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

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In this episode, we review pre-heart transplantation issues, including indications for heart transplant, exclusion criteria for heart transplant, levels of listing for heart transplant, and serial testing while on the wait list. What is the definition of advanced heart failure? What are the indications for evaluation for heart transplant? What are major exclusion criteria for heart transplant? What frequency should serial tests such as right heart catheterization (RHC) and cardiopulmonary exercise testing (CPET) be performed for patients on the transplant waitlist? What steps should be taken to manage patients with HLA and ABO sensitization? What are some reasons for delisting a patient? 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 cardiopulmonary exercise testing (CPET) and its role in heart failure management and transplant evaluation. What term describes the value at which oxygen uptake plateaus despite a continued increase in the intensity of exercise? What term describes the threshold during exercise at which lactic acid begins to accumulate in the blood and carbon dioxide production starts to rise disproportionately compared to oxygen consumption? How is the respiratory exchange ratio defined, and what does it indicate? What is the significance of a VO2 max under 14 mL/kg/min? How can the ventilatory equivalent slope (VE/VCO2) contribute to assessing heart failure prognosis, even when VO2 max is not conclusive? By how much does the cardiac output increase during exercise? 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 the use of imaging in assessing patients before and after LVAD implantation. What are concerning findings on pre-LVAD echocardiogram, other than an overly small left ventricular (LV) cavity? On post-LVAD echocardiogram, what emergency would be suggested by the combined findings of an increased left ventricular internal diameter at end diastole (LVIDd), worsened mitral regurgitation, septal shift toward the right ventricle, and increased aortic valve opening duration or frequency? What concerning development would be suggested by the combined findings of worsened tricuspid regurgitation, right ventricular enlargement, reduced right ventricular fractional area change, and septal shift toward the right ventricle? How does the PW Doppler tracing of LVAD inflow cannula interrogation differ from the PW Doppler tracing of LVAD outflow cannula interrogation? Does a higher S:D velocity ratio suggest better or worse LV function? Severe regurgitation of which valve produces a blind loop of flow? In assessing aortic regurgitation (AR) in a patient with an LVAD, why is not permissible to use AR pressure half time? The equation π×(RVOT radius)^2×RVOT VTI×HR is used to calculate what volume? What is a ramp study? When performing a ramp study, what maneuver results in a reduction in native mitral regurgitation volume, increase in the pulsatility of the LVAD outflow, and reduction in the frequency of native aortic valve opening and closing? What are reasons to terminate a ramp study? 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 patient selection for left ventricular assist devices (LVADs), LVAD types, components, physiology, and troubleshooting. LVAD evaluation may be reasonable in patients in which INTERMACS profiles? What is the function of the driveline, system controller, pump cable, and rotor of the LVAD? What is a typical fixed speed, and how close should the actual speed be to the fixed speed? What low speed limit should you set relative to the fixed speed? Which parameter is inversely proportional to the difference in left ventricular pressure (P_inflow) and aortic pressure (P_outflow)? What is a normal range for flow? What does a gradual creep-up in power required suggest? Which parameter is defined as 10 times the (Power_Max - Power_Min)/Power_Avg, over 15-second intervals? What is a normal range for pulsatility index (PI)? What is a PI event? What are triggers of PI events other than suction events? How do LVAD parameters like speed, flow, power, and pulsatility index help in monitoring and troubleshooting device function? What is the approach to LVAD thrombosis, bleeding, and ventricular arrhythmias? What mean arterial blood pressure should be targeted in patients with LVAD? Tune in for answers to these questions.

Difficulty Level: Advanced

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In this episode, we go over the practical use and management of intra-aortic balloon pumps (IABP) in the cardiac intensive care unit. How does the IABP assist during systole and diastole, and what are the hemodynamic benefits of its inflation and deflation? What physiologic effects does the balloon pump have on cardiac output, coronary perfusion, left ventricular wall stress, pulmonary capillary wedge pressure, heart rate, and urine output? Why is helium used? What are key indications and contraindications for balloon pump placement? Where do you want the IABP to be located on monitoring chest X-ray? What level of diastolic augmentation and assisted end-diastolic pressure do you want to see for the IABP to be effective? When should you use ECG trigger, pressure trigger, pacemaker trigger, and asynchronous mode? How do you recognize and troubleshoot early or late inflation and deflation? What steps should be taken if balloon perforation is suspected? What are best practices for weaning a patient off the balloon pump? 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 use of inotropes in acute decompensated heart failure and cardiogenic shock? What are the effects of activating alpha-1 receptors, beta-1 receptors, and beta-2 receptors? What are the effects of inhibiting phosphodiesterase-5? What is the vasoconstriction-vs-inotropy-plot and where does each inotrope and vasopressor sit on the plot with respect to the intropy=0 vertical line or the vasoconstriction=0 horizontal line? In a patient with pulmonary hypertension with >3 Woods units of pulmonary vascular resistance, is dobutamine or milrinone a more appropriate choice? In a patient with acute kidney injury, is dobutamine or milrinone a more appropriate choice? What are the main contraindications for each inotrope? Tune in for answers to these questions.

Difficulty Level: Intermediate

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In this episode, we review central venous pressure (CVP) waveform interpretation. What is signified by the a, c, and v waves, and the x and y descents? What do giant a peaks signify? What do cannon a waves signify? What does absent a peak signify? What does a prominent v peak or merged CV peak signify? What does a diminished v peak signify? What does a merged ACV peak signify? What does a rapid y descent signify? What does a rapid x descent signify? Tune in for answers to these questions.

Difficulty Level: Intermediate

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In this episode, we review pulmonary artery (Swan-Ganz) catheterization. What are indications and contraindications to pulmonary artery catheter placement? What variables make up the oxygen content equation and oxygen delivery equation? What is the difference between mixed venous oxygen saturation (SvO2) and central venous oxygen saturation (ScvO2)? What conditions cause elevated or depressed SvO2? What conditions cause elevated and depressed pulmonary vascular resistance (PVR) and systemic vascular resistance (SVR)? What are the drawbacks and advantages of Fick cardiac output versus thermodilution cardiac output? What is the pulmonary artery pressure index (PAPi) and cardiac power output (CPO), and how can PAPi and CPO be used to make decisions in cardiogenic shock? Is left ventricular end-diastolic pressure (LVEDP) synonymous with as wedge pressure? Tune in for answers to these questions.

Difficulty Level: Intermediate

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In this episode, we review the assessment of right ventricular (RV) size and function. What is the normal range of RV basal diameter, mid diameter, and longitudinal diameter? What are the relative advantages and drawbacks of tricuspid annular plane systolic excursion (TAPSE), tissue Doppler peak systolic velocity S’ at the tricuspid annulus, RV fractional area change (RV FAC), and RV index of myocardial performance (RIMP)? How are they calculated? 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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