cardiovascular

Cardiovascular TOC

adrenal disorders (3)

thyroid disorders

hypothyroidism

hashimoto thyroiditis
postpartum thyroiditis
congenital hypothyroidism (cretinism)
De Quervain subacute granulomatous thyroiditis
Riedel fibrosing thyroiditis

hyperthyroidism
thyroid tumors

parathyroid disorders (1)

hyperparathyroidism

pituitary disorders (2)

pancreas disorders (2)

neuroendocrine tumors

neuroblastoma
carcinoid syndrome
pheochromocytoma
insulinoma
glucagonoma
somatostatinoma
zollinger-ellison syndrome
VIPoma

Simple Question

Answer

Simple Layered Question

Answer and Question 2

Answer and Question 3

Answer

APC-DMD

Associations?

Answer

Pathophysiology?

Answer

Clinical Features?

Answer

Diagnostic Evaluation?

Answer

Management?

Answer

Differential Diagnosis?

Answer

Subjectively, patient presents with (cc/hpi/pmh). Objectively, vitals are (vitals). Physical exam is significant for (PE). Workup plan?

(Study 1) reveals. (Study 2) reveals. Assessment?

(Diagnosis). Management?

(Management).

cardiovascular UW

Ischemic Heart Disease (5)

Stable Angina
Unstable Angina
NSTEMI
STEMI
Vasospastic (Prinzmetal) Angina

Congestive Heart Failure (2)

Congestive Heart Failure
- Systolic (HFrEF)
- Diastolic (HFpEF)
Acute Decompensated CHF

Arrhythmias

Tachyarrhythmias (4 + 3)

Atrial Fibrillation
Atrial Flutter
Multifocal Atrial Tachycardia
Paroxysmal Supraventricular Tachycardia
Wolf-Parkinson-White Syndrome
Ventricular Tachycardia
Ventricular Fibrillation

Bradyarrhythmias (3)

Sinus Bradycardia
Sick Sinus Syndrome
AV Block
- 1st Degree
- 2nd Degree Mobitz Type 1
- 2nd Degree Mobitz Type 2
- 3rd Degree

Diseases of the Heart Muscle (4)

Dilated Cardiomyopathy
Hypertrophic Cardiomyopathy
Restrictive Cardiomyopathy
Myocarditis

Pericardial Diseases (4)

Acute Pericarditis
Constrictive Pericarditis
Pericardial Effusion
Cardiac Tamponade

Valvular Heart Disease

Mitral Stenosis

Congenital Heart Disease

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 (1)

Atrial Myxoma

Shock (4)

Hypotension causing end-organ hypoperfusion.
Cardiogenic Shock
Hypovolemic Shock
Distributive Shock
- Septic Shock
- Neurogenic Shock
Obstructive Shock

workup stories

Patient presents with chest pain...

EKG shows ST elevations

STEMI

EKG shows ST depressions, cardiac enzymes positive

NSTEMI

EKG shows ST depressions, cardiac enzymes negative

Unstable angina

CXR shows...

Answer

CT Angio shows filling defect

Chest is tender to palpation

Costochondritis

Chest pain. Aggravated by exertion. Alleviated by rest.

Stable Angina

Chest pain at rest. ST-depression on EKG. Negative cardiac enzymes.

Unstable Angina

Chest pain at rest. ST-depression on EKG. Positive cardiac enzymes.

NSTEMI (subendocardial)

Chest pain at rest. ST-elevation on EKG. Positive cardiac enzymes

STEMI (transmural)

Chest pain at rest. ST-elevation on EKG. Smoker or cocaine-user.

Vasospastic (Prinzmetal) Angina

Shortness of breath. Aggravated by laying flat. Alleviated by elevating head.

Congestive Heart Failure

Arrhythmia. Early P waves that differ in morphology from the normal sinus P wave.

Premature Atrial Complexes

Arrhythmia. Wide, bizarre QRS complexes followed by a compensatory pause.

Premature Ventricular Complexes

Arrhythmia. Irregularly, irregular rhythm with no identifiable P waves. [Tx]

Atrial Fibrillation. Tx is rate control (hemodynamically stable) or synchronized cardioversion (hemodynamically unstable).

Arrhythmia. Saw-tooth baseline with a QRS complex after every second or third “tooth” (P wave). [Tx]

Atrial Flutter. Tx is same as Afib.

Arrhythmia. At least 3 different P-wave morphological and variable PR and RR intervals.

Multifocal Atrial Tachycardia

Arrhythmia. Narrow QRS complexes with no discernible P waves. [Tx]

Paroxysmal Supraventricular Tachycardia. Tx is adenosine.

Arrhythmia. Narrow complex tachycardia, short PR interval, and delta wave. [Tx]

Wolff-Parkinson-White (WPW) Syndrome. Tx is procainamide.

Arrhythmia. Wide and bizarre QRS complexes. [Tx]

Ventricular Tachycardia. Tx is amiodarone (hemodynamically stable) or synchronized cardioversion (hemodynamically unstable).

Arrhythmia. No atrial P waves and QRS complexes can be identified (i.e. no waves can be identified). [Tx]

Ventricular Fibrillation. Tx is unsynchronized cardioversion (defibrillation) and/or CPR.

Arrhythmia. Sinus rate <60 bpm. [Tx]

Sinus Bradycardia. Tx is atropine or pacemaker.

Arrhythmia. Persistent spontaneous sinus rate <60 bpm.

Sick sinus syndrome.

Arrhythmia. PR interval is >200 msec.

1st Degree AV Block

Arrhythmia. Progressive prolongation of PR interval until a P wave fails to conduct.

2nd Degree AV Block Mobitz Type I (Wenckebach)

Arrhythmia. P wave fails to conduct suddenly, without a preceding PR interval prolongation; therefore, the QRS drops suddenly. [Tx]

2nd Degree AV Block Mobitz Type II. Tx is pacemaker.

Arrhythmia. Absence of conduction of atrial impulses to the ventricles; no correspondence between P waves and QRS complexes. [Tx]

3rd Degree AV Block. Tx is pacemaker.

Chest pain. Dyspnea or syncope on exertion. Sudden death in young athletes. [Tx]

Hypertrophic Cardiomyopathy. Tx is beta-blocker/verapamil and preventing dehydration.

Chest pain. Fever and fatigue. [Tx]

Myocarditis. Tx is supportive.

Chest pain. Aggravated by breathing and lying supine. Alleviated by sitting up and leaning forward. [Tx]

Acute Pericarditis. Tx is NSAIDs or colchicine.

Dyspnea on exertion. PE significant for JVD, Kussmaul sign, pericardial knock, ascites, and dependent-edema.

Constrictive Pericarditis

Hypotension, muffled heart sounds, and elevated JVP. PE may also be significant for exaggerated decreased in arterial pressure during inspiration (>10 mmHg drop).

Cardiac Tamponade.

Palpitations. Fever, fatigue, and possible syncope. PE is significant for low-pitched diastolic murmur (diastolic plop).

Atrial Myxoma

Hypotension causing end-organ hypoperfusion. PE is significant for tachycardia and MAP <65 mmHg.

Shock

Hypotension causing end-organ hypoperfusion. PE is significant for tachycardia, MAP <65 mmHg, pulmonary crackles, and JVD. Low CO + High SVR (cool skin) + High PCWP. [Tx]

Cardiogenic Shock. Tx is inotropes (dobutamine, norepinephrine) and loop diuretics (if volume overload).

Hypotension causing end-organ hypoperfusion. PE is significant for tachycardia and MAP <65 mmHg. Low CO + High SVR (cool skin) + Low PCWP. [Tx]

Hypovolemic Shock. Tx is fluid resuscitation.

Hypotension causing end-organ hypoperfusion. PE is significant for tachycardia and MAP <65 mmHg. High CO + Low SVR (warm skin) + Low PCWP. [Tx]

Septic Shock. Tx is fluid resuscitation, antibiotics, and pressors (norepinephrine).

Hypotension causing end-organ hypoperfusion. PE is significant for tachycardia and MAP <65 mmHg. Low CO + Low SVR (warm skin) + Low PCWP [Tx]

Neurogenic Shock. Tx is fluid resuscitation and possibly pressors.

Hypotension causing end-organ hypoperfusion. PE is significant for tachycardia and MAP <65 mmHg. Low CO (limited by obstruction) + High SVR (cool skin). [Tx]

Obstructive Shock. Tx is managing underlying disease (massive PE, tension PTX, cardiac tamponade).

Blood pressure >180/120. PE is unremarkable. [Tx]

Hypertensive Urgency. Tx is oral antihypertensives.

Blood pressure >180/120. Severe headache and visual disturbances. PE is significant for papilledema, pulmonary congestion, AMS and/or renal failure. [Tx]

Hypertensive Emergency. Tx is IV antihypertensives (Labetalol, Esmolol, Hydralazine, Nitroprusside).

Chest pain. Sudden onset with tearing pain radiating to back. PE is significant for blood pressure asymmetry in arms. [Tx]

Aortic Dissection. Tx is surgical (type A) or IV beta-blockers (type B)

Sense of fullness. PE is significant for pulsatile mass on abdominal examination.

Abdominal Aortic Aneurysm

Abdominal pain. PE is significant for hypotension and a palpable pulsatile abdominal mass. [Tx]

Ruptured AAA. Tx is emergent laparotomy.

Cramping leg pain when walking. ABI <0.7 in both feet. [Tx]

Peripheral Arterial Disease. Tx is smoking cessation and graduated exercise program.

Cramping leg pain at rest. ABI <0.4 in both feet.

Peripheral Arterial Disease

Sudden onset limb pain. Limb pallor, polar (cold), pulseless, and paresthesias, and paralysis [Tx].

Acute Limb Ischemia. Tx is IV heparin and emergent embolectomy.

PE is significant for blue/black toes, renal insufficiency, and/or abdominal pain.

Cholesterol Embolization Syndrome (“showers” of cholesterol crystals causing small, discrete areas of tissue ischemia).

Unilateral leg pain and swelling. PE is significant for calf pain on ankle dorsiflexion (Homans sign).

Deep Venous Thrombosis. Tx is anticoagulation AFTER positive diagnosis with Doppler U/S.

Leg swelling. Worsened by periods of sitting or inactive standing. [Tx]

Chronic Venous Insufficiency. Tx is leg elevation and compression socks.