⌘K
Volume 03

A study guide to cardiology.

For the internal medicine resident who’d rather read a twelve-lead than dread a cardio consult. Designed to keep your confidence ejection fraction firmly above 50%. Last revised 2026.

10 topics

Cardiology

Coronary · Valvular · Myocardial · Rhythm · Vascular

01

Stable Angina Pectoris

▾
  • Chest pain: cardiac, possibly cardiac, non-cardiac
  • Stable CAD › TTE
  • Exercise stress test (echo, SPECT, ECG) or pharmacological (CMR, echo, PET, SPECT)
    • Age <65 › CT CAG
    • ECG changes at rest › exercise echo / MIBI
    • Cannot exercise › pharmacological MIBI or CT CAG
  • EST CI: MI <48h · ongoing unstable angina · uncontrolled hemodynamically significant arrhythmia · active endocarditis · symptomatic severe AS · decompensated HF · acute PE/DVT · acute myocarditis/pericarditis · acute aortic dissection · physical limitations
  • EST ≥85% max HR (= 220 − age) r/o IHD
  • Foundation: ASA + statin + BBs
  • Adjunctive: smoking cessation, cardiac rehab, weight management, physical activity, alcohol, vaccines
Symptomatic Ladder
  1. BBs +/− long-acting nitrates 8–12h free period overnight · CI PDE5i
  2. Nondihydropyridine CCBs
  3. Ranolazine reduce dose with CCBs
  4. PCI
  5. External counterpulsation or spinal cord stimulation (preserved EF)
  • Target HR 60
  • ACEi LVEF <40%, HTN, CKD, DM
  • DM › SGLT2i or GLP1RA
  • CABG LM, three-vessel CAD, MVD + DM
  • Elective PCI + DES › DAPT for 6 months
  • Primary prevention: age 40–59y + ≥10% 10-year ASCVD risk
02

Acute Coronary Syndrome

▾
STEMI ECG Criteria
  • STE ≥1mm in ≥2 contiguous leads
  • STE V2/V3 ≥2mm ♂ and ≥1.5mm ♀
  • New LBBB
  • Tall R waves + STD V1–V4 (posterior MI)
  • Wellens syndrome: biphasic/deeply inverted TW V2–V3, pseudonormalization during chest pain
STEMI → PCI or tPA
Reperfusion pathway from first medical contact (FMC)
PCI-capable hospital?
→
Yes · FMC → PCI ≤90 min
No · FMC → PCI ≤120 min if transferable
Cannot reach PCI in time?
→
tPA within 30 min FMC + symptom onset ≤12h
CI tPA: active bleeding, recent surgery, recent CVA, BP >180/110
After tPA → PCI within 24h
Failed tPA?
→
Recurrent chest pain OR persistent STE after 90min → rescue PCI
  • Loading: ASA 160–325 mg + P2Y12i + anticoagulation (UFH, LMWH, fondaparinux, bivalirudin) for 48h or until revascularization
    • Ticagrelor 180 mg SE dyspnea
    • Clopidogrel 300–600 mg
    • Prasugrel 60 mg CI CVA/TIA
  • If tPA given › pair with ASA + clopidogrel
  • NSTE-ACS & CAG ≤24h › no P2Y12i pretreatment
    • Risk stratify with GRACE / TIMI
    • High risk › CAG ≤24h · Intermediate › CAG ≤72h
    • Emergency PCI if hemodynamic instability, HF, recurrent chest pain, new/worsening MR murmur, ventricular arrhythmias
DAPT ≥12 months (up to 3 years if low bleeding risk). High bleeding risk › clopidogrel monotherapy after 1–3 months. DES › DAPT ≥6 months.
  • BBs (bisoprolol, metoprolol succinate, carvedilol) within 24h CI HF, hemodynamic instability, heart block, bronchospasm
  • ACEi/ARB within 24h › indefinitely in HF, anterior wall STEMI, DM, or HTN
  • High-intensity statin
    • Hypertriglyceridemia › icosapent ethyl
    • High LDL › ezetimibe › PCSK9i
  • Indication for DOAC › triple therapy 1–4 weeks → clopidogrel + DOAC for 1y → DOAC monotherapy
  • Non-cardiac surgery >3 months post-PCI; semi-urgent >1 month post-PCI
    • Hold clopidogrel & ticagrelor 5–7 days · prasugrel 7–10 days pre-op

Mechanical & Other Complications

Time course and management

ComplicationTimingKey Features / Tx
Acute MR2–7 dPapillary muscle rupture / dysfunction
VSD2–7 dNew holosystolic murmur, shock
VFWR2–7 dTamponade, PEA arrest
RV infarctionInferior MIHypotension, JVD, clear lungs · STE V4R · IVF, inotropes
Pericarditis2–8 wk (Dressler)Pleuritic chest pain, friction rub
Cardiogenic shockVariableDobutamine
LV thrombusDays–weeksAnticoagulate
Reperfusion AIVRAcuteBenign — observe
MINOCA Workup

CAG +/− intracoronary imaging +/− provocative testing for vasospasm, echo, CMR.

Peripartum
SCAD
Vasospasm
Spontaneous · methamphetamines · cocaine · 5-FU · bromocriptine
Microvascular
Cardiac syndrome X
Takotsubo
ACEi/ARB, BBs

Driving Restrictions

After MI / revascularization

ScenarioWait
STEMI / NSTEMI (LVEF preserved)2 weeks
STEMI / NSTEMI · LVEF ≤40%1 month
STEMI / NSTEMI without PCI1 month
UA · with PCI48h
UA · without PCI7 days
Elective PCI48h
CABG1 month
  • Cardiac rehab
  • ICD >40d post-MI or >3mo post-PCI/CABG + LVEF ≤35% & NYHA II/III, OR LVEF ≤30% & NYHA I
03

Heart Failure

▾

HF Classification by EF

TypeLVEFHeart Sounds
HFrEF<40%S1 + S2 + S3
HFmrEF40–50%—
HFpEF>50%S4 + S1 + S2
  • Workup: ECG, echo, CBC, RFT, ferritin, TFT, troponin, BNP, lipids, HbA1c
    • ↑ BNP: CKD, female, old age, sepsis, ARNI
    • ↓ BNP: obesity
  • Ischemic › CAG › CABG
  • Non-ischemic › CMR
  • Acute HF + HTN/MR › IV nitroglycerin
Cardiogenic Shock Criteria

SBP <90 for ≥30min or vasopressors needed to maintain SBP ≥90 + end-organ hypoperfusion (cool extremities, oliguria, AMS, lactic acidosis) · CI <2.2 · PCWP >15

› dobutamine, milrinone › IABP / ECMO / percutaneous VAD

  • Acute HF risk (EHMRG) › loop diuretics (furosemide, torsemide, bumetanide) › metolazone
    • Do not begin BB
    • Continue in-patient diuresis until congestion resolves
    • OPD within 1 week of discharge
  • Adjunctive: exercise, salt <2–3 g/d, fluid <2 L/d, smoking cessation, EtOH avoidance, vaccines, cardiac rehab, treat HTN BP <130/80 + DM
  • Ferritin <50 or TSAT <20% › IV iron
  • NYHA I › BB + ACEi
  • Symptomatic — the four pillars:
    • ARNI / ACEi / ARB · 36h washout · CI angioedema
    • MRA
    • SGLT2i (dapagliflozin eGFR ≥25, empagliflozin eGFR ≥20) CI T1DM
    • BB
  • Titrate every 2–4 weeks; maximally tolerated doses within 3–6 months
  • HR >70 + NSR + LVEF ≤35% › ivabradine
  • Black or cannot tolerate ARNI/ACEi/ARB › hydralazine + nitrates
  • AF › digoxin caution CKD, older age, female
  • Recent HF hospitalization + NYHA II–IV › vericiguat
  • HTN, DM › SGLT2i, MRA, ARNI/ARB, GLP1RA BMI ≥30
  • ICD NYHA II–IV + LVEF ≤35% or NYHA I + LVEF ≤30% or cardiac arrest VT/VF or sustained VT + structural HD
    • 3 months OMT / post-revasc · 40 days post-MI
  • CRT NYHA II–IV + LVEF ≤35% + NSR + LBBB / QRS ≥150
  • Advanced HF: very low EF · recurrent hospitalizations · NYHA IV · organ dysfunction · cachexia · high 1-y mortality · poor CPET
    • › LVAD, transplant, palliative care
    • Asymptomatic transplant rejection › endomyocardial biopsy
    • LVAD › anemia
Avoid in HF

NSAIDs · pioglitazone · nondihydropyridine CCBs · PDEi

  • Routine follow-up: symptoms, functional capacity, volume status, electrolytes, kidney function
  • Change in clinical status or planned intervention › echo
04

Myocardial Disease

▾
Hypertrophic
HCM

Autosomal dominant. Chest pain, dyspnea, syncope, arrhythmia, pulses bisferiens, systolic murmur LLSE (↑ Valsalva & standing), triple apex. › CVA, HF, SCD.

Screen 1st-degree relatives › TTE. AF › DOAC.

ICD: sustained VA · prior arrest · FH SCD · wall >30mm · unexplained syncope · apical aneurysm · LVEF <50% · extensive LGE · NSVT on Holter.

Rx: BBs/CCBs (non-DHP) › disopyramide/mavacamten › myomectomy/EtOH ablation (LVOT gradient ≥50).

Avoid: ACEi/ARBs, vasodilators, diuretics, PDE5i, digoxin, nitrates.

ECG: LVH, LAE, deep symmetric TWI V3–V6 (apical), QW, repol abnormalities.

Echo: asymmetric septal hypertrophy, MV SAM, LVOTO (gradient <50 › stress echo), eccentric MR. Repeat 1–2 yearly.

Infiltrative
Amyloidosis

Restrictive CM, HF, syncope, atrial/ventricular arrhythmia, AS, autonomic dysfunction, neuropathy, carpal tunnel, nephrotic syndrome, hepatomegaly.

AL (MM) · periorbital purpura › SPEP/UPEP, sFLC, abdominal fat pad biopsy › chemo +/− ASCT.

ATTR (hereditary/wild-type) · macroglossia, dysphagia, bilateral CTS › Tc-99m-PYP, TTR sequencing, biopsy › tafamidis / inotersen / patisiran +/− liver transplant.

ECG: low voltage, pseudo-infarction. Echo: LVH, diastolic dysfunction.

Rx: diuretics. Avoid BBs, CCBs, ACEi/ARBs. AF › DOAC.

Restrictive
Restrictive CM

Dyspnea, edema, exercise intolerance, hepatomegaly, ascites, Kussmaul sign, atrial arrhythmias. ↑ BNP.

Etiologies: radiation fibrosis, eosinophilic disease, hemochromatosis. Familial › genetic testing.

Echo: biatrial enlargement, severe diastolic dysfunction, normal wall thickness, PH, TR, MR.

Inflammatory
Acute Myocarditis

Viral (coxsackievirus, echovirus, adenovirus, coronavirus). Presents as acute HF › cardiogenic shock, ventricular arrhythmias.

Toxic
Alcoholic CM

DCM with dilated and hypokinetic LV.

Toxic
Drug-Induced CM

Cocaine, amphetamines › MI, arrhythmia, SCD.

Inflammatory
Giant Cell Myocarditis

Young to middle-aged adults. Shock, biventricular enlargement, refractory ventricular arrhythmias.

Endomyocardial biopsy → multinucleated giant cells. › immunosuppression, LVAD, transplant.

Metabolic
Hemochromatosis

OA, deranged LFTs, ED, skin bronzing, DM. CMR, ↑ferritin, ↑TSAT › phlebotomy.

Obstetric
Peripartum CM

LVEF <45%, from 1 month pre-partum to 5 months postpartum.

Granulomatous
Sarcoidosis

Bilateral hilar lymphadenopathy, skin/joint/eye lesions, conduction disorders. CMR, PET, EMB → noncaseating granulomas, multinucleated giant cells › prednisone.

Stress
Takotsubo CM

Intense emotional/physiologic stress › acute LV dysfunction, dilatation, apical akinesia. Anterior STE, deep TWI, QW.

Rhythm-Related
Tachycardia-Mediated

Sustained rapid AF, SVT, ventricular arrhythmias › ambulatory ECG.

Neoplastic
Atrial Myxoma

MS-like murmur, tumor plop, constitutional symptoms, embolic phenomena, dyspnea, syncope › surgical excision + echo surveillance for recurrence.

05

Valvular Heart Disease

▾
Prosthetic Valve Selection
  • Age <50y › mechanical + warfarin
    • AVR · INR 2–3; thromboembolism RF · 2.5–3.5; On-X AV · 1.5–2
    • MVR · INR 2.5–3.5
  • Age >65y or VKA CI › bioprosthetic + ASA · echo at 5y, then annually after 10y
  • Severe asymptomatic native valve disease › surveillance echo every 6–12 months
  • Etiology: bicuspid (40–60y), RHD, calcification (≥60y) › fatigue, dyspnea, angina, syncope, HF
  • Crescendo-decrescendo systolic murmur · single/absent S2 · weak carotid pulses
  • Echo: LAE, LVH
  • Severe: mean gradient >40, peak velocity >4, AVA ≤1
    • Low flow + low gradient + reduced EF › dobutamine stress echo
    • Normal EF › cardiac CT calcium scoring
  • AVR severe + symptomatic; severe + LVEF <50%; severe + undergoing CV surgery
  • Age >80y › TAVR
  • Avoid ACEi/ARBs; symptomatic › loop diuretics
  • Acute AR: dissection, endocarditis, trauma, prosthetic dysfunction › immediate AVR + bridging sodium nitroprusside + IV diuretics. Short soft diastolic murmur.
  • Chronic AR: aortic dilatation (autoimmune, syphilis, Marfan, HTN), bicuspid, radiation, RHD, VSD
    • Diastolic decrescendo murmur ↑ expiration · Austin Flint murmur · widened pulse pressure · bounding pulses
    • ECG › LAD, LVH
    • AVR severe + symptomatic; severe + LVEF ≤55%; severe + CV surgery; severe + LVESD >50
    • Symptomatic/HTN › ACEi/ARBs or nifedipine
  • RHD › fatigue, dyspnea, orthopnea, PND › echo, CMR
  • Low-pitched diastolic murmur · loud S1 · opening snap
  • ECG › RVH, P mitrale (I, II, aVL)
  • Embolic event / LA thrombus / AF › VKA
  • PMBC (CI LA thrombus, mod/severe MR, severely calcified valve) or surgery: symptomatic + severe; moderate + PH
  • Symptomatic › diuretics, long-acting nitrates, BBs, non-DHP CCBs
  • Acute MR: MI, MVP, endocarditis, trauma › shock, pulmonary edema › vasodilators, IABP, immediate surgical repair. Short soft murmur, soft S3, soft P2.
  • Chronic MR: MVP, Barlow, RHD, endocarditis, calcification, trauma, secondary › DCM, LAE › TTE
    • Holosystolic murmur · systolic click (MVP) · diminished S1
    • ECG › P mitrale
    • Surgical MVR or TEER severe + symptomatic; severe + LVEF ≤60% / LVESD ≥40
    • Embolic / LA thrombus / AF › VKA
    • Secondary MR › maximally tolerated GDMT › TEER
  • TR: lead, trauma, IE, RHD, carcinoid, secondary (PHTN, RV/RA related)
    • Holosystolic murmur LSE · ↑ inspiration
    • TVR severe + undergoing left-sided valve surgery
    • RVF › loop diuretics, MRA › TVR
  • TS: RHD

Prophylaxis for dental procedures only.

  • Indications: prosthetic valve · prosthetic repair material · history of IE · unrepaired cyanotic CHD · repaired CHD with prosthesis/shunt (≤6mo) or residual defect · valvulopathy post cardiac transplant
  • PO amoxicillin 30–60 min pre-op › cephalexin / azithromycin / clarithromycin / doxycycline
  • BAV + aortopathy › TTE, CMR, CTA
  • Screen 1st-degree relatives with echo
  • Annual echo if aortic root >4.5 cm
  • Surgical aortic root repair:
    • Valve replacement + aortic root ≥4.5 cm
    • Root >5 cm + RF for dissection
    • Root >5.5 cm
06

Dyslipidemia

▾
  • Screening: age 40–75y, postmenopausal, pregnancy-related complications, ASCVD, FH DLP, AAA, DM, HTN, smoker, stigmata, premature CVD 1st-deg relative, CKD, obesity, inflammatory diseases, HIV, ED, COPD
  • Secondary causes: DM, hypothyroidism, nephrotic syndrome, glucocorticoids
  • Lifestyle: dietary modification, regular activity, optimal weight, smoking cessation
  • FH: LDL ≥4.9 · 1st-deg relative LDL >5 or early CAD · xanthelasma · xanthomata · corneal arcus
Statin Indications

Primary prevention: LDL ≥4.9; FH; age 40–75y + ≥1 ASCVD RF + 10y ASCVD risk ≥10%.

Unclear indication › CA calcium scoring.

Secondary prevention (age ≤75y): CAD, CVA, PAD, aortic aneurysm › high-intensity statin.

  • Statin › 20–40% LDL reduction · 6% reduction with dose doubling
  • High intensity: atorvastatin 40–80 mg, rosuvastatin 20–40 mg
  • Target: >50% LDL reduction + LDL <1.8
    • Very high risk › >50% LDL reduction + LDL <1.4
  • Baseline LFT and lipids · routine LFT / CK if hepatic / muscle disease

LDL Targets by Risk

ScenarioTargetAdd-on
LDL >5<2.5—
DM / CKD / FRS >10%<2—
ASCVD<1.8—
LDL 1.8–2.2—ezetimibe
LDL >2.2—PCSK9i
  • PCSK9i indications: heterozygous FH, clinical ASCVD, homozygous FH › 50–60% LDL reduction
  • HyperTg (fasting Tg ≥1.5) primary prevention › 5–10% weight loss, ↓alcohol/sugar/fat › fenofibrate
  • HyperTg secondary prevention › statin (high-intensity) + icosapent ethyl
07

Diseases of the Aorta

▾
  • RF: HTN, vasculitis, bicuspid AV, cocaine, Marfan, EDS
  • Features: focal neuro deficit, pulse deficit, AR, HF, tamponade, differential BP
  • Imaging: CTA, TEE, MRA. CXR › enlarged aorta/mediastinum, pleural effusion
  • Medical: BBs (IV labetalol) / CCBs + vasodilators (nitroprusside, ACEi) · analgesia opioids
  • Targets: HR <60–80 · SBP ≤120 within 1h
  • Type A / intramural hematoma / cardiogenic shock › urgent surgery
  • Type B › medical management; ischemia/rupture › urgent surgery/endovascular repair
  • RF: Turner, CTD, FH. Workup: TTE, MRA, CTA; CTD features › genetic testing
  • Surveillance: 3.5–4.4 cm annually · 4.5–5 cm 6-monthly · within 5 mm of surgical threshold or growth >0.5 cm/y › more frequently
  • Target SBP <130/80 › BBs or ARBs. Marfan › BB or losartan
  • Smoking cessation. ASCVD › statins. Fluoroquinolones › rupture risk
  • Surgery: BAV/degenerative >5.5 · genetic >4.5–5 · undergoing cardiac surgery >4.5 · growth >0.5 cm/y
  • RF: male, smoking, older age, HTN, FH. Screen one-time US ♂ 65–75y + smoking / FH › AAA >3 cm
  • Rupture › CTA/MRA
  • Smoking cessation · BP <130/80 · ASCVD › statin
  • Surveillance: <4 cm 2–3 yearly · 4–4.9 (♂) / 4–4.4 (♀) annually · 5–5.4 (♂) / 4.5–4.9 (♀) 6-monthly
  • Surgery: ♂ ≥5.5 · ♀ ≥5 · symptomatic · growth ≥0.5 cm/6mo. Rupture › emergency surgery/endovascular

Recent cardiac catheterization or vascular surgery › livedo reticularis, blue toe syndrome, amaurosis fugax, AKI (eosinophiluria), CVA › APT + statin.

08

Pericardial Disease

▾
  • Etiology: post-MI, Dressler, viral (coxsackievirus, echovirus, adenovirus, influenza, parvovirus), TB, fungal, autoimmune (RA, SLE), uremia, dialysis, hypothyroidism, radiation, post-CV surgery, neoplastic
    • Drugs: procainamide, hydralazine, isoniazid, minoxidil, phenytoin
  • Pleuritic chest pain (worse supine, improves with sitting/leaning forward) · friction rub
  • Treatment: high-dose NSAID 1–2 weeks + colchicine 3 months
  • Myocardial involvement › ↑ troponin
  • ECG › diffuse concave STE · PR depression II. Echo › pericardial effusion. CT/MRI › inflammation
  • Diagnostic criteria (2 of 4): pleuritic chest pain · friction rub · new pericardial effusion · typical ECG changes
Admit if…

Immunocompromised · trauma · anticoagulation · myopericarditis · T >38 · subacute · effusion >20 mm · tamponade · hemodynamic instability · no improvement after 7d.

  • Recurrence › high-dose NSAID 2 weeks + colchicine 6 months › glucocorticoids
  • Autoimmune › glucocorticoids
  • Post-MI › high-dose NSAID 1–2 weeks + ASA 650 mg PO QDS 3 months
  • Idiopathic · autoimmune · cardiac surgery · pericarditis · radiation · TB
  • Kussmaul sign · RV failure · rapid Y descent JVP · ventricular interdependence · pericardial knock
  • ECG › low voltage. CT/MRI › pericardial calcification
  • Definitive: surgical pericardectomy
  • Etiology: metastatic lung/breast cancer · postpericardiotomy syndrome · viral/bacterial pericarditis · rheumatic disease · aortic dissection
  • Tachycardia · pulsus paradoxus · blunted Y descent JVP · Beck's triad · ventricular interdependence
  • ECG › electrical alternans
  • Definitive: pericardiocentesis or surgical drainage

Idiopathic + asymptomatic › periodic surveillance echo. Large/symptomatic › pericardiocentesis.

09

Arrhythmias

▾
Unstable › DC cardioversion.
  • WPW: AVRT, short PR, delta wave › ablation
    • AF › DC cardioversion (unstable), procainamide (stable) — avoid CCBs/BBs/digoxin › VT/VF
  • AVNRT: short RP, absent PW › BBs or CCBs › ablation
  • MAT: irregular SVT · ≥3 PW morphologies · varying PP/PR/RR · severe pulmonary disease › metoprolol or verapamil
  • SVT › Valsalva, carotid sinus massage, cold-water facial immersion › adenosine or verapamil
AF / AFL Workup

Echo, CBC, RFT, coagulation, TFT, HbA1c, lipids, sleep study.

Modifiable RF: alcohol, smoking, exercise, sleep apnea, weight loss, DM, HTN.

  • AFL: sawtooth inferior leads, +ive V1, P rate 250–300 › ablation
  • Rate control › BBs or CCBs › digoxin. HR <100
  • Rhythm control indications: persistent symptoms, HF, <1y, young › AAD or DC cardioversion › catheter ablation
    • Flecainide & propafenone CI in structural HD or EF ≤40%
  • Hemodynamic instability › DC cardioversion
  • Anticoagulation: CHADSVA ≥2 › DOAC. Valvular AF (mechanical valve, rheumatic MS, mod/severe MS) › VKA
    • CAD + high thrombosis risk › clopidogrel + DOAC
  • AF >48h or unknown › ≥3 weeks anticoagulation or TEE (LA thrombus) › cardioversion › 4 weeks anticoagulation › CHADSVA
  • AF <48h › anticoagulation + cardioversion › 4 weeks › CHADSVA
  • Anticoagulation CI › LAA occlusion + short-term anticoag › long-term APT
Bradycardia (Unstable)

Hypotension, DLOC, shock, ischemic chest pain, AHF › atropine › transcutaneous pacing +/− dopamine/epinephrine infusion › transvenous pacing.

Causes: Lyme, OSA, electrolytes, hypothyroidism, sarcoidosis, genetic, age-related fibrosis, inferior ischemia, drugs (BBs, non-DHP CCBs, donepezil).

Symptomatic or high-grade AV block (Mobitz II, complete HB) or alternating BBB › pacemaker.

Conduction Blocks at a Glance

BlockECG
LBBBAbsent Q + wide +ive R I/aVL/V6 · −ive V1 · QRS >120
RBBBrsR′ V1 · wide negative S V6 · QRS 120s
LAFBLAD · +ive QRS I · −ive QRS aVF
LPFBRAD · −ive QRS I · +ive QRS aVF
  • Ventricular arrhythmia workup: resting ECG, exercise treadmill, cardiac imaging
    • VT vs SVT-with-aberrancy: capture beats, fusion beats, PW marching, positive aVR, extreme axis deviation, precordial concordance, RSr′ V1
    • ≥3 episodes/24h › BBs or CCBs › AAD or ablation
    • Stable sustained (>30s) VT › IV procainamide or amiodarone or lidocaine
    • ICM › CAG + revascularization
    • Structural HD / ICM + sustained VT › ICD
    • Polymorphic VT/VF › amiodarone or lidocaine
    • Prolonged QT › TdP › IV Mg, temporary pacing, BBs › lidocaine
    • PVC + CM › ablation
Channelopathy
Brugada Syndrome

Autosomal dominant · incomplete RBBB · STE + TWI V1–V3.

Syncope or VA › ICD.

Channelopathy
Long QT Syndrome

♂ >440 · ♀ >460. Hypokalemia, hypomagnesemia, structural HD, drugs (macrolides, fluoroquinolones, terfenadine, astemizole, antipsychotics, antidepressants, methadone, antifungals, class Ia/III antiarrhythmics).

Rx › BBs › ICD. QTc >500 › high risk SCD.

Genetic
ARVD

Autosomal dominant · TWI V1–V3 · epsilon wave · prolonged S upstroke V1–V3 › CMR.

Autonomic
POTS

↑HR >30 within 10 min standing › midodrine or fludrocortisone.

Amiodarone Monitoring

6-monthly TFT & LFT · annual PFT & ophthalmologic exam.

  • CIED infection › BCS › antibiotics › device removal
10

Peripheral Arterial Disease

▾

ABI Interpretation

ABISeverity
0.8–0.9Mild PAD › duplex US, CTA/MRA
0.5–0.8Moderate
<0.5Severe
>1.4Non-compressible — check TBI <0.7
NormalExercise treadmill ABI
  • Screen: age >50y + RF
  • Smoking cessation · supervised exercise training · DM management
  • High-intensity statins › LDL <1.8
  • HTN › ACEi/ARBs › <130/80
  • Symptomatic › APT (clopidogrel or ASA) › cilostazol › revascularization + ASA + low-dose rivaroxaban
  • High risk thrombosis › ASA + low-dose rivaroxaban
  • T2DM › SGLT2i or GLP1RA
Acute Limb Ischemia · The Six P's

Pain · Pulseless · Pallor · Paresthesia · Paralysis · Poikilothermia

› IV heparin + invasive angiography + urgent surgery

  • Claudication at rest + ulceration › critical limb ischemia › revascularization