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

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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

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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

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In this episode, we review mitral stenosis (MS), including its epidemiology, presentation, imaging features, and management. What are the main causes of MS? What do the the characteristic "fish mouth" and "hockey stick" signs on echocardiography signify regarding the etiology of MS? How do mitral valve area, pressure gradients, and pressure half-time factor into determining the severity of MS, and how are these parameters different from that of aortic stenosis? What are the 4 components of the Wilkins score? At what range of the Wilkins score is balloon mitral valvuloplasty recommended? What are contraindications to performing balloon mitral valvuloplasty? Tune in for answers to these questions.

Difficulty Level: Intermediate

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In this episode, we review the types, presentation, physical exam, and management of aortic regurgitation (AR). What is the difference between types Ia, Ib, Ic, Id, II, and III aortic regurgitation? Why is the murmur of acute AR barely audible compared to the murmur of chronic AR? What are Corrigan's pulse, Muller's sign, Quincke's sign, and De Musset's sign? What is the Austin Flint murmur? Why should vasoconstrictors such as phenylephrine, beta blockers and intra-aortic balloon pumps be avoided in acute AR? , focusing on acute and chronic AR. Why does the LV end-diastolic diameter (LVEDD) and LV end-systolic diameter (LVESD) matter in asymptomatic severe AR? What are the LVEDD, LVESD, and LV ejection fraction thresholds that prompt referral for aortic valve replacement in patients with chronic AR who are asymptomatic? Tune in for answers to these questions.

Difficulty Level: Intermediate

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In this episode, we explore the timing and indications for aortic valve replacement (AVR) in aortic stenosis (AS). Is it possible to qualify for AVR if AS is not severe, or if AS is asymptomatic? What are the key considerations when choosing between transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR), and when might palliation be more appropriate? What are the main types of TAVR valves? What are the access approaches for TAVR? What factors make a patient ineligible for TAVR? What are the rates of intra-procedural and post-procedural complications from TAVR? What anticoagulation or antiplatelet therapy should patients be on post-TAVR? Tune in for answers to these questions.

Difficulty Level: Intermediate

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In this episode, we explore various types of aortic valve stenosis (AS) other than conventional AS, including low-gradient AS, bicuspid and unicuspid valves, subvalvular and supravalvular AS. What is the difference between classical low flow low gradient AS, paradoxical low flow low gradient AS, and normal flow low gradient AS? What parameters on dobutamine stress echo allow you to and valvular computed tomography (CT) distinguish between true severe low-flow low-gradient AS and pseudo-severe AS? What additional structural heart defects are commonly associated with bicuspid aortic valve? Which are the most common cusps to be fused together in bicuspid AS? What are the hallmark features of Shone complex? How do supravalvular and subvalvular aortic stenosis differ in their hemodynamic properties? Tune in for answers to these questions.

Difficulty Level: Intermediate

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In this episode, we explore the epidemiology of valvular disease, and then jump in to aortic stenosis, focusing on the presentation, grading of severity, measurement of gradients on invasive and non-invasive modalities, and calculation of valve area. What is Heyde's syndrome? What is the Gallavardin phenomenon? What is pulsus parvus et tardus? What are the cutoffs for mild, moderate, and severe AS in dimensionless index, and what two variables make up the dimensionless index? What are the Gorlin and Hakki formulas for calculating aortic valve area? Why is the aortic stenosis gradient invariably different when measured on invasive catheterization vs transthoracic echocardiogram? Tune in for answers to these questions.

Difficulty Level: Intermediate

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In this episode, we review post-heart transplant issues, including immunosuppression, rejection, complications, and long-term monitoring. What are the three phases of immunosuppression? How do calcineurin inhibitors, antimetabolites, and corticosteroids prevent rejection? What are the key differences between hyperacute rejection, acute cellular rejection, antibody-mediated rejection, and chronic rejection? At what frequency should heart transplant recipients undergo surveillance for coronary allograft vasculopathy? What factors increase the risk of post-transplant malignancy and infection? Why do heart transplant patients have a higher resting heart rate, and how does this affect their exercise capacity? 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