What right ventricular end-systolic volume should guide timing of pulmonary valve replacement in tetralogy of Fallot? At what pulmonary vascular resistance can closure be pursued for an atrial septal defect in patients with pulmonary hypertension? How often should Fontan patients receive liver imaging and alpha-fetoprotein screening? Should patients with Eisenmenger syndrome be routinely anticoagulated? What is the maternal mortality risk for pregnancy in Eisenmenger syndrome? Should most pregnant patients with adult congenital heart disease undergo cesarean delivery? Should cyanotic ACHD patients undergo prophylactic phlebotomy? Can ACHD patients participate in competitive sports? Watch for answers to these key questions in this "deep dive" of the 2025 ACC/AHA Guideline for the Management of Adults with Congenital Heart Disease.Difficulty Level: Advanced

This episode also available on YouTube: https://youtu.be/IYTn5bjiHqY

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What is the new term for hypertensive urgency? When is single-pill combination antihypertensive indicated? Do ACEI/ARB, MRA, and thiazide or potassium-sparing diuretics need to be held for initial testing of primary aldosteronism? In what neurologic condition should systolic BP be acutely lowered to 130-139 mmHg for 7 days, but not lower than 130 mmHg? Does BP control reduce the risk of dementia? In whom is renal denervation indicated and not indicated? Tune in for answers to these questions in this "deep dive" of the 2025 AHA/ACC Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults.

Watch on YouTube: https://www.youtube.com/watch?v=BkObt8kU9Es

Difficulty Level: Easy

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Can music help us understand cardiac arrhythmias? 🎵💓 In this special podcast episode, I explore how musical notation can be used to visualize and "hear" ECG rhythms, providing an intuitive and structured approach to learning atrial fibrillation, AV blocks, ventricular tachycardia, and more. By "hearing" arrhythmias and "reading" them in a musical framework, trainees can develop an alternative approach to ECG interpretation, reinforcing pattern recognition through both visual and auditory learning modalities.Musical score published in JACC Clinical Electrophysiology:
https://doi.org/10.1016/j.jacep.2025.02.022📖 Musical notation as a novel framework for ECG teaching:🎼 Atrial activity (P waves) = High-pitched chimes🥁 Ventricular beats (QRS complexes) = Low-pitched snare drumNote Durations Reflect Physiological Intervals:🔹 P wave = 32nd note → Approximates a normal PR interval (120-200 ms)🔹 PR prolongation (1° AV block) = 16th note → Reflects delay in AV node conduction🔹 Dropped beats (2° AV block) = Missing notes → Represent non-conducted impulses🔹 Rapid rhythms (VT, SVT) = Increased tempo → Matches clinical tachycardia rates🔹 Irregular rhythms (AFib, MAT) = Variable note spacing → Captures unpredictable R-R intervalsThis lecture is designed for medical students, cardiology fellows, electrophysiologists, and music lovers who want to experience a new way of learning cardiology! I have also provided this talk to JACC: Clinical Electrophysiology as a Supplemental Video. Please see the paper here.

Tweetorial: https://x.com/ruey_hu/status/1919074533354656101🔔 Subscribe for more cardiology and medical education content!📢 Leave a comment below: What other arrhythmias can be represented through classical music notation? Let’s discuss!#Cardiology #MedicalEducation #ECG #Arrhythmia #MusicAndMedicine #Electrophysiology #HeartRhythm

Should 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 questions in this "deep dive" of the 2025 AHA/ACC Guideline for the Management of Patients with Acute Coronary Syndromes.

Bonus – Accompanying YouTube Talk: https://www.youtube.com/watch?v=MccydgyxK_I

Difficulty Level: Intermediate

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In 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 are these complications managed? Tune in for answers to these questions.

Difficulty Level: Advanced

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In 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 is the Rastelli surgery indicated? How can you distinguish truncus arteriosus from tetralogy of Fallot with pulmonary atresia on imaging? Tune in for answers to these questions.

Difficulty Level: Advanced

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In 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 conduits, and when should they be replaced? Tune in for answers to these questions.

Difficulty Level: Intermediate

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In 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 in post-TOF repair patients who have moderate or severe PR that is asymptomatic? Tune in for answers to these questions.

Difficulty Level: Advanced

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In 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 transcatheter intervention? What are the long-term complications after repair? When should you suspect re-coarctation after CoA repair? Tune in for answers to these questions.

Difficulty Level: Intermediate

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In 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 ASD and VSD? Tune in for answers to these questions.

Difficulty Level: Intermediate

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