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	Location	Provocative Maneuvers
AR	Diastolic	Mitral	Example
AS	Systolic	Aortic	Example
MR	Systolic	Aortic	Example
MS	Diastolic, Blowing	Mitral	Example
MP	Systolic, Click	Aortic	Example
TR	Systolic	Tricuspid	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