In this episode, we review pre-operative cardiovascular risk stratification for noncardiac surgery. What is considered a low-risk surgery? What does "risk" refer too–risk of what? How are emergent surgery, urgent surgery, time-sensitive surgery, and elective surgery defined? How does functional capacity factor into decisions about preoperative testing? What are the cardinal steps for determining whether additional cardiac testing is needed pre-operatively? When is it appropriate to get a pre-operative echocardiogram, stress test, coronary CTA, or cardiac catheterization? How long must dual antiplatelet therapy (DAPT) be continued for a drug-eluting stent implanted for a presentation of acute coronary syndrome versus a drug-eluting stent implanted electively? When is the earliest where it is appropriate to interrupt DAPT? What are the new recommendations on holding anticoagulation, beta-blockers, RAAS inhibitors, SGLT2 inhibitors, and statins pre-operatively? Tune in for answers to these questions.

Difficulty Level: Easy

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In this episode, we explore ischemia with non-obstructive coronary arteries (INOCA). How is the diagnosis of microvascular angina (MVA) and vasospastic angina (VSA) made? What cutoffs in the index of microvascular resistance (IMR) and coronary flow reserve (CFR) are used to diagnose MVA and VSA? Which medication for treating MVA will worsen VSA? What factors increase risk of spontaneous coronary artery dissection (SCAD)? What is the consequence of cocaine's blockade of sodium channels and potassium channels? 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 explore flow reserve measurements used to determine lesion significance in coronary artery disease. What is the difference between hyperemic and non-hyperemic wire-derived ratios? Which different segments of diastole are instantaneous wave-free ratio (IFR), diastolic pressure ratio (DPR), and diastolic hyperemia-free ratio (DFR) measured at? What are the cutoffs for fractional flow reserve (FFR), Pd/Pa, resting full-cycle ratio (RFR), IFR, DPR, and DFR? What are the non-wire-based flow reserve measurements? 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 anatomy of normal coronary arteries and provide a systematic framework for thinking about coronary artery anomalies. How do you define proximal vs mid vs distal RCA, LAD, and LCX? What are the normal lengths of the RCA, LAD, and LCX? Which coronary artery anomalies have no clinical significance, and which are associated with sudden cardiac death? Which types of anomalous aortic origin of a coronary artery (AAOCA) are associated with higher risk of sudden cardiac death? How do the indications for surgery for anomalous right coronary artery from the left cusp (ARCA-L) differ from the indications for surgery for anomalous left coronary artery from the right cusp (ALCA-R)? How do the indications for surgery for anomalous right coronary artery from the pulmonary artery (ARCAPA) differ from indications for surgery from anomalous left coronary artery from the pulmonary artery (ALCAPA)? 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 complications that can arise following myocardial infarction (MI). What is the Bezold-Jarisch reflex, and which territory of myocardial infarction (MI) predisposes to it? Where are LV aneurysms most likely to occur post-MI, and how can they be distinguished from LV pseudoaneurysms on echocardiography? Does accelerated idioventricular rhythm (AIVR) post-reperfusion carry any prognostic implications? What physical exam findings distinguish between posteromedial papillary muscle rupture and interventricular septal rupture? Does prior MI increase or decrease the risk of LV free wall rupture? Other than DAPT nonadherence, what factors are associated with development of stent thrombosis? 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 explore the use of fibrinolysis in managing STEMI when PCI is not immediately available. What is the difference between streptokinase, alteplase, reteplase, and tenecteplase? What is the mandated door-to-needle time for receiving fibrinolytic? What is the window for onset of symptoms for which fibrinolysis is acceptable? What loading dose of antiplatelet should you use when giving fibrinolysis? How long should heparin be continued after fibrinolysis? What are the absolute and relative contraindications to giving fibrinolysis? Tune in for answers to these questions.

Difficulty Level: Easy

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In this episode, we explore key aspects of percutaneous coronary intervention (PCI) from the generalist’s perspective. What are the comparative risks of death, stroke, and major vascular complications in diagnostic catheterization versus PCI? What are the relative advantages and disadvantages of radial access over femoral access? What are the mandated durations for first medical contact to PCI, ED to PCI, and onset of symptoms to PCI? When and should a non-infarct artery be revascularized? In a patient with prior CABG, should you pursue PCI of the diseased native coronary artery or the diseased SVG? Tune in for answers to these questions.

Difficulty Level: Easy

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In this episode, we explore key aspects of coronary artery bypass grafting (CABG) revascularization. What are the 10-year patency rates of internal mammary artery (IMA) grafts compared to saphenous venous grafts (SVGs), and what accounts for this difference? Is CABG or PCI a better option for revascularizing patients with left main disease? What about triple-vessel disease with reduced ejection fraction, triple-vessel disease with diabetes, triple-vessel disease with preserved ejection fraction, double-vessel disease, and single-vessel disease? How does one identify sternal wound infection, and how can one diagnose peri-CABG MI, given that troponin will be universally abnormal at baseline in all post-CABG patients? Tune in for answers to these questions.

Difficulty Level: Intermediate

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In this episode, we review preventive and adjunctive therapies in the management of coronary artery disease (CAD). Who qualifies for cardiac rehabilitation (CR)? What are the four phases of CR? What is the difference between the DASH and Mediterranean diets? In which situations are pharmacologic therapies such as GLP-1 receptor agonists appropriate for weight loss in patients with CAD? How can exposure to air pollution and extreme environmental conditions impact cardiovascular health? What is PM2.5? What is the primary metabolite of nicotine, which serves as an effective biomarker of tobacco smoke exposure? How are bupropion, varenicline, and nicotine replacement used to assist individuals in smoking cessation? 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 long-term medication therapy for CAD, including medications used post-myocardial infarction (MI) and medications used for anginal symptom relief in unrevascularizable CAD. What pathways do colchicine interrupt in the development of CAD? Is dual-antiplatelet therapy (DAPT) primarily for prevention of in-stent thrombosis or in-stent restenosis? How many months should you continue DAPT after percutaneous coronary intervention (PCI) for acute coronary syndrome versus after PCI for chronic coronary disease? In which post-MI patients should beta blockers, ACE inhibitors/ARBs, and statins be added? Among the anti-anginal medications beta blockers, nitrates, calcium channel blockers, and ranolazine, which single class has a mortality benefit instead of just a symptom benefit? 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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More MedEd resources available at ⁠⁠www.rueyhu.com⁠⁠

Updates at Twitter/X: ⁠⁠@Ruey_Hu⁠