Cardiovascular

Topics

Ischemic Heart Disease
  • Stable Angina
  • Unstable Angina
  • Vasospastic (Prinzmetal) Angina
  • NSTEMI
  • STEMI
Congestive Heart Failure
  • Systolic CHF (HFrEF)
  • Diastolic CHF (HFpEF)
  • Acute Decompensated CHF
Tachyarrhythmias
  • Atrial Fibrillation
  • Atrial Flutter
  • Multifocal Atrial Tachycardia
  • Paroxysmal Supraventricular Tachycardia
  • Wolf-Parkinson-White Syndrome
  • Ventricular Tachycardia
  • Ventricular Fibrillation
Bradyarrhythmias
  • Sinus Bradycardia
  • Sick Sinus Syndrome
  • 1st Degree AV Block
  • 2nd Degree AV Block, Mobitz Type I (Wenckebach)
  • 2nd Degree AV Block, Mobitz Type II
  • 3rd Degree AV Block (Complete)
Diseases of the Heart Muscle
  • Dilated Cardiomyopathy
  • Hypertrophic Cardiomyopathy
  • Restrictive Cardiomyopathy
  • Myocarditis
Pericardial Diseases
  • Acute Pericarditis
  • Constrictive Pericarditis
  • Pericardial Effusion
  • Cardiac Tamponade
Valvular Heart Disease
  • Aortic Stenosis
  • Ventricular Septal Defect
  • Mitral Regurgitation
  • Mitral Valve Prolapse
Vascular Heart Disease
  • Hypertensive Emergency
  • Aortic Dissection
  • Abdominal Aortic Aneurysm
  • Peripheral Arterial Disease (Chronic Arterial Insufficiency)
  • Acute Arterial Occlusion
  • Cholesterol Embolization Syndrome
  • Mycotic Aneurysm
  • Luetic Heart
  • Deep Venous Thrombosis
  • Chronic Venous Insufficiency (Venous Stasis Disease)
  • Superficial Thrombophlebitis
Cardiac Neoplasms
  • Atrial Myxoma
Shock
  • Cardiogenic Shock
  • Hypovolemic Shock
  • Distributive Shock
    • Septic Shock
    • Neurogenic Shock
  • Obstructive Shock

Chief Complaints

Patient presents with chest pain.
  • If indicated, workup:
  • Physical exam reveals...
      Chest wall tenderness to palpation
      • Costochondritis
    EKG reveals...
      ST elevations (diffusely)
      • Acute pericarditis
      ST elevations (sparsely)
      • STEMI
      ST depressions (+positive cardiac enzymes)
      • NSTEMI
      ST depressions (+negative cardiac enzymes)
      • Unstable Angina
    CXR reveals...
      Air space opacification (consolidation pattern)
      • Pneumonia
      Air space opacification (peripheral wedge shape)
      • Pulmonary embolism
      Mediastinal widening
      • Aortic injury (e.g. aortic dissection, traumatic aortic injury)
    CTA reveals...
      Filling defect in pulmonary vasculature
      • Pulmonary embolism
Patient presents with palpitations...
Patient presents with dyspnea...
Patient presents with edema...
Patient presents with loss of consciousness...

Vignettes

Acute chest pain. Aggravated by movement and/or breathing. Physical exam reveals tenderness to palpation. Likely diagnosis?
  • Costochondritis
  • M: Treatment? (1)
    • Analgesics (e.g. NSAIDs, acetaminophen) along with reassurance that it should resolve within a few weeks

Acute chest pain. Incited by exertion/stress. Relieved with rest. Likely diagnosis?
  • Stable Angina
  • M: First-line treatment? (+2 Others?)
    • Beta-blockers. Other options include nondihydropyridine CCBs or nitrates.
Acute chest pain. Not relieved with rest or nitroglycerin. EKG reveals ST-depressions. Labs show negative cardiac enzymes. Likely diagnosis?
  • Unstable Angina
  • M: Initial treatment? (5)
    • MONA BASH: Nitrate, antiplatelets, beta-blocker, statin, and heparin
    • Optional: Morphine if severe pain, oxygen if SaO2 less than 90, lasix if pulmonary edema without hypovolemia
    M: Definitive treatment within 24-72 hours?
    • Reperfusion (e.g. percutaneous coronary intervention)
Acute chest pain. Episodic and often occurs suddenly at night. Resolves spontaneously after several minutes. Likely diagnosis?
  • Vasospastic (Prinzmetal) Angina
  • A: Risk factors? (3)
    • Risk factors include cigarettes, cocaine, and triptans.
    P: Mechanism?
    • Intrinsic hypercontractility of coronary artery smooth muscles that leads to vasospasms
    D: Possible finding on an EKG? (1)
    • ST segment elevation
    M: Treatment to abort an episode? (1)
    • Nitroglycerin
    M: Treatment for prophylaxis? (1)
    • Calcium channel blockers (CCBs)
Acute chest pain. EKG reveals ST-depressions. Labs show elevated cardiac enzymes. Likely diagnosis?
  • Non-ST Elevation Myocardial Infarction (NSTEMI)
  • Subendocardial infarction
  • myocardial infarction patterns, CC-BY-3.0
Acute chest pain. EKG reveals ST-elevations. Labs show elevated cardiac enzymes. Likely diagnosis?
  • ST Elevation Myocardial Infarction (STEMI
  • Transmural infarction
  • myocardial infarction patterns, CC-BY-3.0

Shortness of breath. Aggravated by laying flat. Sometimes wake up at night gasping for air. Exam reveals wheezes and bibasilar crackles. Likely diagnosis?
  • Acute Decompensated Heart Failure (ADHF)
  • C: Common findings on physical examination?
    • Physical examination can reveal bibasilar crackles and/or wheezes on auscultation, peripheral edema, jugular venous distention, S3 or S4 heart sounds
    M: Treatment?
    • LMNOP: Lasix (furosemide), morphine, nitroglycerin, oxygen supplementation, positioning (sitting upright)

Palpitations. EKG reveals “early P waves that differ in morphology from normal sinus P waves”. Likely diagnosis?
  • Premature Atrial Complexes
  • premature atrial contraction, public domain