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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

00:09:58

3.14 Pressure Waveform Interpretation

Hu Said: Cardiology Board Review Series ·

2024/08/08

In 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

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00:09:24

3.13 Right Ventricular Function

Hu Said: Cardiology Board Review Series ·

2024/08/07

In 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

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00:28:09

3.13 Pulmonary Artery (Swan-Ganz) Catheterization

Hu Said: Cardiology Board Review Series ·

2024/08/07

In 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

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00:22:54

3.11 Diuretic Resistance and Cardiorenal Syndromes

Hu Said: Cardiology Board Review Series ·

2024/08/05

In 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

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00:35:55

3.11 Diastolic Function and Dysfunction

Hu Said: Cardiology Board Review Series ·

2024/08/05

In this episode, we review diastolic function and diastolic dysfunction. What are the four phases of diastole? What are the characteristics of normal diastolic filling patterns, and how do they change in mild, moderate, and severe diastolic dysfunction? How do the E and A waves on Doppler of mitral inflow evolve with increasing stages of diastolic dysfunction? How do E and A waves vary with age, preload, and heart rate? What does the L wave (mid-diastolic flow across the mitral valve) represent? How

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00:09:32

3.10 Biomarkers and Lab Abnormalities in Heart Failure

Hu Said: Cardiology Board Review Series ·

2024/08/04

In 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

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00:29:10

3.08 Acute Heart Failure Decompensation

Hu Said: Cardiology Board Review Series ·

2024/08/02

In 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

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00:26:17

3.07 Chronic Heart Failure: Pathophysiology and GDMT

Hu Said: Cardiology Board Review Series ·

2024/08/01

In 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

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00:16:57

3.06 Non-compaction cardiomyopathy, stress...

Hu Said: Cardiology Board Review Series ·

2024/07/31

In 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 You are listening to Hu Said: Cardiology Board

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00:29:00

3.05 Dilated Cardiomyopathies

Hu Said: Cardiology Board Review Series ·

2024/07/30

In 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

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00:17:16

3.04 Restrictive Cardiomyopathies, including Amyloidosis

Hu Said: Cardiology Board Review Series ·

2024/07/29

In 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

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00:14:00

3.03 Other Hypertrophic Cardiomyopathies

Hu Said: Cardiology Board Review Series ·

2024/07/28

In 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

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00:20:23

3.02. HCM and HOCM Part 2

Hu Said: Cardiology Board Review Series ·

2024/07/27

In 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

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00:15:51

3.01 HCM and HOCM Part 1

Hu Said: Cardiology Board Review Series ·

2024/07/26

In 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 You are listening to Hu Said: Cardiology Board Review Series (2024-2025

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00:18:53

3.19 Pre-operative Risk Stratification

Hu Said: Cardiology Board Review Series ·

2024/07/24

In 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

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00:16:53

2.18 INOCA, SCAD, Cocaine Cardiotoxicity

Hu Said: Cardiology Board Review Series ·

2024/07/23

In 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

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00:11:02

2.17 Flow Reserve Measurements

Hu Said: Cardiology Board Review Series ·

2024/07/22

In 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

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00:12:36

2.16 Normal and Anomalous Coronary Arteries

Hu Said: Cardiology Board Review Series ·

2024/07/21

In 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

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00:19:11

2.15 Complications of MI

Hu Said: Cardiology Board Review Series ·

2024/07/20

In 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

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00:08:42

2.14 Fibrinolysis

Hu Said: Cardiology Board Review Series ·

2024/07/19

In 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

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