Cardiovascular

What is seen in 1st-degree AV block?

PR > 200 ms (1 large box); all P waves are conducted

What is seen in 2nd-degree AV block, Mobitz Type I (Wenckebach)?

Progressive PR interval lengthening followed by a dropped QRS complex

What is seen in 2nd-degree AV block, Mobitz Type II?

Constant PR interval with randomly dropped QRS complexes

What is seen in 3rd-degree AV block (complete heart block)?

P waves and QRS complexes occur independently (AV dissociation)

What is the treatment for AV blocks?

Type I and Mobitz I: Atropine if symptomatic; Mobitz II and 3rd-degree: Pacemaker

What is the rate control for Afib when HR > 40 bpm?

CCB (e.g., Diltiazem) or Beta-blocker (e.g., Metoprolol)

What is the rate control for Afib when HR < 40 bpm?

Beta-blocker or Digoxin

What is the rhythm control strategy for Afib < 48 hours?

Cardioversion without prior anticoagulation

What is the rhythm control strategy for Afib > 48 hours?

Anticoagulation x 3 weeks → Cardioversion → Continue AC x 4 weeks

What causes PSVT?

Often AVRT, including WPW

What does PSVT look like on EKG?

Narrow QRS tachycardia, HR 150–250 bpm, buried P wave

What is first-line acute treatment for PSVT?

Vagal maneuvers → Adenosine

What are long-term treatments for PSVT?

Beta-blockers or CCBs

What is seen in PACs?

Early abnormal P wave (±QRS), often with a pause

What is seen in PVCs?

Early wide QRS with compensatory pause

What is the treatment for symptomatic PACs or PVCs?

Beta-blockers

What is sick sinus syndrome?

SA node dysfunction causing bradycardia, pauses, or alternating brady/tachycardia

What are the classic EKG findings in WPW?

Delta wave (slurred upstroke), Wide QRS (>120 ms), Short PR interval (<120 ms)

What defines WAP?

HR < 100, 3+ P wave morphologies, irregularly irregular

What defines MAT?

HR > 100, 3+ P wave morphologies, irregularly irregular

What are common causes of MAT?

Pulmonary disease (e.g., COPD), heart failure

What does Vfib look like on EKG?

Chaotic, irregular, no clear QRS complexes

Treatment for Vfib?

Immediate defibrillation (ACLS protocol)

What does Vtach look like on EKG?

Wide, regular QRS complexes (monomorphic)

Treatment for unstable Vtach?

Defibrillation

Treatment for stable Vtach?

Antiarrhythmics: Amiodarone or Lidocaine

What is the most common type of cardiomyopathy?

Dilated cardiomyopathy

Is DCM associated with systolic or diastolic dysfunction?

Systolic dysfunction (reduced ejection fraction)

What are common symptoms of DCM?

Dyspnea, pulmonary congestion, signs of right heart failure (JVD, edema)

What heart sound is associated with DCM?

S3 gallop

What medications are used to manage DCM?

ACE inhibitors, beta-blockers (e.g., Carvedilol, Metoprolol), diuretics

When is an implantable defibrillator indicated in DCM?

If EF < 35%

What type of dysfunction is seen in HCM?

Diastolic dysfunction

What are hallmark symptoms of HCM?

Sudden cardiac death, exertional syncope, chest pain

What murmur is associated with HCM?

Harsh systolic crescendo-decrescendo murmur at LLSB; Louder with Valsalva or standing; Softer with squatting

What is first-line treatment for HCM?

Beta-blockers or CCBs (Verapamil); disopyramide

Which medications are contraindicated in HCM?

Diuretics, nitrates, digoxin (↓ preload = ↑ obstruction)

What is the pathophysiology of RCM?

Stiff ventricles with impaired filling, no dilation

What are the most common causes of RCM?

Amyloidosis (MC), sarcoidosis, hemochromatosis, scleroderma

What physical exam sign is associated with RCM?

Kussmaul’s sign (JVP rises with inspiration)

How is RCM treated?

Treat underlying cause; supportive care with diuretics for symptoms

Which medications improve mortality in HFrEF (reduced EF)?

Beta-blockers (Carvedilol, Metoprolol succinate), ACE inhibitors or ARBs, Mineralocorticoid receptor antagonists (e.g., spironolactone)

What drugs relieve symptoms in HF?

Diuretics

What inotropes are used in hypotensive or decompensated HF?

Dobutamine or dopamine

What is the most common valvular lesion?

Aortic stenosis

What causes AS in younger patients?

Congenital bicuspid aortic valve

What causes AS in older adults?

Calcification of the valve

Describe the murmur of AS.

Harsh crescendo-decrescendo systolic murmur at RUSB, radiates to carotids

What is the most common cause of PS?

Congenital disorders (e.g., Tetralogy of Fallot), rubella syndrome

Describe the murmur of PS.

Crescendo-decrescendo systolic murmur at LUSB, increases with inspiration

What is the most common cause of AR worldwide?

Rheumatic fever

What are other causes of AR?

Endocarditis, aortic dissection, myocardial infarction

Describe the murmur of AR.

Early diastolic decrescendo murmur at LSB

What physical signs are associated with AR?

Bounding pulses, Water hammer pulse, Quincke’s pulse (nailbed flushing)

Describe the murmur of PR.

Early decrescendo diastolic murmur at LUSB (Graham Steell murmur)

What is the most common cause of MS?

Rheumatic fever

What arrhythmia is associated with MS?

Atrial fibrillation

What is “mitral facies”?

Flushed cheeks and cyanotic nose

Describe the murmur in MS.

Opening snap followed by diastolic rumble, best heard at apex (LLD position)

Treatment for symptomatic MS?

Percutaneous balloon valvotomy

What is the most common cause of TS?

Rheumatic fever

Describe the murmur of TS.

Diastolic rumble with opening snap, increases with inspiration

What are common causes of MR?

Mitral valve prolapse (MVP), rheumatic fever

What arrhythmia is associated with MR?

Atrial fibrillation

Describe the murmur of MR.

Holosystolic murmur at apex, radiates to axilla

Describe the murmur in TR.

Holosystolic murmur at LLSB, increases with inspiration

What is the most common cause of MVP?

Marfan syndrome, connective tissue disorders

What are typical symptoms of MVP?

Palpitations, anxiety, chest pain (often in young women)

Describe the murmur of MVP.

Mid-to-late systolic click followed by late systolic murmur, best at apex

What are the 4 main types of ACS and their key features?

Stable Angina (SA): Ischemia w/o necrosis, improves with rest/NTG; Unstable Angina (UA): Ischemia w/o necrosis, pain at rest or minimal exertion; NSTEMI: Ischemia with necrosis, elevated troponin, no ST elevation; STEMI: Ischemia + necrosis, elevated troponin, ST elevation on EKG.

What are classic symptoms of ACS?

Substernal chest pressure, worse with exertion, relieved with rest (not in UA/STEMI)

What is the gold standard test for ACS?

Coronary angiography

What is the non-invasive test used for ischemia?

Stress testing (exercise or pharmacologic)

What is the preferred reperfusion strategy in STEMI?

PCI within 90 min (or transfer within 120 min)

What is the alternative if PCI unavailable within 120 min?

Fibrinolysis within 30 min (door-to-needle)

What are absolute contraindications to thrombolysis?

Prior ICH, Ischemic stroke within 3 months, Suspected aortic dissection

What does the mnemonic MNOP stand for in ACS treatment?

M: Morphine; N: Nitrates; O: Oxygen (<90%); P: Pulse/platelets = BB + ASA + P2Y12

What are discharge meds post-ACS?

ASA, P2Y12 (e.g., clopidogrel), high-dose statin, BB, ACEI (if EF < 40%)

What defines a hypertensive emergency?

BP ≥180/120 with end-organ damage

What defines a hypertensive urgency?

BP ≥180/120 without end-organ damage

Sx of flash pulmonary edema?

Dyspnea, crackles, JVD, S3 gallop

Diagnostic findings for flash pulmonary edema?

CXR (pulmonary edema), BNP elevated

Treatment for flash pulmonary edema?

Loop diuretics + nitroglycerin

Treatment of HTN-related ACS?

BB (esmolol, metoprolol), NTG, CCB (clevidipine) if BB contraindicated

Classic presentation of aortic dissection?

Tearing chest/back pain + asymmetric pulses/SBP

Initial and confirmatory tests for aortic dissection?

CXR: widened mediastinum; Confirm: CTA (stable) or TEE (unstable)

First-line treatment for aortic dissection?

IV BB (e.g., labetalol); Add nitroprusside after HR controlled; Surgery if Type A

Diagnostic criteria for orthostatic hypotension?

SBP ↓ ≥20 mmHg or DBP ↓ ≥10 mmHg on standing

Causes of orthostatic hypotension?

Dehydration, blood loss, meds (e.g., diuretics)

Workup for orthostatic hypotension?

Supine vs standing BP, CBC, BMP, cortisol, ECG

Treatment for orthostatic hypotension?

Midodrine (if needed), Increase salt/water, Educate on slow positional changes

What causes vasovagal syncope?

Reflex vagus stimulation from pain, stress, standing

Prodromal symptoms of vasovagal syncope?

Nausea, pallor, blurry vision, sweating

Management for vasovagal syncope?

Supine positioning, leg elevation, midodrine (if recurrent)

MCC of pericarditis?

Idiopathic (viral — Coxsackie), post-MI, trauma

Symptoms of pericarditis?

Sharp pleuritic chest pain, worse lying down, better sitting up

PE finding in pericarditis?

Pericardial friction rub

EKG findings in pericarditis?

Diffuse ST elevation + PR depression

Treatment for pericarditis?

NSAIDs or ASA x 2 weeks ± colchicine

MCC of cardiac tamponade?

Trauma, malignancy, pericarditis