Welcome to Hu Said, a cardiology #MedEd podcast. Every episode cuts straight to the core of the topic, delivering the high-yield information you need to know for your exams. In this 2nd season of the podcast, new topics have been added, with >100 total topics. Whenever possible, evidence-based statements from the latest ACC/AHA/HRS/HFSA/SCAI guidelines are interwoven. Whether you are a resident, fellow, or re-certifying cardiologist, subscribe for precise, curated pearls. Ensure you get maximum knowledge in minimal time, because your time is valuable.
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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 ho...
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 syste...
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 pregna...
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 ...
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 can develop an alternative approach to ECG interpretation, reinforcing pattern recognition through both visual and auditory learn...
This episode provides a deep dive into the 2025 AHA/ACC Guideline for Acute Coronary Syndromes, comparing new recommendations with previous versions across four key pillars: revascularization, dual antiplatelet therapy, lipid management, and mechanical circulatory support. It clarifies strategies for multivessel disease in STEMI and NSTEMI, optimal DAPT duration and agent choice, lipid-lowering targets, and the evolving role of devices like Impella, IABP, and VA-ECMO in cardiogenic shock. The discussion is supported by evidence from pivotal clinical trials, offering practitioners essential updates for patient care.
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...
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 (Musta...
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? W...
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 lon...
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 coa...
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...
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 ...
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 regurg...
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 significanc...
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 echocardio...
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 p...
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 Ei...
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...
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 source...
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. Di...
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 ne...
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 ...
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 re...
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...
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?...
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 You are listening to Hu Said: Cardiology Board...
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 w...
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 betwee...
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 ...
