In 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 pulmonary artery pressure from non-invasive imaging? Tune in for answers to these questions.

Difficulty Level: Intermediate

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In 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 endarterectomy (PEA), balloon pulmonary angioplasty (BPA), or sGCS? Tune in for answers to these questions.

Difficulty Level: Easy

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In 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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In 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.

Difficulty Level: Easy

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In 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 versus surgery? Tune in for answers to these questions.

Difficulty Level: Advanced

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In 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.

Difficulty Level: Intermediate

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In 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 these questions.

Difficulty Level: Easy

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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 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

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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? 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 for answers to these questions.

Difficulty Level: Advanced

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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 not MR and TR? Why is the proximal isovelocity surface area (PISA) radius omitted from the algorithm for AR severity, but included in that of MR and TR severity? What vena contracta width cutoff for mild, moderate, and severe regurgitation holds true across AR, MR and TR? Which vessel is interrogated in examining flow reversal in AR, MR, and TR? Which cardiac chamber's dimensions are measured in examining severity of AR, MR, and TR? Tune in for answers to these questions.

Difficulty Level: Advanced

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

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