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PODCAST

Hu Said: Cardiology Board Review Series

Ruey Hu, MD, MPH

Welcome to Hu Said, a cardiology #MedEd podcast. Every episode cuts straight to the core of the topic, delivering the high-yield information you need to know for your exams. In this 2nd season of the podcast, new topics have been added, with >100 total topics. Whenever possible, evidence-based statements from the latest ACC/AHA/HRS/HFSA/SCAI guidelines are interwoven. Whether you are a resident, fellow, or re-certifying cardiologist, subscribe for precise, curated pearls. Ensure you get maximum

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All Episodes

00:22:01

4.16 Infective Endocarditis Part 1

Hu Said: Cardiology Board Review Series ·

2024/08/30

In 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

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00:08:21

4.15 Differentiating the Doppler envelope of AS, MR,...

Hu Said: Cardiology Board Review Series ·

2024/08/29

In 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

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00:20:45

4.14 Common Principles in Valve Regurgitation...

Hu Said: Cardiology Board Review Series ·

2024/08/28

In 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

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00:09:21

4.13 Pulmonic Stenosis and Pulmonic Regurgitation

Hu Said: Cardiology Board Review Series ·

2024/08/27

In 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

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00:21:37

4.12 Tricuspid Stenosis, Tricuspid Regurgitation,...

Hu Said: Cardiology Board Review Series ·

2024/08/26

In 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

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00:26:44

4.11 Mitral Regurgitation Management

Hu Said: Cardiology Board Review Series ·

2024/08/25

In 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

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00:26:41

4.10 Mitral Regurgitatation Quantification

Hu Said: Cardiology Board Review Series ·

2024/08/24

In 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

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00:13:19

4.09 Mitral Regurgitation Classification

Hu Said: Cardiology Board Review Series ·

2024/08/23

In 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

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00:22:45

4.08 Mitral Stenosis

Hu Said: Cardiology Board Review Series ·

2024/08/22

In 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

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00:17:49

4.06 Aortic Regurgitation Types and Management

Hu Said: Cardiology Board Review Series ·

2024/08/20

In 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

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00:28:49

4.05 Aortic Valve Replacement

Hu Said: Cardiology Board Review Series ·

2024/08/19

In 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

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00:20:52

4.04 Low Gradient, Bicuspid, Unicuspid, Subvalvular,...

Hu Said: Cardiology Board Review Series ·

2024/08/18

In 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

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00:28:13

4.03 Valve Disease Epidemiology, Conventional Aortic...

Hu Said: Cardiology Board Review Series ·

2024/08/17

In 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

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00:24:04

3.21 Post Heart Transplant

Hu Said: Cardiology Board Review Series ·

2024/08/15

In 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

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00:27:18

3.20 Pre-Heart Transplant

Hu Said: Cardiology Board Review Series ·

2024/08/14

In 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

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00:10:14

3.19 Cardiopulmonary Exercise Testing

Hu Said: Cardiology Board Review Series ·

2024/08/13

In 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,

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00:16:20

3.18 Left Ventricular Assist Devices Part 2

Hu Said: Cardiology Board Review Series ·

2024/08/12

In 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

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00:28:53

3.17 Left Ventricular Assist Devices Part 1

Hu Said: Cardiology Board Review Series ·

2024/08/12

In 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

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00:18:17

3.16 Intra-Aortic Balloon Pumps

Hu Said: Cardiology Board Review Series ·

2024/08/10

In 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

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00:16:24

3.15 Inotropes

Hu Said: Cardiology Board Review Series ·

2024/08/09

In 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

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