Hu Said: Cardiology Board Review Series

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

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

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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

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

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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

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

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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

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

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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

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

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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

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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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More MedEd resources available at ⁠⁠⁠www.rueyhu.com⁠⁠⁠

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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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More MedEd resources available at ⁠⁠⁠www.rueyhu.com⁠⁠⁠

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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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More MedEd resources available at ⁠⁠⁠www.rueyhu.com⁠⁠⁠

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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

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

Please subscribe, rate, and support the channel! Ads help keep materials free for everyone.

More MedEd resources available at ⁠⁠www.rueyhu.com⁠⁠

Updates at Twitter/X: ⁠⁠@Ruey_Hu⁠