In this episode, we review diastolic function and diastolic dysfunction. What are the four phases of diastole? What are the characteristics of normal diastolic filling patterns, and how do they change in mild, moderate, and severe diastolic dysfunction? How do the E and A waves on Doppler of mitral inflow evolve with increasing stages of diastolic dysfunction? How do E and A waves vary with age, preload, and heart rate? What does the L wave (mid-diastolic flow across the mitral valve) represent? How do the E/e' ratio on TDI of the basal segment of the lateral and septal walls evolve with increasing stages of diastolic dysfunction? When is it invalid to use E/e’ for estimating diastolic dysfunction? On PW Doppler of the pulmonary veins, why is S>D in mild diastolic dysfunction? Why does atrial reversal flow in the pulmonary vein increase in moderate and severe diastolic dysfunction? How can diastolic dysfunction be assessed in patients with atrial fibrillation? What additional findings are seen during a diastolic stress test? Tune in for answers to these questions.

In this episode, we review the very common issue of diuretic resistance and cardiorenal syndromes. What are the key actions of diuretics along different segments of the nephron? How do factors like hypoalbuminemia, renal perfusion pressure, and competing anions reduce loop diuretic efficacy? What role does chronic RAAS activation play in creating sodium avidity in the distal tubules and collecting ducts? How can sequential nephron blockade help overcome diuretic resistance? What are the five types of cardiorenal syndrome? Why is it that BUN:Cr ratio is >20:1 in pre-renal acute kidney injury? What are situations in which fractional excretion of sodium (FENa) can be <1% even if there is no volume depletion? Tune in for answers to these questions.

Difficulty Level: Easy

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In this episode, we review the role of biomarkers and lab abnormalities in congestive heart failure. What are ANP, BNP, CNP, and DNP? What effect does BNP have on glomerular filtration rate, urinary sodium excretion, adrenal aldosterone secretion, and peripheral vascular tone? What is the relationship between BNP and NTproBNP? What are some factors that increase BNP and NTproBNP? What are some factors that decrease BNP and NTproBNP? How should NTproBNP thresholds be adjusted in older adults and patients with obesity? Why does hyponatremia occur in acute decompensated heart failure? Tune in for answers to these questions.

Difficulty Level: Easy

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In this episode, we review the presentation and management of acute heart failure decompensation (ADHF). Why is venous dilation with IV nitroglycerin beneficial in patients with ADHF? What are the four quadrants of the Forrester-Stevenson classification? What is the relative conversion between oral and IV loop diuretics? When is a right heart catheterization indicated? What is the difference between transferrin, total iron binding capacity (TIBC), ferritin, and transferrin saturation? How are absolute iron deficiency and functional iron deficiency defined? What is the role of oral versus intravenous iron in heart failure? What are the clinical criteria for diagnosis of cardiogenic shock, and the invasive hemodynamic criteria for diagnosis of cardiogenic shock? What cutoffs in pulmonary artery pulse index (PAPi), central venous pressure to wedge ratio characterize right ventricular shock? What are the A-B-C-D-E stages of shock? What are the INTERMACS 1 through 7 profiles of shock? Tune in for answers to these questions.

Difficulty Level: Easy

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In this episode, we review chronic heart failure with reduced, mildly reduced, improved, and preserved ejection fraction (HFrEF, HFmrEF, HFimpEF, HFpEF). What are the stages of HF, and what therapies should be given to patients with pre-heart failure? What does adverse myocardial remodeling involve? While core GDMT for HFrEF is well-known, what constitutes core GDMT for HFpEF and HFmrEF? When should you use adjunctive GDMT such as ivabradine, vericiguat, digoxin, polyunsaturated fatty acids, and potassium binders? Tune in for answers to these questions.

Difficulty Level: Easy

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In this episode, we go over the diagnosis and management of non-compaction cardiomyopathy (LVNC), stress cardiomyopathy, and myocarditis. What imaging criteria are used to define LV noncompaction, and how does this differ between echocardiography and cardiac MRI? What are the most common microbes causing myocarditis? Can athletes with LVNC or myocarditis participate in competitive sports? Tune in for answers to these questions.

Difficulty Level: Easy

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In this episode, we explore various forms of dilated cardiomyopathies (DCM) and their distinct features. What are the hallmark characteristics of idiopathic dilated cardiomyopathy on echocardiogram, and how does the sphericity index predict prognosis? How do we differentiate between dilated cardiomyopathies like sarcoidosis, peripartum cardiomyopathy, tachycardia-mediated cardiomyopathy, and hemochromatosis? How is sarcoidosis diagnosed using FDG-PET, and what are the prognostic indicators in laminopathies and arrhythmogenic right ventricular cardiomyopathy (ARVC)? What are the diagnostic features and treatment options for PVC-mediated cardiomyopathy and peripartum cardiomyopathy? Tune in for answers to these questions.

Difficulty Level: Easy

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In this episode, we review restrictive cardiomyopathies (RCM), including amyloidosis and hypereosinophilic syndrome. What is the ice-cream cone appearance of the atria? What is the cherry-on-top appearance on strain imaging? What is the difference between AL, SSA, ATTR, and AA amyloidosis – which ones never have cardiac involvement and which ones always have cardiac involvement? Which amyloidosis type is the only one assessed by PyP scan? How do tafamidis and patisiran work? What are the three stages of cardiac hypereosinophilic syndrome? What is Merlon sign? Which restrictive cardiomyopathy has a tendency for developing subvalvular thrombosis, causing entrapment of the mitral valve leaflets and consequent mitral regurgitation? Tune in for answers to these questions.

Difficulty Level: Easy

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In this episode, we explore types of hypertrophic cardiomyopathy (HCM) other than idiopathic HCM and obstructive HCM, including apical HCM, Fabry's disease, and Danon's disease. We also review an HCM-mimic, athlete's heart. What are 10 ways that athlete's heart can be distinguished from HCM on imaging? Which cardiomyopathies will have thinning (echogenecity) of the basal inferolateral wall instead of thinning of the basal septum? What genetic property accounts for why male patients with Danon disease are more severely affected than female patients and have younger onset? Tune in for answers to these questions.

Difficulty Level: Intermediate

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In this episode, we explore the medical and surgical management of hypertrophic cardiomyopathy (HCM) and hypertrophic obstructive cardiomyopathy (HOCM). What cautions should you take with inotropes, vasodilators, diuretics, preload, and afterload in patients with HOCM? Do you initiate and uptitrate therapies based on symptoms, heart rate, QTc, or left ventricular outflow tract (LVOT) gradient? How does mavacamten work? What are the indications for referral to septal reduction therapy? What are the comparative benefits and drawbacks of surgical myectomy and alcohol septal ablation? How do you determine if ICD placement is indicated? 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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