Hu Said: Cardiology Board Review Series

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

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

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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

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

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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

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

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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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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 as a result of intervention for PS, in what situation is pulmonary valve replacement indicated in the absence of symptoms? 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 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 etiology of TR would have apical displacement of the tricuspid valve septal and posterior leaflets from the atrioventricular ring? What would the jugular venous pressure and central venous pressure waveform of TR show? What are the qualitative, semiquantitative, and quantitative features on echo for quantifying TR severity? Are there any indications for moderate TR to undergo tricuspid valve surgery? Are there any indications for asymptomatic severe TR to undergo tricuspid valve surgery? 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 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 when LVEF is just dropping below 60% and LVESD is just widened to 40mm? Why is guideline-directed therapy especially important in chronic secondary MR? What is the management of acute MR? 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 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 radius of ≥1.0cm versus ≤0.3cm suggest? What does an enlarged LV versus a normal-sized LV suggest? What does a regurgitant fraction of ≥50% versus <30% suggest? Why does late systolic MR often result in discrepancies between EROA and RVol? 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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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 disease and fibroelastic deficiency contribute to type II MR, and how do they differ in presentation? How does acute severe MR differ from chronic MR in physical exam and Doppler echo findings? What are the characteristic findings of rheumatic and ischemic MR on echocardiography? 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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More MedEd resources available at ⁠www.rueyhu.com⁠

Updates at Twitter/X: ⁠@Ruey_Hu⁠