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 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 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 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 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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In this episode, we review mitral stenosis (MS), including its epidemiology, presentation, imaging features, and management. What are the main causes of MS? What do the the characteristic "fish mouth" and "hockey stick" signs on echocardiography signify regarding the etiology of MS? How do mitral valve area, pressure gradients, and pressure half-time factor into determining the severity of MS, and how are these parameters different from that of aortic stenosis? What are the 4 components of the Wilkins score? At what range of the Wilkins score is balloon mitral valvuloplasty recommended? What are contraindications to performing balloon mitral valvuloplasty? Tune in for answers to these questions.

Difficulty Level: Intermediate

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In this episode, we review the types, presentation, physical exam, and management of aortic regurgitation (AR). What is the difference between types Ia, Ib, Ic, Id, II, and III aortic regurgitation? Why is the murmur of acute AR barely audible compared to the murmur of chronic AR? What are Corrigan's pulse, Muller's sign, Quincke's sign, and De Musset's sign? What is the Austin Flint murmur? Why should vasoconstrictors such as phenylephrine, beta blockers and intra-aortic balloon pumps be avoided in acute AR? , focusing on acute and chronic AR. Why does the LV end-diastolic diameter (LVEDD) and LV end-systolic diameter (LVESD) matter in asymptomatic severe AR? What are the LVEDD, LVESD, and LV ejection fraction thresholds that prompt referral for aortic valve replacement in patients with chronic AR who are asymptomatic? 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 explore the timing and indications for aortic valve replacement (AVR) in aortic stenosis (AS). Is it possible to qualify for AVR if AS is not severe, or if AS is asymptomatic? What are the key considerations when choosing between transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR), and when might palliation be more appropriate? What are the main types of TAVR valves? What are the access approaches for TAVR? What factors make a patient ineligible for TAVR? What are the rates of intra-procedural and post-procedural complications from TAVR? What anticoagulation or antiplatelet therapy should patients be on post-TAVR? Tune in for answers to these questions.

Difficulty Level: Intermediate

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In this episode, we explore various types of aortic valve stenosis (AS) other than conventional AS, including low-gradient AS, bicuspid and unicuspid valves, subvalvular and supravalvular AS. What is the difference between classical low flow low gradient AS, paradoxical low flow low gradient AS, and normal flow low gradient AS? What parameters on dobutamine stress echo allow you to and valvular computed tomography (CT) distinguish between true severe low-flow low-gradient AS and pseudo-severe AS? What additional structural heart defects are commonly associated with bicuspid aortic valve? Which are the most common cusps to be fused together in bicuspid AS? What are the hallmark features of Shone complex? How do supravalvular and subvalvular aortic stenosis differ in their hemodynamic properties? Tune in for answers to these questions.

Difficulty Level: Intermediate

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In this episode, we explore the epidemiology of valvular disease, and then jump in to aortic stenosis, focusing on the presentation, grading of severity, measurement of gradients on invasive and non-invasive modalities, and calculation of valve area. What is Heyde's syndrome? What is the Gallavardin phenomenon? What is pulsus parvus et tardus? What are the cutoffs for mild, moderate, and severe AS in dimensionless index, and what two variables make up the dimensionless index? What are the Gorlin and Hakki formulas for calculating aortic valve area? Why is the aortic stenosis gradient invariably different when measured on invasive catheterization vs transthoracic echocardiogram? Tune in for answers to these questions.

Difficulty Level: Intermediate

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In this episode, we go over the practical use and management of intra-aortic balloon pumps (IABP) in the cardiac intensive care unit. How does the IABP assist during systole and diastole, and what are the hemodynamic benefits of its inflation and deflation? What physiologic effects does the balloon pump have on cardiac output, coronary perfusion, left ventricular wall stress, pulmonary capillary wedge pressure, heart rate, and urine output? Why is helium used? What are key indications and contraindications for balloon pump placement? Where do you want the IABP to be located on monitoring chest X-ray? What level of diastolic augmentation and assisted end-diastolic pressure do you want to see for the IABP to be effective? When should you use ECG trigger, pressure trigger, pacemaker trigger, and asynchronous mode? How do you recognize and troubleshoot early or late inflation and deflation? What steps should be taken if balloon perforation is suspected? What are best practices for weaning a patient off the balloon pump? Tune in for answers to these questions.

Difficulty Level: Intermediate

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In this episode, we review the assessment of right ventricular (RV) size and function. What is the normal range of RV basal diameter, mid diameter, and longitudinal diameter? What are the relative advantages and drawbacks of tricuspid annular plane systolic excursion (TAPSE), tissue Doppler peak systolic velocity S’ at the tricuspid annulus, RV fractional area change (RV FAC), and RV index of myocardial performance (RIMP)? How are they calculated? Tune in for answers to these questions.

Difficulty Level: Advanced

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In this episode, we review chronic heart failure with reduced, mildly reduced, improved, and preserved ejection fraction (HFrEF, HFmrEF, HFimpEF, HFpEF). What are the stages of HF, and what therapies should be given to patients with pre-heart failure? What does adverse myocardial remodeling involve? While core GDMT for HFrEF is well-known, what constitutes core GDMT for HFpEF and HFmrEF? When should you use adjunctive GDMT such as ivabradine, vericiguat, digoxin, polyunsaturated fatty acids, and potassium binders? Tune in for answers to these questions.

Difficulty Level: Easy

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In this episode, we go over the diagnosis and management of non-compaction cardiomyopathy (LVNC), stress cardiomyopathy, and myocarditis. What imaging criteria are used to define LV noncompaction, and how does this differ between echocardiography and cardiac MRI? What are the most common microbes causing myocarditis? Can athletes with LVNC or myocarditis participate in competitive sports? Tune in for answers to these questions.

Difficulty Level: Easy

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In this episode, we explore various forms of dilated cardiomyopathies (DCM) and their distinct features. What are the hallmark characteristics of idiopathic dilated cardiomyopathy on echocardiogram, and how does the sphericity index predict prognosis? How do we differentiate between dilated cardiomyopathies like sarcoidosis, peripartum cardiomyopathy, tachycardia-mediated cardiomyopathy, and hemochromatosis? How is sarcoidosis diagnosed using FDG-PET, and what are the prognostic indicators in laminopathies and arrhythmogenic right ventricular cardiomyopathy (ARVC)? What are the diagnostic features and treatment options for PVC-mediated cardiomyopathy and peripartum cardiomyopathy? Tune in for answers to these questions.

Difficulty Level: Easy

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In this episode, we review restrictive cardiomyopathies (RCM), including amyloidosis and hypereosinophilic syndrome. What is the ice-cream cone appearance of the atria? What is the cherry-on-top appearance on strain imaging? What is the difference between AL, SSA, ATTR, and AA amyloidosis – which ones never have cardiac involvement and which ones always have cardiac involvement? Which amyloidosis type is the only one assessed by PyP scan? How do tafamidis and patisiran work? What are the three stages of cardiac hypereosinophilic syndrome? What is Merlon sign? Which restrictive cardiomyopathy has a tendency for developing subvalvular thrombosis, causing entrapment of the mitral valve leaflets and consequent mitral regurgitation? Tune in for answers to these questions.

Difficulty Level: Easy

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In this episode, we explore types of hypertrophic cardiomyopathy (HCM) other than idiopathic HCM and obstructive HCM, including apical HCM, Fabry's disease, and Danon's disease. We also review an HCM-mimic, athlete's heart. What are 10 ways that athlete's heart can be distinguished from HCM on imaging? Which cardiomyopathies will have thinning (echogenecity) of the basal inferolateral wall instead of thinning of the basal septum? What genetic property accounts for why male patients with Danon disease are more severely affected than female patients and have younger onset? 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 explore the medical and surgical management of hypertrophic cardiomyopathy (HCM) and hypertrophic obstructive cardiomyopathy (HOCM). What cautions should you take with inotropes, vasodilators, diuretics, preload, and afterload in patients with HOCM? Do you initiate and uptitrate therapies based on symptoms, heart rate, QTc, or left ventricular outflow tract (LVOT) gradient? How does mavacamten work? What are the indications for referral to septal reduction therapy? What are the comparative benefits and drawbacks of surgical myectomy and alcohol septal ablation? How do you determine if ICD placement is indicated? Tune in for answers to these questions.

Difficulty Level: Easy

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In this episode, we review the diagnosis and imaging of hypertrophic cardiomyopathy (HCM) and hypertrophic obstructive cardiomyopathy (HOCM). How does the location of septal hypertrophy differ by age? Why does systolic anterior motion (SAM) of the mitral valve occur? What is the role of crypts in HCM? What is the Brockenbrough-Braunwald-Morrow sign? Tune in for answers to these questions.

Difficulty Level: Intermediate

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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

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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

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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

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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

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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 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

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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 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

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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

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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

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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

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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

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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

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In this episode, we clarify key terms related to pacemakers (PPMs) and implantable cardioverter-defibrillators (ICDs). What do the common two-letter labels AR, VR, AS, VS, AP, VP, FD, TD, TP, CD, RV, and RT mean on EGM of an ICD? What is the relationship between the lower rate limit and the lower rate interval? What is the relationship between the post-ventricular atrial refractory period (PVARP) and the total atrial refractory period (TARP)? What is hysteresis? What is a typical upper tracking rate? What is fusion and pseudofusion? Tune in for answers to these questions.

Difficulty Level: Advanced

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In this episode, we explore the concept of ventricular dyssynchrony and cardiac resynchronization therapy (CRT). What are the eleven scenarios in which CRT is recommended, according to the 2022 heart failure guidelines? What benefits to patients receive when CRT is appropriately used? What factors could contribute to nonresponse to CRT? How can echocardiography be used to find the atrioventricular delay to optimize LV filling? Tune in for answers to these questions.

Difficulty Level: Intermediate

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In this episode, we review the key aspects of ICD therapies. What are typical thresholds for a VT monitor zone, regular VT zone, fast VT zone, and VF zone? How is the number of intervals to detect (NID) defined deterministically vs probabilistically for VT vs VF detection? What is a typical rate and interval decrement for anti-tachycardia pacing (ATP)? What is the difference between a burst and a ramp of ATP? What do the B>AX, B>X, and B>A vectors for ICD shock describe? What are strategies for reducing inappropriate shocks? When is it appropriate to use a subcutaneous ICD or a wearable ICD? Tune in for answers to these questions.

Difficulty Level: Advanced

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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 explore the fundamentals of permanent pacemaker (PPM) and implantable cardioverter-defibrillator (ICD) interrogation. What are the most common pacing modes, and when are they used? What is rate-adaptive pacing, mode switching, and managed ventricular pacing? What mode do you induce when you place a magnet? How do you perform a sensing test and a threshold test? What are the timing cycles in single-chamber pacing and dual-chamber pacing? What mode is induced when the device reaches the recommended replacement time (RRT), and how many months are left when RRT is reached? Tune in for answers to these questions.

Difficulty Level: Advanced

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In this episode, we review Brugada Syndrome, syndrome of syncope and/or sudden death in healthy patients associated with mutations in SCN5A. How is Brugada pattern different from Brugada syndrome? How do you recognize the three main types, and how do they differ in management? Who should receive an implantable cardiac defibrillator, and who should receive antiarrhythmics such as quinidine? Tune in for answers to these questions.

Difficulty Level: Easy

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In this episode, we go over how to localize the origin of ventricular tachycardia (VT) and premature ventricular contractions (PVCs). What clues on ECG allow you to distinguish VT coming from outflow tracts vs the inferior ventricles? What clues on ECG allow you to distinguish VT arising from the LV free wall vs VT arising from the RV or inter-ventricular septum? Which types of VT have the highest procedural success rates with ablation? Which type of VT is verapamil-sensitive, and which is propranolol-sensitive? Can individuals with PVCs participate in competitive sports? Tune in for answers to these questions.

Difficulty Level: Advanced

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In this episode, we explore the definitions, mechanisms, and management of ventricular tachycardia (VT). What is the significance of sustained vs non-sustained VT, and monomorphic vs polymorphic VT? How is VT storm defined in patients without implantable cardiac defibrillators (ICDs) vs those with ICDs? What are common doses of medications for VT storm? What are examples of appropriate and inappropriate shocks? What should you do about ICD shocks? What morphologies in lead aVR allow you to distinguish between VT and SVT with aberrancy? Tune in for answers to these questions.

Difficulty Level: Intermediate

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