocardial injury, ischemia, and infarction? Why is the term "Type 2 NSTEMI" no longer appropriate? Why is the term "atypical angina" deprecated? What does the GRACE score and TIMI score contain? Tune in for answers to these questions.
Difficulty Level: Easy
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2024-07-0928 minHu Said: Cardiology Board Review Series2.03 ACS Part 1In this episode, we review ECG changes in acute coronary syndromes (ACS). What constitutes a significant vs a non-significant Q wave? Can the shape of the curve of the ST elevation or depression offer clues about whether the ST change is ischemic or non-ischemic? What types of infarctions would you not see reciprocal changes on in the standard ECG? How do you define Sgarbossa's criteria, Wellen's syndrome, and De Winter's syndrome? Tune in for answers to these questions.
Difficulty Level: Easy
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2024-07-0822 minHu Said: Cardiology Board Review Series2.02 Apolipoproteins, Lp(a) and Familial DyslipidemiasIn this episode, we review apolipoproteins, Lp(a), and familial dyslipidemias. What roles do apolipoproteins like ApoB48, ApoB100 and ApoA-I play in lipid transport and cardiovascular risk? Why is measuring Lp(a) in nmol/L more informative than mg/dL? Who should ApoB and Lp(a) level testing be sent on? How do conditions like familial hypercholesterolemia differ from dysbetalipoproteinemia or familial hypertriglyceridemia? Tune in for answers to these questions.
Difficulty Level: Intermediate
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2024-07-0721 minHu Said: Cardiology Board Review Series2.01 ASCVD Risk Estimation and Lipid LoweringIn this episode, we review ASCVD risk estimation and lipid-lowering therapies. What low-density lipoprotein cholesterol (LDL-C) level should be targeted for patients who have had an ASCVD event versus those who have not, and how do these target LDL-C levels vary based on the presence of risk factors, diabetes status, and estimated 10-year ASCVD risk? What equation recently replaced the pooled cohort equations for estimating 10-year risk of ASCVD, and what new variables are introduced in the updated equation? What does high, moderate, and low intensity statin mean? In which two populations do you bypass the classic ASCVD risk...
2024-07-0634 minHu Said: Cardiology Board Review Series1.19 Pacemaker and ICD ComplicationsIn this episode, we discuss common complications of pacemaker (PPM) and implantable cardioverter-defibrillator (ICD) implantation, along with considerations at the end of life. What are the risks of pacemaker pocket hematoma, pneumothorax, lead dislodgement, diaphragmatic stimulation, and muscular stimulation post-implantation, and how are these managed? What is twiddler's syndrome? What is the difference between pacemaker syndrome and pacemaker-mediated tachycardia, and how do they occur? When is it appropriate and necessary to deactivate an ICD at the end of life? Do PPMs need to be deactivated at the end of life? Tune in for answers to these questions.
2024-07-0410 minHu Said: Cardiology Board Review Series1.18 Pacemaker and ICD TermsIn this episode, we clarify key terms related to pacemakers (PPMs) and implantable cardioverter-defibrillators (ICDs). What do the common two-letter labels AR, VR, AS, VS, AP, VP, FD, TD, TP, CD, RV, and RT mean on EGM of an ICD? What is the relationship between the lower rate limit and the lower rate interval? What is the relationship between the post-ventricular atrial refractory period (PVARP) and the total atrial refractory period (TARP)? What is hysteresis? What is a typical upper tracking rate? What is fusion and pseudofusion? Tune in for answers to these questions.
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2024-07-0319 minHu Said: Cardiology Board Review Series1.17 Reduction of Ventricular DyssynchronyIn this episode, we explore the concept of ventricular dyssynchrony and cardiac resynchronization therapy (CRT). What are the eleven scenarios in which CRT is recommended, according to the 2022 heart failure guidelines? What benefits to patients receive when CRT is appropriately used? What factors could contribute to nonresponse to CRT? How can echocardiography be used to find the atrioventricular delay to optimize LV filling? Tune in for answers to these questions.
Difficulty Level: Intermediate
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2024-07-0212 minHu Said: Cardiology Board Review Series1.16 Programming ICD TherapiesIn this episode, we review the key aspects of ICD therapies. What are typical thresholds for a VT monitor zone, regular VT zone, fast VT zone, and VF zone? How is the number of intervals to detect (NID) defined deterministically vs probabilistically for VT vs VF detection? What is a typical rate and interval decrement for anti-tachycardia pacing (ATP)? What is the difference between a burst and a ramp of ATP? What do the B>AX, B>X, and B>A vectors for ICD shock describe? What are strategies for reducing inappropriate shocks? When is it appropriate to use...
2024-07-0120 minHu Said: Cardiology Board Review Series1.15 Pacemaker and ICD InterrogationIn this episode, we explore the fundamentals of permanent pacemaker (PPM) and implantable cardioverter-defibrillator (ICD) interrogation. What are the most common pacing modes, and when are they used? What is rate-adaptive pacing, mode switching, and managed ventricular pacing? What mode do you induce when you place a magnet? How do you perform a sensing test and a threshold test? What are the timing cycles in single-chamber pacing and dual-chamber pacing? What mode is induced when the device reaches the recommended replacement time (RRT), and how many months are left when RRT is reached? Tune in for answers to these...
2024-06-3032 minHu Said: Cardiology Board Review Series1.14 QT ProlongationIn this episode, we review QT prolongation and QT shortening. What is the QT interval, and how is it corrected (QTc) for heart rate variations? Which arrhythmogenic syndromes are associated with mutations in KCNQ1, KCNH2, and SCN5A? How do the T waves of long QT syndrome types 1, 2, and 3 differ? Which long QT syndrome is suggested by arrhythmia triggered from swimming? Which long QT syndrome is suggested by arrhythmia from noises and auditory triggers? Which long QT syndrome will need addition of mexiletine (on top of nadolol) sooner? What are the QT and QRS effects of hypocalcemia, hypomagnesemia, and...
2024-06-2919 minHu Said: Cardiology Board Review Series1.13 ARVC and CPVTIn this episode, we review arrhythmogenic right ventricular cardiomyopathy (ARVC) and catecholaminergic polymorphic VT (CPVT). Other than epsilon waves at the end of QRS complexes, what other features on ECG characterize ARVC? What are the echocardiographic and cardiac MRI findings of ARVC? Is diltiazem used in atrial fibrillation in patients with ARVC? What right ventricular ejection fraction makes an ARVC patient eligible for ICD placement? Can patients with ARVC participate in competitive sports? What is the difference between the bidirectional VT of CPVT and the bidirectional VT of digoxin toxicity? Can patients with CPVT participate in competitive sports? Tune...
2024-06-2811 minHu Said: Cardiology Board Review Series1.12 Brugada SyndromeIn this episode, we review Brugada Syndrome, syndrome of syncope and/or sudden death in healthy patients associated with mutations in SCN5A. How is Brugada pattern different from Brugada syndrome? How do you recognize the three main types, and how do they differ in management? Who should receive an implantable cardiac defibrillator, and who should receive antiarrhythmics such as quinidine? Tune in for answers to these questions.
Difficulty Level: Easy
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2024-06-2716 minHu Said: Cardiology Board Review Series1.11 Localizing the Origin of VT and PVCsIn this episode, we go over how to localize the origin of ventricular tachycardia (VT) and premature ventricular contractions (PVCs). What clues on ECG allow you to distinguish VT coming from outflow tracts vs the inferior ventricles? What clues on ECG allow you to distinguish VT arising from the LV free wall vs VT arising from the RV or inter-ventricular septum? Which types of VT have the highest procedural success rates with ablation? Which type of VT is verapamil-sensitive, and which is propranolol-sensitive? Can individuals with PVCs participate in competitive sports? Tune in for answers to these questions.
2024-06-2619 minHu Said: Cardiology Board Review Series1.10 Ventricular TachycardiaIn this episode, we explore the definitions, mechanisms, and management of ventricular tachycardia (VT). What is the significance of sustained vs non-sustained VT, and monomorphic vs polymorphic VT? How is VT storm defined in patients without implantable cardiac defibrillators (ICDs) vs those with ICDs? What are common doses of medications for VT storm? What are examples of appropriate and inappropriate shocks? What should you do about ICD shocks? What morphologies in lead aVR allow you to distinguish between VT and SVT with aberrancy? Tune in for answers to these questions.
Difficulty Level: Intermediate
2024-06-2520 minHu Said: Cardiology Board Review Series1.09 Mechanisms of ArrhythmiaIn this episode, we delve into the mechanisms of arrhythmias, exploring the roles of abnormal automaticity, early afterdepolarizations (EADs), and delayed afterdepolarizations (DADs). What is the difference between disorders of impulse formation and disorders of impulse conduction? How do the phases of the ventricular action potential (0, 1, 2, 3, 4) differ from the phases of the sinoatrial nodal action potential (4, 0, 3)? Which arrhythmias occur via abnormal automaticity vs normal automaticity? Which arrhythmias occur via early after depolarization (EAD) vs delayed afterdepolarization (DAD)? Which ventricular tachycardia subtypes do not occur via EADs or DADs? Tune in for answers to these questions.
2024-06-2414 minHu Said: Cardiology Board Review Series1.08 Left and Right Bundle Branch Blocks, Left and Right Ventricular HypertrophyIn this episode, we delve into the diagnosis and interpretation of left and right bundle branch blocks (LBBB and RBBB) and left and right ventricular hypertrophy (LVH and RVH). At what rate does bifascicular block progress to complete heart block? Can athletes with bundle branch blocks participate in competitive sports? What is the difference in the sensitivity and specificity for LVH of the Sokolow-Lyon criteria, the Cornell voltage summation criteria, and the Cornell product criteria? In which leads are you expected to have ST depression or ST elevation in LVH and RVH? Tune in for answers to these questions.
2024-06-2321 minHu Said: Cardiology Board Review Series1.07 Atrioventricular BlocksIn this episode, we review the diagnosis and management of atrioventricular blocks (AVB). What are the differences between first-degree, second-degree Mobitz I, second-degree Mobitz II), and third-degree AV blocks? What is Stokes-Adams attack? What are reversible etiologies of AV block other than medications and Lyme disease? What is the role of carotid sinus massage and exercise treadmill testing in determining the level of the block? When is a pacemaker indicated? Tune in for answers to these questions.
Difficulty Level: Easy
You are listening to Hu Said: Cardiology Board Review...
2024-06-2218 minHu Said: Cardiology Board Review Series1.06 Sinus Node DysfunctionIn this episode, we review sinus node dysfunction. What is the difference between sinus arrest, sinus pause, sinoatrial exit block, and non-conducted premature atrial contraction? How is 1st, 2nd, and 3rd degree sinoatrial exit block similar or different from 1st, 2nd, and 3rd degree atrioventricular block, and how is sinoatrial Wenckebach similar or different from atrioventricular Wenckebach? Which of these are undetectable on surface ECG? When should you provide permanent pacing in sinus node dysfunction? Which medications can be used for reversal of symptomatic bradycardia? Tune in for answers to these questions.
Difficulty Level...
2024-06-2121 min