Cardiology

Arrhythmias

SA node -> AV node -> bundle of His -> left/right bundles -> Purkinje fibers

• Bradyarrhythmias and Conduction Abnormalities
  • H&P: syncope, nausea, vomiting, blurred vision, dizziness
  • DDx: sinus brady, SSS, 1st degree AV block, 2nd degree AV block (Mobitz 1), 2nd degree AV block (Mobitz 2), 3rd degree AV block
  • Tx: correct electrolytes/hypothermia, atropine/dopamine, transcutaneous pacing, transvenous pacing, leadless pacing, permanent pacemaker
• Tachyarrhythmias
  • H&P: palpitations, syncope
  • DDx: Sinus tach, Afib, Aflutter, Vtach, Vfib, Vflutter, AVNRT, AVRT, WPW
  • Tx: Stable vs. Unstable. Synchronized cardioversion vs DCCV. Vagal maneuvers, atropine, beta blockers, amiodarone, digoxin, diltiazem. Rate control superior to rhythm control most of the time. Calculate a CHAD2S2VASc for Afib patients. Consider cardioablation vs. Watchman. Always get a TEE/cardioversion for chronic Afib. The most effective AC is warfarin. Best AC is usually DOAC because of once daily oral dosing. LMWH is an alternative if they can't have a DOAC. Aflutter can be 2:1, 3:1, or 4:1 with fixed rates of 150, 100, and 75 respectively. Do NOT shock sinus tach.

Congestive Heart Failure

• Systolic Dysfunction/HFrEF
• Non-systolic Dysfunction/HFpEF

Cardiomyopathy

• Dilated Cardiomyopathy
• Hypertrophic Cardiomyopathy
• Restrictive Cardiomyopathy

Coronary Artery Disease

• Angina Pectoris
• Prinzmetal Angina
• Carotid Artery Stenosis

Acute Coronary Syndromes

• Unstable Angina/NSTEMI
• STEMI

Dyslipidemia

• Age 45-74, LDL > 190
• Age 45-74, LDL 70-190 ASCVD > 10%
• Age 45-74, LDL 70-190 ASCVD > 7.5%
• Age 45-74, Diabetes
• ACS = HD
• > 75 = MD

Hypertension

• Primary/Essential Hypertension
  • Dx: Rule out secondary causes, BP > 130/90 on two separate occasions.
  • DDx: Secondary HTN--RAS, Hypo/Hyper(para)thyroidism, Conn syndrome, Cushing's syndrome, Pheochromocytoma
  • Tx: Can start with 1 or 2 agents depending on severity. First line: ACEI/ARB (good for kidney protection), (Non)Dihydropyridine CCB, Beta Blockers (cardiac selective, non-selective), Thiazide/Non-Thiazide Type Diuretics (second line)
• Hypertensive Urgency BP > 180
• Hypertensive Emergency BP > 180 + symptoms

Pericardial Disease

• Pericarditis
• Cardiac Tamponade (Beck's triad)

Valvular Heart Disease

Cardiac Murmur Descriptions and Maneuvers

Murmur	Description	Provocative Maneuvers
AR	Diastolic, M	Example
AS	Systolic, A	Example
MR	Systolic, A	Example
MS	Diastolic, Blowing, M	Example
MP	Systolic, Click, A	Example
TR	Systolic	Example
PDA	Continuous, Machine-like	Example

• Maneuvers increase afterload (hand grip, standing), preload (passive leg raise, lying down), or both (vagal).

• Endocarditis: Janeway lesions, Osler nodes, Splinter hemorrhages

Vascular Diseases

• Aortic Aneurism: Different types of repair (open vs endovascular), when to intervene (> 5.5 cm or rapidly enlarging), one time screening abd US in ever smokers at age 50
• Aortic Dissection: Stanford classification: type B (post arch and descending aorta) is medically managed; type A (ascending or arch) is surgical emergency.
• Deep Venous Thrombosis: Virchow's triad
• Peripheral Arterial Disease: ABI
• Lymphedema