Hu Said: Cardiology Board Review Series

In 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 is surgery or percutaneous intervention indicated? Tune in for answers to these questions.

Difficulty Level: Easy

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In 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 is an endoleak? Tune in for answers to these questions.

Difficulty Level: Easy

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

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In 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, aortic annulus, and left ventricular outflow tract, which lengths should be measured leading edge to leading edge, and which should be measured inner edge to inner edge on echocardiography? Which should be measured in end-diastole and which should be measured in mid-systole? In what situation is echo sufficient for monitoring ascending aorta dilation instead of CT/MRI? How often should you perform serial imaging for monitoring of ascending aorta dilation that has not yet met the cutoff for surgical intervention? What does medical management consist of? What are manifestations of Marfan's syndrome other than aortic root dilation, and how are they similar or different than the manifestations of Ehlers-Danlos' syndrome? What does bifid uvula suggest? Which syndrome presents with foot pain, multiple food allergies, and bifid uvula? Tune in for answers to these questions.

Difficulty Level: Intermediate

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

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In 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 is it reasonable to discontinue therapy? Tune in for answers to these questions.

Difficulty Level: Easy

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

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In 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 these questions.

Difficulty Level: Easy

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

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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

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

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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

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

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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

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

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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

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

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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

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

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Updates at Twitter/X: ⁠@Ruey_Hu⁠