Hu Said: Cardiology Board Review Series

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...

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 antip...

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 anticoagu...

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?...

Can music help us understand cardiac arrhythmias? 🎵💓 In this special podcast episode, I explore how musical notation can be used to visualize and "hear" ECG rhythms, providing an intuitive and structured approach to learning atrial fibrillation, AV blocks, ventricular tachycardia, and more. By "hearing" arrhythmias and "reading" them in a musical framework, trainees...

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 pos...

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 (u...

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 ide...

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 s...

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 strategi...

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...

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 pr...

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...

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 tricus...

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 regu...

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 bra...

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?...

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 occ...

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...

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 mas...

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 ar...

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?...

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 requi...

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? Wh...

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, wh...