Hu Said: Cardiology Board Review Series

In what settings should you use the H₂FPEF, HFA-PEFF, and HFpEF-ABA scores in the diagnosis of HFpEF? What are HFpEF mimics? What is the difference between OMT and GDMT? Why is finerenone now preferred over spironolactone as the mineralocorticoid antagonist of choice in HFpEF? In which HFpEF patients should semaglutide or tirzepatide be prescribed? Why should ACE inhibitors be avoided in HFpEF, and which RAAS agents are actually supported by evidence? In which specific subgroups of HFpEF patients should sacubitril/valsartan be considered? Should HFpEF patients be given beta blockade? Which diabetes medications should be avoided in HFpEF patients, and which should replace them? How does the cardiovascular-kidney-metabolic framework help prioritize therapies with overlapping benefits across heart failure, diabetes, CKD, and obesity? Watch for answers to these key questions and more in this deep dive of the 2026 ACC Expert Consensus Decision Pathway on the Management of Heart Failure with Preserved Ejection Fraction.

Watch on YouTube: https://youtu.be/HazAsFCjiAI

Difficulty Level: Medium

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Why did the 2026 universal definition abandon specific numerical cutoffs for HFrEF and HFpEF? What are the three positive trajectories that can emerge from symptomatic HF? How do impHF (heart failure with improvement), remHF (heart failure with remission), and recHF (heart failure with recovery) differ from one another? What is the distinction between worsening HF and decompensated HF? What are the categories in the new Universal Classification of HF by Cause? How does the cause of HF differ between geographic regions? Watch for answers to these key questions and more in this deep dive of the 2026 AHA/ACC/ESC/WHF Expert Consensus Document: Second Universal Definition of Heart Failure.

Watch on YouTube: https://youtu.be/MR20wFklefg

Difficulty Level: Easy

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When should apoB be measured? In whom should lipoprotein(a) be measured? Should LDL-C be calculated by the Friedewald, Martin-Hopkins, or Sampson-NIH equations? How do the PREVENT-ASCVD equations differ from the Pooled Cohort Equations? How long is a coronary artery calcium (CAC) score of 0 "good for"? How should CAC scoring be used to guide statin initiation and intensity? What are the new LDL-C, non-HDL-C, and apoB targets for secondary prevention? What counts as "very high-risk" ASCVD, and how does treatment differ? In which patients should bempedoic acid, inclisiran, or olezarsen be added? Watch for answers to these key questions and more in this "deep dive" of the 2026 ACC/AHA Guideline on the Management of Dyslipidemia.

Watch on YouTube: https://youtu.be/yHXL_dH8zCo

Difficulty Level: Easy

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What is the new 2026 classification for acute pulmonary embolism? What is the respiratory modifier? What category encompasses normotensive shock? What is the difference between the PESI score, sPESI score, Hestia score, and CPES score? Should LMWH or unfractionated heparin be used for initial parenteral anticoagulation for PE? What anticoagulation agent for PE is recommended in patients with antiphospholipid syndrome, chronic kidney disease, brain tumors, or pregnancy? In which patients is systemic lysis, catheter-directed thrombolysis, mechanical thrombectomy, or surgery appropriate? How should clot-in-transit be managed? Is there a role for pulmonary vasodilators? How should vasopressors be dosed in acute PE? How is CTEPD different from CTEPH? How long should anticoagulation be continued after PE? Watch for answers to these key questions in this "deep dive" of the 2026 AHA/ACC/ACCP/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN Guideline for the Evaluation and Management of Acute Pulmonary Embolism in Adults — the first-ever dedicated AHA/ACC guideline on acute PE.This episode also available on YouTube: https://youtu.be/rE-I4Jwq1UA

Difficulty Level: Easy

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What right ventricular end-systolic volume should guide timing of pulmonary valve replacement in tetralogy of Fallot? At what pulmonary vascular resistance can closure be pursued for an atrial septal defect in patients with pulmonary hypertension? How often should Fontan patients receive liver imaging and alpha-fetoprotein screening? Should patients with Eisenmenger syndrome be routinely anticoagulated? What is the maternal mortality risk for pregnancy in Eisenmenger syndrome? Should most pregnant patients with adult congenital heart disease undergo cesarean delivery? Should cyanotic ACHD patients undergo prophylactic phlebotomy? Can ACHD patients participate in competitive sports? Watch for answers to these key questions in this "deep dive" of the 2025 ACC/AHA Guideline for the Management of Adults with Congenital Heart Disease.Difficulty Level: Advanced

This episode also available on YouTube: https://youtu.be/IYTn5bjiHqY

Difficulty Level: Intermediate

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What is the new term for hypertensive urgency? When is single-pill combination antihypertensive indicated? Do ACEI/ARB, MRA, and thiazide or potassium-sparing diuretics need to be held for initial testing of primary aldosteronism? In what neurologic condition should systolic BP be acutely lowered to 130-139 mmHg for 7 days, but not lower than 130 mmHg? Does BP control reduce the risk of dementia? In whom is renal denervation indicated and not indicated? Tune in for answers to these questions in this "deep dive" of the 2025 AHA/ACC Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults.

Watch on YouTube: https://www.youtube.com/watch?v=BkObt8kU9Es

Difficulty Level: Easy

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Should non-culprit lesions be revascularized in STEMI and NSTEMI? Should revascularization of non-culprit lesions occur in a simultaneous or staged manner? How do these recommendations differ when acute MI presents with cardiogenic shock? When DAPT is reduced to SAPT, which P2Y12 inhibitor is favored for monotherapy? When is de-escalation from ticagrelor/prasugrel to clopidogrel reasonable? In post-PCI patients requiring antithrombotic therapy, what should the duration of triple therapy be, and what is the P2Y12 inhibitor of choice? What is the role of Impella, IABP, and VA-ECMO in ACS with cardiogenic shock? Tune in for answers to these questions in this "deep dive" of the 2025 AHA/ACC Guideline for the Management of Patients with Acute Coronary Syndromes.

Bonus – Accompanying YouTube Talk: https://www.youtube.com/watch?v=MccydgyxK_I

Difficulty Level: Intermediate

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In this episode, we review congenital single ventricle, including physiology, surgical repair, and long-term management. What are the different types of univentricular heart defects, and how do they affect the systemic and pulmonary circulations? What are the three steps of staged surgical repair for single ventricle, and what are the indications for each? What is the difference between classic (unidirectional) Glenn surgery and bidirectional Glenn surgery? What is the difference between classic Fontan surgery, direct RA-to-PA Fontan, lateral tunnel Fontan, and extracardiac Fontan? What are the common post-repair complications, including arrhythmias, Fontan-associated liver disease (FALD), and thrombosis, and how are these complications managed? Tune in for answers to these questions.

Difficulty Level: Advanced

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In this episode, we review transposition of the great arteries (TGA), including the physiology, imaging, repair strategies, and potential complications. What is the difference between D-TGA (complete TGA) and L-TGA (congenitally corrected TGA), and why are they named D- and L-? How does blood flow through the heart in D-TGA, and why is a shunt necessary for survival? What imaging features help identify what is serving as a right ventricle versus a left ventricle? What do the atrial switch (Mustard, Senning), arterial switch (Jatene), and Rastelli surgeries entail, and what are their complications? In what subset of D-TGA patients is the Rastelli surgery indicated? How can you distinguish truncus arteriosus from tetralogy of Fallot with pulmonary atresia on imaging? Tune in for answers to these questions.

Difficulty Level: Advanced

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In this episode, we review right side congenital abnormalities, including Ebstein’s anomaly, double-chambered right ventricle (DCRV), tricuspid hypoplasia, and pulmonic hypoplasia. Which condition is characterized by "atrialization" of the right ventricle? How does the apical displacement of the septal leaflet of the tricuspid valve in Ebstein anomaly compare with what occurs in atrioventricular septal defect? What is the significance of an accessory pathway in patients with Ebstein’s anomaly? What are the indications for surgical intervention in Ebstein’s anomaly? How can tricuspid valve dysplasia be distinguished from Ebstein’s anomaly? What is the role of right ventricle-to-pulmonary artery conduits, and when should they be replaced? Tune in for answers to these questions.

Difficulty Level: Intermediate

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In this episode, we review Tetralogy of Fallot (TOF), including its pre-repair issues, surgical options, and post-repair complications. What are the four cardinal abnormalities seen in TOF, and how do they impact right-to-left shunting and systemic oxygenation? What are the differences between the Blalock-Taussig shunt, the Waterston or Potts shunts, and complete TOF repair? What surgical strategies are used today? When are temporizing procedures acceptable over complete repair? What are the long-term complications after TOF repair, including pulmonary regurgitation (PR), arrhythmias, and sudden cardiac death, and how are these managed? When is it acceptable to perform pulmonary valve replacement in post-TOF repair patients who have moderate or severe PR that is asymptomatic? Tune in for answers to these questions.

Difficulty Level: Advanced

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In this episode, we review coarctation of the aorta (CoA), including its epidemiology, presentation, imaging, and management. Which type of VSD is commonly seen in patients with CoA? What proportion of CoA patients have bicuspid aortic valve, and what proportion of bicuspid aortic valve patients have CoA? What key physical exam findings suggest CoA, and how does it present in young patients versus adults? What pattern should you see on PW Doppler of the descending aorta and CW Doppler of the coarctation? What is considered a significant peak-to-peak gradient across a coarctation? What are the criteria for surgical or transcatheter intervention? What are the long-term complications after repair? When should you suspect re-coarctation after CoA repair? Tune in for answers to these questions.

Difficulty Level: Intermediate

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In this episode, we review the physiology, imaging, and management of patent ductus arteriosus (PDA). What is the classic murmur of PDA, and how does it change with shunt reversal? Why do patients with PDA get left heart enlargement instead of right heart enlargement? How does the differential cyanosis seen in PDA with Eisenmenger syndrome present? How do you calculate pulmonary artery systolic pressure using PDA velocity? How do you distinguish the Doppler CW profile of PDA from pulmonary valve regurgitation? What are the indications for PDA closure, and why are Qp ratios not used as they are for ASD and VSD? Tune in for answers to these questions.

Difficulty Level: Intermediate

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In this episode, we explore anomalous pulmonary venous return (APVR), including its types, associated conditions, and management. What is the difference between total anomalous pulmonary venous return (TAPVR) and partial anomalous pulmonary venous return (PAPVR)? How do supracardiac, cardiac, infracardiac, and mixed types of TAPVR differ? Which ASD type is most commonly associated with PAPVR? What are the physiologic consequences of right heart overload caused by APVR, and what are the criteria for surgical intervention? How is Scimitar syndrome diagnosed and managed, and when should surgery be considered for this rare condition? Lastly, we will touch upon persistent superior vena cava syndrome. Tune in for answers to these questions.

Difficulty Level: Advanced

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In this episode, we explore atrioventricular septal defects (AVSD), covering its types, physiology, and when to intervene. How do complete, partial, transitional, and intermediate AV septal defects differ in structure and physiology? What are the anatomic and functional consequences of a primum ASD with cleft mitral valve, and how does this affect the mitral valve's position relative to the tricuspid valve? What challenges do patients with AVSD face post-surgery, including risks of mitral regurgitation, left ventricular outflow tract obstruction, and arrhythmias? When is surgery recommended for AVSD, and what are the key considerations for long-term follow-up? Tune in for answers to these questions.

Difficulty Level: Advanced

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In this episode, we review ventricular septal defects (VSDs), including their types, physiology, and management. What are the differences between inlet, outlet, membranous, and trabecular VSDs? How do these defects vary in terms of location, association with other cardiac conditions, and suitability for percutaneous closure? Which VSD types tend to have aortic cusp prolapse, leading to aortic regurgitation? If you see a color jet from a VSD in parasternal short axis view, what is the significance of the color jet being adjacent to the tricuspid valve versus being adjacent to the pulmonary valve? What are the physiologic consequences of left-to-right shunting in VSDs, and how does this lead to left heart dilation, pulmonary overcirculation, and potential progression to Eisenmenger syndrome? What are the criteria for VSD closure? Which is the only VSD type that is amenable to percutaneous closure? Tune in for answers to these questions.

Difficulty Level: Advanced

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In this episode, we review patent foramen ovale (PFO), including its types, physiology, presentation, and when to intervene. How does a PFO differ from an atrial septal defect (ASD), and why does PFO not cause the right heart enlargement and pulmonary hypertension seen in ASD? What is platypnea-orthodeoxia syndrome? What can cause platypnea-orthodeoxia syndrome other than PFO? What features on brain MRI suggest that the etiology of an ischemic stroke is cardioembolic? What features on echocardiography distinguish between PFOs and ASDs? How can PFOs contribute to cryptogenic stroke, and what high-risk features indicate the need for closure? Tune in for answers to these questions.

Difficulty Level: Intermediate

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In this episode, we review atrial septal defects (ASDs), including their types, imaging, and management. What is the difference between secundum defect, primum defect, sinus venosus defect, and coronary sinus defect? Which is the only ASD defect out of the four that can be percutaneously closed (in addition to surgically closed)? Which ASD type is accompanied by anomalous pulmonary venous return? What are the physiologic consequences of left-to-right shunting in ASDs, and how can these lead to pulmonary hypertension and RV failure? What is Holt-Oram syndrome? What are the criteria for ASD closure? Tune in for answers to these questions.

Difficulty Level: Advanced

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In this episode, we review the epidemiology of congenital heart diseases and develop a framework for categorizing them by cyanotic and non-cyanotic disorders, and go over physiologic concepts across congenital conditions. What are the 5 'T' disorders that are characterized by cyanosis? What are the non-T disorders that can develop cyanosis? What is the tipping point for Eisenmenger syndrome to occur? What are the non-cardiac manifestations of Eisenmenger syndrome? Is phlebotomy appropriate in Eisenmenger syndrome? What is the role of bosentan and sildenafil/tadalafil in Eisenmenger syndrome? What Qp/Qs ratio indicates a large left-to-right shunt that requires repair? What Qp/Qs ratio indicates a a small left-to-right shunt? What Qp/Qs ratio indicates net right-to-left shunting? What is the Flamm formula for calculating mixed venous saturation proximal to a transatrial shunt? What should you suspect if pulmonary oxygen saturation exceeds 80%, or is 8% higher than the superior vena cava's oxygen saturation? What is the difference between physiologic shunting and anatomic shunting? What conditions comprise ACHD physiologic stages A, B, C, and D? Tune in for answers to these questions.

Difficulty Level: Intermediate

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In this episode, we review highlights of cardiovascular considerations in pregnancy. How does pregnancy affect blood volume, systemic vascular resistance, pulmonary vascular resistance, heart rate, and cardiac output? What routine physical exam findings in pregnancy that can mimic heart disease, and what physical exam findings are abnormal in pregnancy? How do LV mass, chamber size, and LV outflow tract velocity time integral (VTI) change in pregnancy? What is the effect of labor and delivery on cardiac output, blood volume, and venous return? What conditions comprise WHO risk class IV pregnancy patients? If a patient with peripartum cardiomyopathy has recovery of LV ejection fraction to >=50%, which WHO pregnancy class does that place them in? Are aspirin, clopidogrel, and heparin safe in pregnancy? What is the difference between gestational hypertension, pre-eclampsia, and eclampsia? What severe features comprise the diagnosis of pre-eclampsia with severe features? What is the target blood pressure in pregnancy? Tune in for answers to these questions.

Difficulty Level: Intermediate

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In this episode, we review cardiac masses, including primary benign, primary malignant, and secondary (metastatic) cardiac tumors. Are malignant tumors much more likely to occur in the ventricles or the atria? If you see a myxoma in any cardiac chamber other than the left atrium, what syndromic complex should you suspect? What echocardiographic features distinguish benign and malignant cardiac masses? Which type of sarcoma is the most common primary cardiac tumor? What are the most common sources of metastatic cancer to the heart? Which cardiac chamber or junction would you find the moderator band, eustachian valve, crista terminalis, and Chiari network, which may be mistaken as cardiac masses? In what situation is resection of a papillary fibroelastoma indicated? How can you differentiate between Lambl's excrescences, fenestrated aortic valve, and nonbacterial thrombotic endocarditis? Tune in for answers to these questions.

Difficulty Level: Intermediate

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In this episode, we review orthostatic hypotension (OH). What criteria define OH? What is a simple way to distinguish neurogenic OH from volume depletion-related OH? What criteria define postural orthostatic tachycardia syndrome (POTS)? What non-pharmacologic measures should be undertaken as first-line measures for OH? How do fludrocortisone, midodrine, droxidopa, and atomoxetine work, and what are their side effects? How is supine hypertension managed? Tune in for answers to these questions.

Difficulty Level: Easy

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In this episode, we explore the diagnosis and management of three important causes of secondary hypertension: renovascular hypertension, primary aldosteronism, and pheochromocytoma. Which segments of the renal artery are preferentially affected by atherosclerotic renovascular hypertension versus fibromuscular dysplasia, and which is more likely to be accompanied by disease in other arterial beds? What characteristics suggest that a patient may benefit from renal artery revascularization? What next steps do you pursue if a plasma aldosterone to renin ratio exceeds 20? How do you differentiate between unilateral adenoma and bilateral adrenal hyperplasia? When would you pursue a MIBG scan in pheochromocytoma? Tune in for answers to these questions.

Difficulty Level: Easy

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In this episode, we review hypertensive urgency and emergency. What counts as "end-organ" damage in hypertensive emergency? What neurological signs are consistent with hypertensive encephalopathy? Which acute conditions require bringing systolic blood pressure (SBP) down to ≤160 mmHg in the first hour, and which require bringing SBP down to ≤140 mmHg in the first hour? Which acute conditions require bringing SBP down to ≤120 mmHg in the first 5 minutes? How does the BP threshold change in acute ischemic stroke depending on whether you plan to give tissue plasminogen activator (tPA) or not? What is permitted hypertension? Tune in for answers to these questions.

Difficulty Level: Intermediate

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In this episode, we review chronic hypertension. How did the the definitions of stage 1 and stage 2 hypertension change in the most recent AHA/ACC/ASH guidelines? What happened to "prehypertension"? Which chronic condition needs control of systolic blood pressure (SBP) to <120/80; which conditions need control of SBP to <130/80? What is the natural variation in BP with sleep and with age? What are the most common causes of secondary hypertension? Which outpatient antihypertensives cause reflex tachycardia, and which cause salt and water retention? Tune in for answers to these questions.

Difficulty Level: Easy

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In this episode, we review the large vessel vasculitides, medium-vessel vasculitides, ANCA-associated small-vessel vasculitides, and immune complex associated small-vessel vasculitides. What is the difference in the population of patients affected by Takayasu's arteritis of the aorta and its branches versus giant cell arteritis of the temporal artery? What about subcranial giant cell arteritis, which affects the aorta instead of the temporal artery? Which disease is characterized by corkscrewing, inflammation, and thrombosis of vessels of the upper and lower limbs, leading to reduced pulses and gangrenous ulcers, which cannot resolve without smoking cessation? What are the criteria for diagnosing Kawasaki disease? What percent of Kawasaki disease patients will go on to develop coronary artery aneurysms? Tune in for answers to these questions.

Difficulty Level: Easy

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In this episode, we review carotid artery stenosis (CAS), including its presentation, diagnosis, medical management, and intervention. Do dizziness, presyncope, or syncope count as symptomatic CAS? What is the definition of nondisabling stroke and transient cerebral ischemic symptoms? What risk factors permit ordering a carotid duplex ultrasound before coronary artery bypass graft surgery? What peak systolic velocity on ultrasound correspond to >=50% and >=70% stenosis of a carotid artery? What antiplatelet regimen is recommended for CAS? In patients with symptomatic CAS, in what time window after the non-disabling stroke or TIA should you perform revascularization? Is there any role for revascularization of severe CAS that is asymptomatic? Tune in for answers to these questions.

Difficulty Level: Easy

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In this episode, we review limb peripheral artery disease (PAD). What is the difference in management of a marginally threatened limb vs immediately threatened limb? In whom can you order ankle brachial index (ABI) testing on? When do you reach for toe brachial index (TBI) or exercise ABI? Is there a role for cilostazol or pentoxifylline? Who should be given low-dose rivaroxaban therapy? Tune in for answers to these questions.

Difficulty Level: Easy

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In this episode, we review aortic intramural hematoma (IMH), penetrating aortic ulcer (PAU), infectious aortitis and aortic atheroemboli. What condition is characterized by a crescentic aortic wall thickening and echolucency within the aortic wall with no intimal flap on transesophageal echocardiogram? What percent of IMH progresses to aortic dissection?What imaging findings distinguish IMH from dissection on non-contrast CT, contrast CT, and TEE? What are the criteria for complicated IMH, and when is emergent surgical repair recommended? How does the management of type A IMH differ from that of type B IMH? How are grades 1, 2, 3, 4, and 5 aortic plaques defined? What features on imaging of PAU designate PAU as high-risk? When should PAU be repaired? Which organisms are responsible for infectious aortitis? Tune in for answers to these questions.

Difficulty Level: Easy

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In this episode, we review aortic dissection, its risk factors, presentation, physical exam findings, imaging findings, and management. Other than aortic dissection, what other cardiovascular conditions can present with unequal arterial pulsations? How do gender and age affect the risk of aortic dissection? What are risks for aortic dissection for women, especially during pregnancy, and for patients with conditions such as Marfan syndrome or a bicuspid aortic valve? How do you distinguish between a true and false lumen on imaging studies? What target blood pressure and heart rate should be achieved within 10 minutes of presentation for aortic dissection? When is surgery or percutaneous intervention indicated? Tune in for answers to these questions.

Difficulty Level: Easy

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In this episode, we review abdominal aortic aneurysm (AAA), including its diagnosis, screening, and management. What are the current guidelines for screening and surveillance of AAA, and how do they differ for men and women? At what size does the risk of rupture significantly increase, and what surveillance intervals are recommended based on the size of the aneurysm? What does Laplace's Law say about how the rate of expansion of AAA correlates with its size? What are the key differences between endovascular aneurysm repair (EVAR) and open surgical repair, and what are the long-term complications associated with EVAR? What is an endoleak? Tune in for answers to these questions.

Difficulty Level: Easy

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In this episode, we review ascending aorta dilation and ascending aorta aneurysm, including the key syndromes associated. What is cystic medial degeneration? Which diseases cause dilation of the aortic root versus dilation of the ascending aorta? In which diseases is ascending aorta dilation defined by diameter (cm) versus body surface area-indexed diameter (cm/m^2) versus aortic root cross sectional area to height ratio (cm^2/m)? In which diseases is the cutoff for surgical intervention ≥5.5cm, ≥5.0cm, ≥4.5cm, and ≥4.0cm? What is the definition of rapid growth in 1 year and in 2 years? Among the sinotubular junction, sinuses of Valsalva, aorto-ventricular junction, aortic annulus, and left ventricular outflow tract, which lengths should be measured leading edge to leading edge, and which should be measured inner edge to inner edge on echocardiography? Which should be measured in end-diastole and which should be measured in mid-systole? In what situation is echo sufficient for monitoring ascending aorta dilation instead of CT/MRI? How often should you perform serial imaging for monitoring of ascending aorta dilation that has not yet met the cutoff for surgical intervention? What does medical management consist of? What are manifestations of Marfan's syndrome other than aortic root dilation, and how are they similar or different than the manifestations of Ehlers-Danlos' syndrome? What does bifid uvula suggest? Which syndrome presents with foot pain, multiple food allergies, and bifid uvula? Tune in for answers to these questions.

Difficulty Level: Intermediate

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In this episode, we review left ventricular (LV) thrombus, including its pathophysiology, imaging characteristics, and treatment. How are the components of Virchow's triad disrupted by myocardial infarction, predisposing to formation of LV thrombus? What are the echocardiographic features of LV thrombus? How can LV thrombus be distinguished from myxoma on cardiac MRI and angiogram? Can the chronic versus acute nature of LV thrombus be discerned on imaging? Is there a role for transesophageal echocardiogram for assessing LV thrombus? What anticoagulation agents are allowed in the treatment of LV thrombus? What evidence supports continuing anticoagulation beyond three months, and when is it reasonable to discontinue therapy? Tune in for answers to these questions.

Difficulty Level: Easy

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In this episode, we review deep vein thrombosis (DVT). What are the ultrasound features of a DVT? What counts as a proximal DVT? Why are patients with proximal DVT at higher risk, and how does this impact management? What are the recommended anticoagulation strategies, including the use of DOACs versus VKAs? How long should anticoagulation continue for provoked versus unprovoked DVT? When is indefinite anticoagulation recommended, and in what situations might aspirin be a reasonable alternative? What counts as provoked versus unprovoked? How do you approach testing for thrombophilia, and when is it appropriate? Tune in for answers to these questions.

Difficulty Level: Easy

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In this episode, we review how to calculate pulmonary artery pressures (PASP) on echocardiography. How does the simplified Bernoulli equation relate the velocity of flow through the tricuspid valve (tricuspid regurgitant velocity, V_TR) to the right ventricular systolic pressure (RVSP)? When is it permissible and not permissible to assume that PASP is equivalent to RVSP? How can the maximal tricuspid regurgitant velocity (V_max TR), maximal pulmonic regurgitant velocity (V_max PR), and end pulmonic regurgitant velocity (V_end PR) be used to calculate systolic, mean, and diastolic pulmonary artery pressure? What are five ways to calculate mean pulmonary artery pressure from non-invasive imaging? Tune in for answers to these questions.

Difficulty Level: Intermediate

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In this episode, we review the essentials of pulmonary hypertension (PH), including the five groups. What echocardiographic findings allow you to distinguish between pre-capillary and post-capillary PH without information from right heart catheterization? In patients with PH non-vasoresponsive to nitric oxide, how do you decide whether to use phosphodiesterase-5 inhibitors (PDE-5 inhibitors), prostacyclin analogs, endothelin receptor antagonists (ERAs), or soluble guanylate cyclase stimulators (sGCS)? What is the criteria for vasorespose to nitric oxide, and how does the results of that testing change management? In patients with chronic thromboembolic pulmonary hypertension (CTEPH), how do you decide whether to offer pulmonary endarterectomy (PEA), balloon pulmonary angioplasty (BPA), or sGCS? Tune in for answers to these questions.

Difficulty Level: Easy

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In this episode, we dive into the pathophysiology, diagnosis, and treatment of inflammatory pericarditis. How do diagnostic criteria differ for first-time pericarditis and recurrent pericarditis? What is the sequence of ECG changes over the course of pericarditis? How many components would you expect to hear in a pericardial friction rub? Is post-MI pericarditis the same thing as Dressler's syndrome? What medications should be avoided? Can athletes who develop pericarditis play in competitive sports? Tune in for answers to these questions.

Difficulty Level: Easy

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In this episode, we review pericardial effusion and cardiac tamponade. What is the definition of small, moderate, and large pericardial effusion? What is ventricular interdependence? What is pulsus paradoxus? What conditions can cause a false positive or false negative pulsus paradoxus? What comprises Beck's triad? What are seven cardinal findings of tamponade physiology on echocardiography? What common comorbidity can cause RV collapse to be negative in tamponade? How do you distinguish pericardial cysts from pericardial diverticulae and hiatal hernia? What is the appearance of congenital absence of the pericardium on echocardiography? Tune in for answers to these questions.

Difficulty Level: Easy

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In this episode, we review patient-prosthesis mismatch (PPM) and prosthetic valve stenosis. What cutoffs for indexed effective orifice area (EOA) suggest severe, moderate, or mild PPM of an aortic valve prosthesis? What about for mitral valve prosthesis? What are the causes of prosthetic valve stenosis? How do you differentiate PPM from prosthetic valve stenosis using Doppler velocity index (DVI), acceleration time, and jet contour? What factors determine whether prosthetic valve stenosis should be treated with a transcatheter valve-in-valve procedure (ViV TAVR) versus reoperation? What factors determine whether prosthetic valve thrombosis should be treated with anticoagulation only, or additional fibrinolysis versus surgery? 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 anticoagulant targets after valve replacement. What are the anticoagulation goals for mechanical and bioprosthetic valves? Why does a mechanical mitral valve have a higher INR target compared to a mechanical aortic valve? What are the risk factors that can increase the target INR for a mechanical aortic valve? How does the On-X mechanical valve’s anticoagulation regimen differ? What antiplatelet regimen is used after transcatheter valve replacement? Can direct oral anticoagulants (DOACs) be used in valve replacement patients? What are the guidelines for bridging anticoagulation before surgery? Tune in for answers to these questions.

Difficulty Level: Intermediate

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In this episode, we continue our review on infective endocarditis (IE), covering antibiotic prophylaxis, prosthesis-related endocarditis, and device-related infections. Which are the high-risk cardiac conditions and high-risk procedures that warrant antibiotic prophylaxis for IE? How do the pathogens differ between early and late prosthetic valve endocarditis, and how do these impact prognosis and treatment? What are the common pathogens associated with endocarditis after transcatheter aortic valve replacement (TAVR), and why is diagnosing TAVR endocarditis particularly challenging? When endocarditis occurs in patients with cardiac devices such as pacemakers or ICDs, when is device removal mandatory? Tune in for answers to these questions.

Difficulty Level: Easy

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In this episode, we review the epidemiology, diagnosis, and management of infective endocarditis (IE). What five cardinal characteristics lead you to suspect a vegetation on echocardiography? Which heart valves are most commonly affected, and how does the microbial etiology differ between IV drug use and non-drug use-related endocarditis? When is it appropriate to repeat transthoracic echocardiography (TTE) or transesophageal echocardiography (TEE)? What features of left-sided endocarditis and right-sided endocarditis should prompt you to refer to early surgery? What is non-bacterial thrombotic endocarditis (NBTE)? Tune in for answers to these questions.

Difficulty Level: Easy

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In this episode, we review how to differentiate the Doppler signals of aortic stenosis (AS), mitral regurgitation (MR), tricuspid regurgitation (TR), and left ventricular outflow tract obstruction (LVOTO) in hypertrophic obstructive cardiomyopathy (HOCM) – as all four of these occur during the systolic phase of the cardiac cycle. Which jets are separated by the isovolumic contraction time (IVCT) and the isovolumic relaxation time (IVRT)? Which jets can blend into each other across cardiac cycles? Which jets are parabola-shaped, and which are dagger-shaped? How can the point of velocity aliasing on color Doppler distinguish between valvular AS from subaortic membrane? Tune in for answers to these questions.

Difficulty Level: Advanced

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In this special episode, we sit down and examine the flowcharts for guideline-based quantification of aortic regurgitation (AR) severity, mitral regurgitation (MR) severity, and tricuspid regurgitation (TR) severity, and compare and contrast the differences in the cutoffs used, and the physiologic reasons for these differences. How are EROA and regurgitant volume thresholds the same or different across AR, MR, and TR, and why? Why is pressure half time only used in the algorithm for AR severity, but not MR and TR? Why is the proximal isovelocity surface area (PISA) radius omitted from the algorithm for AR severity, but included in that of MR and TR severity? What vena contracta width cutoff for mild, moderate, and severe regurgitation holds true across AR, MR and TR? Which vessel is interrogated in examining flow reversal in AR, MR, and TR? Which cardiac chamber's dimensions are measured in examining severity of AR, MR, and TR? Tune in for answers to these questions.

Difficulty Level: Advanced

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In this episode, we review pulmonic stenosis (PS) and pulmonic regurgitation (PR). How do you distinguish between the click of pulmonic stenosis, aortic stenosis, Ebstein anomaly, and mitral valve prolapse? What cutoffs in peak velocity and mean gradient define severe, moderate, and mild PS? What is branch PS? Is surgical repair or pulmonary balloon valvuloplasty preferred for the treatment of moderate and severe PS? What echocardiographic findings characterize severe PR? In patients who develop PR as a result of intervention for PS, in what situation is pulmonary valve replacement indicated in the absence of symptoms? Tune in for answers to these questions.

Difficulty Level: Intermediate

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In this episode, we review tricuspid stenosis (TS) and tricuspid regurgitation (TR). What are the echocardiographic criteria for diagnosing severe TS, and how does it differ from that of severe mitral stenosis? Which etiology of TR would have diffuse leaflet thickening with restriction of opening due to commisural fusion, chordal shortening, and calcification with characteristic diastolic doming? Which etiology of TR would have short, thick leaflets with systolic and diastolic restriction? Which etiology of TR would have apical displacement of the tricuspid valve septal and posterior leaflets from the atrioventricular ring? What would the jugular venous pressure and central venous pressure waveform of TR show? What are the qualitative, semiquantitative, and quantitative features on echo for quantifying TR severity? Are there any indications for moderate TR to undergo tricuspid valve surgery? Are there any indications for asymptomatic severe TR to undergo tricuspid valve surgery? Tune in for answers to these questions.

Difficulty Level: Intermediate

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In this episode, we review the management of mitral regurgitation (MR). How is the management of chronic primary MR, chronic secondary, and acute MR different from each other? What is the relative difficulty of repair for Carpentier type I vs II vs III type MR? In patients with severe primary MR who are asymptomatic, what are the four factors which permit mitral valve surgery? Why does the LV end-systolic diameter (LVESD) matter in MR? Why is the ideal time for surgery for mitral valve regurgitation when LVEF is just dropping below 60% and LVESD is just widened to 40mm? Why is guideline-directed therapy especially important in chronic secondary MR? What is the management of acute MR? Tune in for answers to these questions.

Difficulty Level: Intermediate

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In this episode, we review methods to quantify the severity of mitral regurgitation (MR), including the calculation of effective regurgitant orifice area (EROA) and regurgitant volume (RVol) by the proximal isovelocity surface area (PISA) method, and calculation of EROA and RVol using stroke volume by the continuity equation. What numerical cutoffs for EROA, RVol, and regurgitant fraction (RF) indicate severe MR? What does a vena contract width of ≥0.7cm versus ≤0.3cm suggest? What does a PISA radius of ≥1.0cm versus ≤0.3cm suggest? What does an enlarged LV versus a normal-sized LV suggest? What does a regurgitant fraction of ≥50% versus <30% suggest? Why does late systolic MR often result in discrepancies between EROA and RVol? Tune in for answers to these questions.

Difficulty Level: Advanced

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In this episode, we explore how mitral regurgitation (MR) is categorized based on anatomy, leaflet motion, and acuity. Are the A1, A2, A3, P1, P2, P3 scallops/segments of the mitral valve named from medial to lateral or lateral to medial? What is the difference between primary and secondary MR, and what are the most common etiologies of each? How does the Carpentier classification system categorize MR into types I, II, and III, based on leaflet and chord motion? What distinct features of Barlow disease and fibroelastic deficiency contribute to type II MR, and how do they differ in presentation? How does acute severe MR differ from chronic MR in physical exam and Doppler echo findings? What are the characteristic findings of rheumatic and ischemic MR on echocardiography? Tune in for answers to these questions.

Difficulty Level: Intermediate

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