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

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In this episode, we explore the role of antiplatelets and anticoagulants in managing acute coronary syndromes (ACS) and during percutaneous coronary intervention (PCI). How many days off clopidogrel, prasugrel, ticagrelor, and cangrelor is advised prior to proceeding to CABG? In patients not undergoing CABG, how does one decide which P2Y12 inhibitor to use? How do glycoprotein IIb/IIIa inhibitors such as abciximab, eptifibatide, and tirofiban prevent platelet aggregation, and in what situations are they indicated in PCI? What anticoagulant can be used in patients who present with ACS but are unable to take heparin due to allergy, religious reasons, or heparin-induced thrombocytopenia? 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 concepts in myocardial hibernation and stunning. What is the difference between myocardial stunning, hibernation, and scar? What is considered viable and what is not? What cellular adaptations occur in the process of hibernation? What pattern of rest perfusion, stress perfusion, and FDG metabolism on FDG PET imaging would indicate hibernation instead of scar? What would a hypokinetic->better->worse response vs a hypokinetic->better->worse response imply on dobutamine stress 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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In this episode, we review anatomic testing for coronary artery disease. When can you draw upon coronary artery calcium (CAC) scoring to guide statin therapy? When can you use coronary CT angiography (CCTA) with CT-FFR? What are pitfalls of each? Should you choose anatomic testing or functional stress tests for your patients? 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 the essentials of stress testing, including indications and contraindications of exercise and pharmacologic stress agents, features and pitfalls of imaging-based stress, and a systematic framework for reporting stress test results. What are normal and abnormal ECG changes in response to stress? What baseline abnormalities render exercise ECG uninterpretable? When should you terminate a stress test prematurely? When should you give aminophylline to reverse the effect of regadenoson? Which findings on nuclear stress testing are associated with a >3% risk of annual mortality? 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 presentation of acute coronary syndromes (ACS) and the Fourth Universal Definition of Myocardial Infarction (MI). What is the difference between myocardial injury, ischemia, and infarction? Why is the term "Type 2 NSTEMI" no longer appropriate? Why is the term "atypical angina" deprecated? What does the GRACE score and TIMI score contain? 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 ECG changes in acute coronary syndromes (ACS). What constitutes a significant vs a non-significant Q wave? Can the shape of the curve of the ST elevation or depression offer clues about whether the ST change is ischemic or non-ischemic? What types of infarctions would you not see reciprocal changes on in the standard ECG? How do you define Sgarbossa's criteria, Wellen's syndrome, and De Winter's syndrome? Tune in for answers to these questions.

Difficulty Level: Easy

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In this episode, we review apolipoproteins, Lp(a), and familial dyslipidemias. What roles do apolipoproteins like ApoB48, ApoB100 and ApoA-I play in lipid transport and cardiovascular risk? Why is measuring Lp(a) in nmol/L more informative than mg/dL? Who should ApoB and Lp(a) level testing be sent on? How do conditions like familial hypercholesterolemia differ from dysbetalipoproteinemia or familial hypertriglyceridemia? 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 ASCVD risk estimation and lipid-lowering therapies. What low-density lipoprotein cholesterol (LDL-C) level should be targeted for patients who have had an ASCVD event versus those who have not, and how do these target LDL-C levels vary based on the presence of risk factors, diabetes status, and estimated 10-year ASCVD risk? What equation recently replaced the pooled cohort equations for estimating 10-year risk of ASCVD, and what new variables are introduced in the updated equation? What does high, moderate, and low intensity statin mean? In which two populations do you bypass the classic ASCVD risk chart for statin initiation and go straight for a high-intensity statin? What events and conditions comprise the definition of secondary prevention patients who are at "very high risk" of additional ASCVD events? How do these differ from the primary prevention risk enhancing factors? Furthermore, how do these differ from the diabetes-specific risk enhancing factors? In what situations is it appropriate to obtain a coronary artery calcium (CAC) score? What are the implications of a CAC score of 0, 1-99, and 100+? What is the definition of statin intolerance? Which statins are hydrophilic and which are lipophilic? Which statins are metabolized by CYP3A and which are metabolized by CYP2C9? What non-statin therapies are available for additional lipid lowering? What is the difference between the Friedewald equation and the Martin-Hopkins equation? How often do you need to be checking a lipid panel? 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 discuss common complications of pacemaker (PPM) and implantable cardioverter-defibrillator (ICD) implantation, along with considerations at the end of life. What are the risks of pacemaker pocket hematoma, pneumothorax, lead dislodgement, diaphragmatic stimulation, and muscular stimulation post-implantation, and how are these managed? What is twiddler's syndrome? What is the difference between pacemaker syndrome and pacemaker-mediated tachycardia, and how do they occur? When is it appropriate and necessary to deactivate an ICD at the end of life? Do PPMs need to be deactivated at the end of life? 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