Cardiology secrets

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Front Matter Copyright Dedication Contributors Preface Top 100 Secrets PART I DIAGNOSTIC EXAMINATIONS AND PROCEDURES 1 - Cardiovascular Physical Examination 1. What is the meaning of a slow rate of rise of the carotid arterial pulse 2. What is the significance of a brisk carotid arterial upstroke 3. In addition to aortic regurgitation, which other processes cause rapid upstroke and widened pulse pressure 4. What is pulsus paradoxus 5. What is pulsus alternans 6. What is the Duroziez double murmur 7. What is the carotid shudder 8. What is the Corrigan pulse 9. How do you auscultate for carotid bruits 10. What is the correlation between symptomatic carotid bruit and high-grade stenosis 11. What is central venous pressure 12. Which veins should be evaluated for assessing venous pulse and central venous pressure 13. Can the external jugulars be used for evaluating central venous pressure 14. What is a cannon a wave 15. How do you estimate the central venous pressure 16. Can the jugular vein examination be used to diagnose cardiac pathology 17. What is the significance of leg swelling without increased central venous pressure 18. What is the Kussmaul sign 19. What is the “venous hum” 20. Which characteristics of the apical impulse should be analyzed 21. What is a thrill Bibliography and Suggested Readings 2 - Heart Murmurs AND SOUNDS 1. What are the auscultatory areas of murmurs 2. What is the Levine system for grading the intensity of murmurs 3. What are the causes of a systolic murmur 4. What are common causes of systolic, diastolic, and continuous murmurs 5. What are functional murmurs 6. What is the most common systolic ejection murmur of the elderly 7. How can physical examination help differentiate functional from pathologic murmurs 8. How much reduction in valvular area is necessary for the aortic stenosis murmur to become audible 9. What factors may suggest severe aortic stenosis 10. What is a thrill 11. What is isometric hand grip, and what does it do to aortic stenosis and mitral regurgitation murmurs 12. What is the Gallavardin phenomenon 13. Where is the murmur of hypertrophic cardiomyopathy best heard 14. What are the characteristics of a ventricular septal defect murmur 15. What is a systolic regurgitant murmur 16. What are the auscultatory characteristics of systolic regurgitant murmurs 17. What are the characteristics of the mitral regurgitation murmur 18. What are the characteristics of the acute mitral regurgitation murmur 19. What are the characteristics of the mitral valve prolapse murmur 20. How are diastolic murmurs classified 21. What is the best strategy to detect the mitral stenosis murmur 22. What are the typical auscultatory findings of aortic regurgitation 23. What is a mammary souffle 24. Which murmurs require further evaluation Bibliography, Suggested Readings, and Listenings 3 - Electrocardiography 1. What are the most commonly used voltage criteria to diagnose left ventricular hypertrophy 2. What are common nonvoltage electrocardiographic findings that suggest left ventricular hypertrophy 3. What are the most commonly used criteria to diagnose right ventricular hypertrophy 4. What criteria are used to diagnose left atrial enlargement 5. What electrocardiogram finding suggests right atrial enlargement 6. What is the normal rate of a junctional rhythm 7. How can one distinguish a junctional escape rhythm from a ventricular escape rhythm in a patient with complete heart block 8. Describe the three types of heart blocks 9. What are the causes of ST-segment elevation 10. What are the electrocardiographic findings of hyperkalemia 11. What are the electrocardiographic findings in pericarditis 12. What is electrical alternans 13. What are the main electrocardiographic findings in hyper- and hypocalcemia 14. What electrocardiographic findings may be present with a pulmonary embolus 15. How is the QT interval calculated, and what are the causes of short-QT and long-QT intervals 16. What is torsades de pointes 17. What are cerebral T waves 18. What are Osborne waves 19. What findings help distinguish ventricular tachycardia from supraventricular tachycardia with aberrancy 20. In a patient presenting with angina and left bundle branch block, what features help determine if there is an ST-segment–elev... Bibliography and Suggested Readings 4 - Chest X-Ray 1. Describe a systematic approach to interpreting a chest radiograph (chest x-ray) 2. Identify the major cardiovascular structures that form the silhouette of the mediastinum 3. What is the most anterior cardiac structure on the lateral chest x-ray 4. How is heart size measured on a chest radiograph 5. What factors can affect heart size on the chest radiograph 6. What additional items should be reviewed when examining a chest radiograph from the intensive care unit 7. How can one determine which cardiac chambers are enlarged 8. What are some of the common causes of chest pain that can be identified on a chest radiograph 9. What are the causes of a widened mediastinum 10. What are the common radiographic signs of congestive heart failure 11. What is vascular redistribution When does it occur in congestive heart failure 12. How do left ventricular dysfunction and right ventricular dysfunction lead to pleural effusions 13. How helpful is the chest radiograph at identifying and characterizing a pericardial effusion 14. What are the characteristic radiographic findings of significant pulmonary hypertension 15. What is Westermark’s sign and Hampton’s hump 16. What is rib notching 17. What does the finding in Fig. 4.9 suggest 18. What is subcutaneous emphysema 19. What is pneumopericardium 20. What is a pericardial cyst Bibliography and Suggested Readings 5 - Exercise Stress Testing 1. What is the purpose of exercise stress testing, and how can a patient exercise during stress testing? 2. What is the difference between a maximal and submaximal exercise stress test 3. How helpful is an exercise stress test in the diagnosis of coronary artery disease 4. What are the risks associated with exercise stress testing 5. What are the indications for exercise stress testing 6. Should asymptomatic patients undergo exercise stress tests 7. What are contraindications for exercise stress testing 8. What parameters are monitored during an exercise stress test 9. What is an adequate heart rate to elicit an ischemic response 10. How do I calculate the predicted maximal heart rate 11. What is the Borg Scale 12. What is a metabolic equivalent 13. What is considered a hypertensive response to exercise 14. Can I order an exercise stress test for a patient taking beta-blockers 15. What baseline electrocardiographic findings interfere with the interpretation of an exercise stress test 16. When can an exercise stress test be performed after an acute myocardial infarction 17. Are the patient’s sex and age considerations for exercise stress testing 18. When is an exercise stress test interpreted as positive 19. What are the indications for terminating an exercise stress test 20. What is a cardiopulmonary exercise stress test, and what are the indications of this diagnostic test 21. On the basis of the electrocardiogram obtained during exercise stress testing, can I localize which coronary artery is affect... 22. If a patient cannot exercise, can he or she still undergo stress testing 23. How often should a stress test be repeated 24. Is the 12-lead electrocardiogram obtained during an exercise stress test the same as a regular 12-lead electrocardiogram 25. What is the Duke treadmill score 26. How can I estimate the pretest probability of coronary artery disease Bibliography and Suggested Readings 6 - Ambulatory Electrocardiogram Monitoring 1. What are the major indications for ambulatory electrocardiogram monitoring? 2. What are the different types of ambulatory electrocardiogram monitoring available 3. How does an implantable loop recorder work 4. Do patients with pacemakers or implantable cardioverter defibrillators require Holter monitors for the detection atrial arrhyt... 5. Is every “abnormality” detected during monitoring a cause for concern 6. What is the diagnostic yield of Holter monitors, event monitors, and implantable loop recorders in palpitations and syncope 7. How often are ventricular arrhythmias identified in apparently healthy subjects during ambulatory electrocardiogram monitoring... 8. What is the significance of frequent premature ventricular contractions detected by ambulatory monitoring 9. What is the role of ambulatory electrocardiogram monitoring in patients with known ischemic heart disease 10. Can Holter monitors assist in the diagnosis of suspected ischemic heart disease 11. What have Holter monitors demonstrated about angina and its pattern of occurrence 12. What is the role of ambulatory monitoring in stroke Bibliography and Suggested Readings 7 - Echocardiography 1. How does echocardiography work 2. What is the difference between echocardiography and Doppler 3. How is systolic function assessed using echocardiography 4. What is an echocardiographic diastolic assessment What information can it provide 5. How can echocardiography with Doppler be used to answer cardiac hemodynamic questions 6. How is echocardiography used to evaluate valvular disease 7. How can echocardiography help diagnose and manage patients with suspected pericardial disease 8. What is the role of echocardiography in patients with ischemic stroke 9. What are the echocardiographic findings in hypertrophic cardiomyopathy 10. What are the common indications for transesophageal echocardiography 11. What is contrast echocardiography 12. What is stress echocardiography Bibliography and Suggested Readings 8 - Nuclear Cardiology 1. What is nuclear cardiology 2. What is myocardial perfusion imaging 3. What are the uses of myocardial perfusion imaging 4. What is a perfusion defect, and how can a fixed and reversible defect be differentiated 5. What are the sensitivity and specificity of myocardial perfusion imaging for diagnosing coronary artery disease 6. What perfusion agents are used in myocardial perfusion imaging 7. What are the different stress modalities for myocardial perfusion imaging 8. How is left ventricular function assessed 9. Functional assessment of cardiac performance is determined using which nuclear cardiology techniques 10. Why should one use radionuclide angiography to assess left ventricular ejection fraction 11. How much radiation is a patient exposed to Bibliography and Suggested readings 9 - Cardiac Positron Emission Tomography 1. What is positron emission tomography? 2. Which are the two most common positron emission tomography radiopharmaceuticalsused for myocardial perfusion imaging? 3. What are the characteristics of rubidium-82 4. What are the characteristics of N-13 ammonia 5. What are the advantages of positron emission tomography myocardial perfusion imaging over single-photon emission computed tomo... 6. My patient’s positron emission tomography myocardial perfusion study was reported as demonstrating severe ischemia, but the co... 7. How is coronary flow reserve determined on a positron emission tomography scan 8. What is the relationship between fractional flow reserve and coronary flow reserve 9. Can coronary flow reserve (or myocardial flow reserve) be incorporated into routine clinical decision making 10. What is the radiopharmaceutical used in cardiac positron emission tomography for the assessment of myocardial viability 11. What is meant by “glucose loading” when a viability F-18 fluorodeoxyglucose cardiac positron emission tomography is being per... 12. What is the most common approach to preparing a nondiabetic patient for a fluorodeoxyglucose myocardial viability positron em... 13. What are common approaches to preparing a patient with diabetes for fluorodeoxyglucose myocardial viability positron emission... 14. What is meant by perfusion/metabolism “mismatch” on cardiac positron emission tomography viability imaging 15. What is meant by perfusion/metabolism “match” on cardiac positron emission tomography viability imaging 16. Are there any other tracers that can be used for positron emission tomography cardiac imaging 17. Aside from myocardial perfusion and viability, are there other applications for cardiac positron emission tomography/computed... Bibliography, Suggested Readings, and Websites 10 - Cardiac Magnetic Resonance Imaging 1. How does cardiac magnetic resonance imaging produce images? 2. What is unique about cardiac magnetic resonance 3. What are the limitations of cardiac magnetic resonance 4. What are the common imaging pulse sequences used in cardiac magnetic resonance 5. What are the appropriate uses of cardiac magnetic resonance 6. What is late gadolinium enhancement cardiac magnetic resonance imaging 7. Does cardiac magnetic resonance have a role in the evaluation of chest pain 8. Can cardiac magnetic resonance coronary angiography be used to assess chest pain 9. What is the role of cardiac magnetic resonance in the assessment of ventricular function 10. Does cardiac magnetic resonance have a role in the assessment of cardiomyopathies 11. What is the role of cardiac magnetic resonance in myocardial infarction 12. Can valvular disease be assessed by cardiac magnetic resonance 13. Can cardiac magnetic resonance be used in the assessment of congenital heart disease 14. Can cardiac magnetic resonance be used to assess cardiac masses 15. What are some of the other clinical uses of cardiac magnetic resonance 16. What are the contraindications to cardiac magnetic resonance 17. Can cardiac magnetic resonance be performed in patients with implanted cardiovascular devices 18. What is nephrogenic systemic fibrosis Bibliography, Suggested Readings, and Websites Useful Websites 11 - Cardiac Computed Tomography 1. What are the contraindications for cardiac computed tomography 2. What is the difference between prospective triggering and retrospective gating 3. When might retrospective gating be used rather than prospective triggering 4. Is it possible to scan the entire heart in a single heartbeat 5. What is the radiation dose of a standard cardiac computed tomography examination 6. What is blooming and what techniques can be done to reduce it 7. Are beta-blockers necessary for coronary computed tomography angiography 8. What is a coronary calcium score 9. What is the value of a negative calcium score in a patient with low to intermediate risk 10. Is calcium scoring an appropriate test in a patient of low coronary heart disease risk but with a family history of premature... 11. In which patients is coronary computed tomography angiography appropriate and inappropriate 12. A 49-year-old man with severe osteoarthritis presents with nonacute chest pain. You determine that he has an intermediate pre... 13. A 59-year-old woman with a low to intermediate pretest probability of coronary artery disease presents with acute chest pain.... 14. A 61-year-old woman presents to your office with nonacute chest pain. She has a history of prior stent placement in the right... 15. A 69-year-old man with a history of prior coronary artery bypass graft presents with nonacute chest pain. Is coronary compute... 16. What is the role of cardiac computed tomography in patients presenting for noncoronary cardiac surgery 17. What are the diagnostic accuracy and clinical utility of plaque characterization by cardiac computed tomography 18. Is cardiac computed tomography safe and useful in patients presenting with newly diagnosed heart failure and reduced left ven... 19. Can cardiac computed tomography be used to differentiate between a subacute and an old myocardial infarction 20. Should noncoronary structures be reviewed and reported on during a cardiac computed tomography examination 21. Summarize the appropriate uses of cardiac computed tomography in regard to the evaluation of cardiac structure and function 22. Would cardiac CT be an appropriate first modality in the assessment of a 29-year-old woman with suspected Turner syndrome pre... 23. A 56-year-old woman is being evaluated for syncope. Coronary angiography was not able to image the left circumflex coronary a... 24. A 45-year-old woman is having computed tomography of the pulmonary veins prior to radiofrequency ablation for atrial fibrilla... 25. Can cardiac computed tomography be used to measure fractional flow reserve What are the situations in which it may be helpful... 26. An 85-year-old woman with severe aortic stenosis is being evaluated for transcutaneous aortic valve replacement. Should she u... Bibliography and Suggested Readings 12 - Swan-Ganz Catheters and Cardiac Hemodynamics 1. What is a Swan-Ganz catheter 2. How is a Swan-Ganz catheter constructed 3. What information can be gained from a Swan-Ganz catheter 4. How is a Swan-Ganz catheter inserted 5. Describe the normal pressure waveforms along the path of an advancing Swan-Ganz catheter 6. How do we know that the catheter is in the true wedge position 7. What does the pulmonary artery wedge pressure signify 8. How is cardiac output determined 9. What are normal values for intravascular pressures and hemodynamic parameters 10. Why are cardiac output and left ventricular preload important 11. What are possible uses of a Swan-Ganz catheter in patients with heart failure or shock 12. What are possible uses of a Swan-Ganz catheter in patients with acute myocardial infarction 13. What are possible perioperative uses of a Swan-Ganz catheter 14. What are possible uses of a Swan-Ganz catheter in patients with pulmonary hypertension 15. What are possible uses of a Swan-Ganz catheter in intensive care units 16. What are absolute and relative contraindications to placement of a Swan-Ganz catheter 17. What diagnoses can the catheter help make 18. How can causes of shock be differentiated by Swan-Ganz catheterization 19. How can left-to-right intracardiac shunts be diagnosed by Swan-Ganz catheterization 20. What complications are associated with use of a Swan-Ganz catheter 21. How can complications be minimized 22. The wedge tracing is abnormal. What should I do 23. The cardiac output does not make sense. What is wrong Bibliography and Suggested Readings 13 - Coronary Angiography and Intracoronary Imaging and Physiologic Assessment 1. What are generally accepted indications for cardiac catheterization 2. What findings on noninvasive testing prompt performance of cardiac catheterization 3. What are the risks of cardiac catheterization 4. How are coronary lesions assessed 5. What is considered a “significant” stenosis 6. What are the major vascular complications associated with cardiac catheterization 7. What is fractional flow reserve 8. How is fractional flow reserve used to guide coronary stenting 9. During cardiac catheterization, how is aortic or mitral regurgitation graded 10. What is thrombolysis in myocardial infarction flow grade 11. What is intravascular ultrasound 12. What is optical coherence tomography 13. What are the different methods of describing the aortic transvalvular gradient in a patient undergoing cardiac catheterizatio... 14. Which patients should be premedicated to prevent allergic reactions to iodine-based contrast 15. What are the major risk factors for contrast nephropathy 16. What are vascular closure devices 17. What is the difference between radial and femoral access in cardiac catheterization 18. What is intracardiac echo 19. How are coronary angiographic projections named 20. What are the standard angiographic views to image the left coronary system 21. What are the standard angiographic views to image right coronary artery Bibliography and Suggested Readings PART II CHEST PAINS, CORONARY ARTERY DISEASE, AND ACUTE CORONARY SYNDROMES 14 - Chest Pains and Angina 1. Are most emergency room visits for chest pain caused by acute coronary syndromes 2. What are the other important causes of chest pains besides chronic stable angina and acute coronary syndrome 3. Why is prompt diagnosis of acute aortic dissection so important 4. What is angina 5. Who first described angina and when Table 14.1. Common Causes of Acute Chest Pain 6. What is the difference between stable and unstable angina Table 14.2. Specific Details of the Chest Pain History Helpful in DistinguishingAnginal Chest Pain Due to Myocardial Infarction from Pain ofNoncardiac Causation 7. What are the associated symptoms that people with angina may experience in addition to chest discomfort 8. What are the major risk factors for coronary artery disease 9. What symptoms and findings make it more (or less) likely that the patient’s chest pains are due to angina or that the patient ... Table 14.3. Value of Specific Components of the Chest Pain History for theDiagnosis of Acute Myocardial Infarction 10. What physical exam findings make the chest pain more or less likely to be due to angina 11. How is an electrocardiogram helpful in distinguishing the causes of chest pain 12. What is the initial workup of patients presenting with chest pain 13. If one is still in doubt as to the diagnosis of coronary artery disease, should a stress test be obtained 14. Are there exceptions to the classic presentations of anginal pain Fig. 14.1. A comprehensive approach to the patient with chest pain. ACS, Acute coronary syndrome; CT, computed tomography;CXR, chest x-ray; ECG, electrocardiogram; MRI, magnetic resonance imaging; NSTEMI, non-ST-elevation myocardialinfarction; PE, pulmonary embolism; ST is a segment of the ECG and is not defined; STE, ST elevation; STEMI, ST elevationmyocardial infarction; TEE, transesophagael echocardiogram; TWI, T wave inversion; UA, unstable angina; V/Q, ventilation/perfusion. 15. What is Prinzmetal angina 16. What is cardiac syndrome X and microvascular angina 17. Does an elevated troponin level confirm the diagnosis acute coronary syndrome Bibliography and Suggested Readings 15 - Chronic Stable Angina 1. Can a patient with new-onset chest pain have chronic stable angina 2. What causes chronic stable angina 3. How is chronic stable angina classified or graded 4. What tests should be obtained in the patient with newly diagnosed angina 5. What are the goals of treatment in the patient with chronic stable angina 6. What therapies improve symptoms 7. What is the initial approach to the patient with chronic stable angina 8. What is first-line drug therapy for the treatment of stable angina 9. Is any beta-blocker better than the others 10. What is the proper dosage for a beta-blocker 11. Which is more effective: calcium-channel blockers or beta-blockers 12. When should a peripherally acting calcium-channel blocker (i.e., dihydropyridine, such as amlodipine or felodipine) be used v... 13. Should sublingual nitroglycerin (or nitroglycerin spray) be prescribed to all chronic stable angina patients 14. When is a long-acting nitrate prescribed 15. When is ranolazine added 16. What medications prevent myocardial infarction or death in patients with stable chronic angina 17. What is the proper dose of aspirin 18. How should patients with chronic stable angina and aspirin allergy be treated 19. Which patients with chronic stable angina should be treated with both clopidogrel and a P2Y12 receptor blocker 20. Should patients with chronic stable angina be treated with an ACE inhibitor 21. What is the proper statin dose for the patients with chronic stable angina 22. Which patients with chronic stable angina should be referred for stress testing 23. Which patients with chronic stable angina should have a cardiac catheterization 24. Which patients with chronic stable angina should be referred for revascularization 25. Is there an easy way to remember how to manage the patient with chronic stable angina Bibliography and Suggested Readings 16 - Non–ST-Elevation Acute Coronary Syndrome 1. What is non–ST-elevation acute coronary syndrome 2. What is the current definition of a myocardial infarction 3. What other conditions besides epicardial coronary artery disease and acute coronary syndrome can cause elevations in troponin 4. What are the factors that make up the thrombolysis in myocardial infarction risk score 5. What are the components of the GRACE acute coronary syndrome risk model (at the time of admission) 6. What other biomarkers and measured blood levels have been shown to correlate with increased risk of adverse cardiovascular out... 7. What are the three currently used P2Y12 receptor inhibitors 8. What antiplatelet agents are recommended in patients with non–ST-elevation acute coronary syndrome 9. What are the differences between the intravenous antiplatelet agents 10. What anticoagulant agents are recommended by the American College of Cardiology/American Heart Association and European Socie... 11. Which patients with non–ST-elevation acute coronary syndrome should be treated with a strategy of early catheterization and r... 12. Should platelet function testing be used routinely to determine platelet inhibitory response 13. Should all patients who present with non–ST-elevation acute coronary syndrome be treated with supplemental oxygen 14. Should nonsteroidal anti-inflammatory drugs or COX-2 inhibitors (other than aspirin) be continued in patients admitted for no... 15. Can nitrate therapy be administered to patients currently taking erectile dysfunction agents 16. Can statin therapy be safely started in patients admitted with acute coronary syndromes 17. What are the recommendations regarding drug discontinuation in patients who are to undergo coronary artery bypass grafts 18. How long should patients with non–ST-elevation acute coronary syndrome be treated with dual antiplatelet therapy Bibliography and Suggested Readings 17 - ST-Elevation Myocardial Infarction 1. What are the electrocardiograph criteria for the diagnosis of ST-segment elevation myocardial infarction? 2. In patients who clinically appear to be having an acute myocardial infarction but do not have ST elevation, what else can be d... 3. Is intracoronary thrombus common in ST-segment elevation myocardial infarction 4. What is primary percutaneous coronary intervention 5. What are considered to be contraindications to thrombolytic therapy 6. What is door-to-balloon time 7. What is door-to-needle time 8. In patients treated with thrombolytic therapy, how long should antithrombin therapy be continued 9. Which patients with ST-segment elevation myocardial infarction should undergo cardiac catheterization 10. Which patients with ST-segment elevation myocardial infarction should undergo primary percutaneous coronary intervention 11. What is rescue percutaneous coronary intervention 12. In patients with ST-segment elevation myocardial infarction who present to rural hospitals without percutaneous coronary inte... 13. Which patients should not be treated with beta-blocker therapy 14. Which patients should be treated with nitrate therapy 15. Should patients with ST-segment elevation myocardial infarction be continued on nonselective nonsteroidal anti-inflammatory d... 16. What are the main mechanical complications of myocardial infarction 17. What is the triad of findings suggestive of right ventricular infarction 18. In addition to plaque rupture and thrombotic occlusion, what are other causes of ST-segment elevation myocardial infarction 19. What is Takotsubo cardiomyopathy 20. What findings suggest pericarditis 21. What is Dressler syndrome 22. Should a prophylactic implantable cardioverter-defibrillator be implanted in ST-segment elevation myocardial infarction patie... 23. What long-term therapies are indicated in patients with ST-segment elevation myocardial infarction 24. What other therapies and interventions should be considered 25. How long should patients with ST-segment elevation myocardial infarction be treated with dual antiplatelet therapy 26. What intermediate and long-term complications can result from ST-segment elevation myocardial infarction Bibliography and Suggested Readings 18 - Cardiogenic Shock 1. Define cardiogenic shock. 2. What are the various types of shock 3. Describe the clinical signs observed in cardiogenic shock and other types of shock 4. Do all patients with cardiogenic shock have an increased heart rate 5. What are the determinants of central venous pressure 6. How can one differentiate cardiogenic from septic shock 7. What is the most common cause of cardiogenic shock 8. Describe the pathophysiology of cardiogenic shock among patients with acute myocardial infarction 9. Describe other mechanisms that cause or contribute to cardiogenic shock after myocardial infarction 10. What is the significance of a loud holosystolic murmur in a patient with shock after acute myocardial infarction 11. Can right ventricular dysfunction result in cardiogenic shock 12. List the other major causes of cardiogenic shock 13. What are the mortality and morbidity rates of cardiogenic shock 14. What is the mainstay therapy for patients with cardiogenic shock complicating myocardial infarction 15. Which is the best revascularization strategy in patients with cardiogenic shock complicating myocardial infarction 16. Does the timing of revascularization matter in the treatment of cardiogenic shock 17. Describe the common medical therapies for cardiogenic shock 18. What are percutaneous circulatory assist devices Bibliography and Suggested Readings 19 - Percutaneous Coronary Intervention 1. What does the term percutaneous coronary intervention mean? 2. Which patients with chronic stable angina benefit from percutaneous coronary intervention 3. Which patients with non–ST-segment elevation acute coronary syndrome should undergo a strategy of early cardiac catheterizatio... 4. What are the contraindications to percutaneous coronary intervention and the predictors of adverse outcomes 5. What are the major complications related to percutaneous coronary intervention 6. What laboratory values should be measured in post–percutaneous coronary intervention patients 7. What is abrupt vessel closure 8. What is stent thrombosis 9. What do the terms slow flow and no reflow mean 10. Are bleeding complications related to percutaneous coronary intervention clinically important 11. What important complications can occur at the access site 12. What are some treatment options for various vascular complications 13. What is contrast nephropathy 14. What is restenosis 15. What are the recommendations regarding antiplatelet therapy after percutaneous coronary intervention 16. What steps should be taken to prevent premature discontinuation of dual antiplatelet therapy 17. What should be the management of a patient with a drug-eluting stent who requires urgent noncardiac surgery 18. What should be discussed with the patient after percutaneous coronary intervention and before discharge 19. What is the dual antiplatelet therapy score, and how can we use it Bibliography and Suggested Readings 20 - Coronary Artery Bypass Surgery 1. What are the indications for coronary artery bypass grafting 2. How does coronary artery bypass grafting compare with medical management for coronary artery disease 3. How does coronary artery bypass grafting compare with drug-eluting stents 4. What is the syntax score 5. Which patients benefit most from coronary artery bypass grafting 6. What is the cardiopulmonary bypass pump, and how is it used 7. Why is heparin required for cardiopulmonary bypass 8. How is the heart stopped while on cardiopulmonary bypass 9. How is the myocardium protected during cardiac arrest during bypass surgery 10. What is the long-term patency of the saphenous vein 11. What are the benefits of using the internal mammary artery for bypass 12. What about other arterial conduits 13. What is off-pump coronary artery bypass grafting, and what are the differences between on-pump and off-pump coronary artery b... 14. What is a “mid-cab” operation 15. What is robotic coronary artery bypass grafting 16. What is a “hybrid” procedure 17. What complications can occur following coronary artery bypass grafting 18. Who is at risk for mediastinitis 19. What causes strokes during coronary bypass 20. What is a type II neurologic deficit 21. How should clopidogrel and other antiplatelet agents be managed preoperatively 22. Which patients should be on dual antiplatelet therapy after coronary artery bypass grafting 23. What factors are important in the follow-up of coronary artery bypass grafting patients 24. What is the incidence of recurrent disease requiring redo coronary artery bypass grafting Bibliography and Suggested Readings PART III HEART FAILURE AND CARDIOMYOPATHIES 21 - Myocarditis 1. What is myocarditis 2. What is the incidence of myocarditis 3. What is the demographic presentation of myocarditis 4. What is the etiology of myocarditis 5. What is the pathogenesis of myocarditis Fig. 21.2. Pathogenesis of viral myocarditis. Table 21.1. Causes of Myocarditis 6. What is the clinical presentation 7. What is the clinical classification based on the level of diagnostic certainty Fig. 21.3. Time course of viral myocarditis in three phases (derived from murine models). The acute phase of myocarditistakes only a few days, whereas the subacute and chronic phases cover a few weeks to several months. Table 21.2. Clincopathologic Classification of Myocarditis 8. What blood tests can guide the diagnosis 9. What noninvasive diagnostic tests are useful in myocarditis 10. Is viral serology useful 11. What is giant cell myocarditis 12. What is the role of endomyocardial biopsy 13. How is an endomyocardial biopsy performed 14. How is the endomyocardial biopsy tissue analyzed? 15. What are the risks associated with an endomyocardial biopsy 16. When is it appropriate to proceed with an endomyocardial biopsy 17. What are the limitations of the endomyocardial biopsy How can the sensitivity be increased 18. What is the treatment of myocarditis 19. Should physical exercise be avoided in myocarditis 20. What are the outcomes, prognoses, and long-term sequelae in myocarditis Bibliography and Suggested Readings 22 - Dilated Cardiomyopathy 1. What is dilated cardiomyopathy? 2. Are nonischemic cardiomyopathy and dilated cardiomyopathy the same 3. What are the incidence and prevalence of dilated cardiomyopathy 4. How does dilated cardiomyopathy present 5. What kinds of diagnostic studies should be obtained in patients with suspected dilated cardiomyopathy 6. What are the common causes of dilated cardiomyopathy 7. What are the features of alcohol-induced cardiomyopathy 8. What are the features of cocaine-induced cardiomyopathy 9. What are the features of chemotherapy-induced cardiomyopathy 10. What are the features of human immunodeficiency virus–related cardiomyopathy 11. What are the associations between collagen vascular disease and dilated cardiomyopathies 12. What is peripartum cardiomyopathy 13. What are the features of tachycardia-induced cardiomyopathy 14. What are the features of nutritional causes of dilated cardiomyopathy 15. What are the features of cardiomyopathy caused by iron overload 16. Which patients with heart failure should be considered for endomyocardial biopsy 17. What is the natural history of dilated cardiomyopathy 18. What are the prognostic features of dilated cardiomyopathy 19. What are the pharmacologic treatments to be used in dilated cardiomyopathy 20. Should dilated cardiomyopathy patients be anticoagulated 21. What is the role of exercise therapy 22. Should patients with dilated cardiomyopathy be prescribed statin therapy 23. When is device therapy (implantable cardioverter defibrillator or cardiac resynchronization therapy) recommended in patients ... Bibliography and Suggested Readings 23 - Heart Failure With Preserved Ejection Fraction 1. What is diastolic dysfunction 2. What is diastolic heart failure 3. What is the prevalence of heart failure with preserved ejection fraction 4. What are the morbidity and mortality associated with heart failure with preserved ejection fraction compared with heart failur... 5. Which patients are at highest risk for developing heart failure with preserved ejection fraction 6. What are the proposed pathophysiologic mechanisms of heart failure with preserved ejection fraction 7. What factors can precipitate decompensated heart failure with preserved ejection fraction 8. How is the diagnosis of heart failure with preserved ejection fraction made 9. What common tests are useful in the diagnosis of heart failure with preserved ejection fraction, and what do they often reveal... 10. What is the clinical approach to further evaluate patients with heart failure with preserved ejection fraction 11. What tests are available for the evaluation of diastolic function 12. How do you treat acutely decompensated heart failure with preserved ejection fraction 13. How do you treat patients with chronic heart failure with preserved ejection fraction 14. What are current class I recommendations for the treatment of heart failure with preserved ejection fraction Bibliography, Suggested Readings, and Websites 24 - Hypertrophic Cardiomyopathy 1. What is hypertrophic cardiomyopathy? 2. What is the prevalence of hypertrophic cardiomyopathy 3. What are the genetic mutations that cause hypertrophic cardiomyopathy, and how are they transmitted 4. Who should be screened for hypertrophic cardiomyopathy 5. Who should undergo genetic testing 6. What are the histologic characteristics of hypertrophic cardiomyopathy 7. What are the common types of hypertrophic cardiomyopathies 8. What are the most common symptoms in patients with hypertrophic cardiomyopathy 9. How is hypertrophic cardiomyopathy differentiated from athlete’s heart 10. Describe the classic murmur of obstructive hypertrophic cardiomyopathy and bedside maneuvers that differentiate it from other... 11. How does the carotid pulse in obstructive hypertrophic cardiomyopathy differ from that in valvular aortic stenosis 12. What noninvasive studies are helpful in making the diagnosis of hypertrophic cardiomyopathy 13. What is systolic anterior motion, and what causes it 14. Describe the mechanism of left ventricular outflow tract obstruction in hypertrophic cardiomyopathy 15. What are the characteristic hemodynamic findings during cardiac catheterization in obstructive hypertrophic cardiomyopathy 16. What is the Brockenbrough-Braunwald sign 17. What are the risk factors for sudden cardiac death in patients with hypertrophic cardiomyopathy 18. What medications should generally be avoided in patients with obstructive hypertrophic cardiomyopathy 19. What are the pharmacologic therapies for patients with hypertrophic cardiomyopathy 20. What nonpharmacologic treatments are available to patients with hypertrophic cardiomyopathy 21. What are the indications for an implantable cardioverter defibrillator in hypertrophic cardiomyopathy 22. What is the natural history of hypertrophic cardiomyopathy Bibliography and Suggested Readings 25 - Restrictive Cardiomyopathy 1. What is the basic pathophysiology in restrictive cardiomyopathy? 2. What are the main causes of restrictive cardiomyopathy 3. What are the usual echocardiographic findings in restrictive cardiomyopathy 4. How does amyloidosis affect the heart 5. How is cardiac amyloidosis diagnosed 6. What are the main cardiac manifestations of sarcoidosis 7. Is endomyocardial biopsy useful in cases of suspected restrictive cardiomyopathy 8. Is cardiac computed tomography or cardiac magnetic resonance imaging useful in cases of possible restrictive cardiomyopathy 9. What are hypereosinophilic syndrome and Loeffler’s disease 10. What is Gaucher’s disease 11. How does Hurler’s syndrome affect the heart 12. What are the clinical features of restrictive cardiomyopathy 13. What drugs can cause restrictive cardiomyopathy 14. What are the hemodynamic findings on cardiac catheterization 15. What is the prognosis of idiopathic restrictive cardiomyopathy 16. What are the treatment options for restrictive cardiomyopathy 17. What is diabetic cardiomyopathy Bibliography and Suggested Readings 26 - Acute Decompensated Heart Failure 1. What is acute decompensated heart failure Isn’t it just a worsening of chronic heart failure 2. Are there clinically important subcategories of acute decompensated heart failure 3. Is heart failure simply a problem of too much extra fluid 4. What is the role of biomarkers like b-type natriuretic peptides in the diagnosis of acute decompensated heart failure 5. What features suggest patients who are particularly high risk 6. What are the goals of therapy in acute decompensated heart failure 7. What is the role of noninvasive cardiac imaging and invasive cardiac monitoring 8. How should we give diuretics in acute decompensated heart failure 9. What about vasodilators 10. What is the role of inotropes like dobutamine or milrinone in patients with acute decompensated heart failure 11. What is cardiorenal syndrome in acute decompensated heart failure 12. How should we determine when to discharge patients Bibliography and Suggested Readings 27 - Heart Failure: Long-Term Management 1. How are heart failure symptoms classified 2. What is the stage system for classifying heart failure 3. Which medical treatments have been shown to decrease mortality in patients with heart failure 4. What is the suggested dosing regimen of sacubitril and valsartan 5. Which therapies in heart failure have been shown to reduce hospitalization 6. What is the suggested dosing regimen of ivabradine 7. How do angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers work 8. What approach should be taken if a patient treated with an angiotensin-converting enzyme inhibitor develops a cough 9. How do aldosterone antagonists work 10. List the two primary indications of aldosterone antagonists in heart failure 11. What is the recommended dosing of aldosterone antagonists in heart failure 12. Can all patients with heart failure safely be started on an aldosterone antagonist 13. Describe common adverse effects of angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, and aldosteron... 14. What are the indications for combination therapy with nitrates plus hydralazine in patients with chronic heart failure 15. What dosing is used in treating patients with nitrates and hydralazine 16. How should patients be treated with beta-blockers 17. What diuretics should be used and at what doses should they be initiated in heart failure patients 18. Should all heart failure patients be placed on statins 19. What is the mechanism of action of digoxin 20. What are some of the relevant drug interactions of digoxin 21. What are the clinical manifestations of digoxin toxicity 22. What are the electrocardiographic findings of digoxin toxicity 23. How is digoxin toxicity treated 24. What are the indications for Digibind 25. What four classes of drugs exacerbate the syndrome of heart failure and should be avoided in most heart failure with reduced ... 26. Is dietary restriction of sodium recommended in patients with symptomatic heart failure 27. Is fluid restriction recommended in all patients with heart failure 28. Should patients with heart failure be told to use salt substitutes instead of salt 29. What are the current criteria for consideration of cardiac resynchronization therapy with biventricular pacing 30. Which patients with heart failure should be considered for an implantable cardioverter defibrillator 31. How is advanced heart failure defined Bibliography, Suggested Readings, and Websites 28 - Heart Transplantation 1. How many heart transplants are performed in the United States each year What are the most frequent causes of heart disease req... 2. List common indications for heart transplantation 3. What baseline evaluations are obtained in the pretransplant workup 4. What are contraindications to heart transplantation 5. What do the terms allotransplantation, xenotransplantation, orthotopic transplantation, and heterotopic transplantation mean 6. Define ischemic time of the donor heart. Why is it important 7. What is the estimated graft survival at 1 year, 3 years, 5 years, and 10 years posttransplant What are the common causes of de... 8. What is cardiac allograft vasculopathy Describe its pathophysiology, incidence, risk factors, and outcome 9. List infections that are encountered early and late after cardiac transplantation 10. What types of malignancies are encountered post transplant 11. Describe potential arrhythmias encountered post transplantation 12. What are the clinical signs and symptoms associated with acute cardiac transplant rejection (allograft rejection) 13. List the different types of acute allograft rejections 14. Describe the grading and immunohistologic findings of acute cellular rejection and acute antibody-mediated rejection 15. How is allograft rejection diagnosed 16. What is gene expression profiling, and how is it used in the diagnosis of rejection 17. How is an endomyocardial biopsy performed, and what are potential complications 18. What is induction therapy Describe its role in cardiac transplantation, 19. What is the incidence of acute cellular rejection Describe predisposing factors and treatment 20. Describe predisposing risk factors and treatment for acute antibody-mediated rejection 21. Describe typical maintenance immunosuppression therapy 22. What are common medical conditions encountered in posttransplant patients 23. Describe adverse effects encountered with calcineurin inhibitor use and potential drug interactions that may lead to calcineu... 24. How do patients with transplant vasculopathy clinically present What invasive and noninvasive tests are used to assist in the... 25. Describe strategies to prevent and treat cardiac allograft vasculopathy 26. When should mechanical circulatory support device implantation be considered 27. What is the Interagency Registry for Mechanically Assisted Circulatory Support profile 28. How are the Interagency Registry for Mechanically Assisted Circulatory Support profiles helpful Bibliography and Suggested Readings PART IV VALVULAR HEART DISEASE 29 - Aortic Stenosis 1. What is the prevalence of aortic stenosis What are the trends in aortic stenosis with age 2. What are the risk factors for, and common causes of, aortic stenosis 3. What is the pathophysiology of aortic stenosis, and what effect does it have on the left ventricle 4. What are the symptoms of aortic stenosis How are they related to outcome 5. What are the signs of aortic stenosis 6. What are the preferred modalities for diagnosis of aortic stenosis 7. How is aortic stenosis graded by echocardiography 8. What is the role of exercise stress testing in aortic stenosis 9. What medical therapies are effective in the treatment of aortic stenosis What is the risk of mortality in severe symptomatic a... 10. When is surgery indicated in aortic stenosis 11. What are the indications for surgical aortic valve replacement versus transcatheter aortic valve replacement 12. What are the outcomes with aortic valve replacement Bibliography and Suggested Readings 30 - Aortic Regurgitation 1. What are the causes of aortic regurgitation 2. What are the most common causes of acute aortic regurgitation 3. What are the most common causes of chronic aortic regurgitation 4. What is the pathophysiology of aortic regurgitation 5. What are the symptoms of aortic regurgitation 6. Is the presentation of acute aortic regurgitation different from that of chronic aortic regurgitation 7. What are the findings of aortic regurgitation on physical examination 8. How is the diagnosis of aortic regurgitation confirmed 9. What imaging test should be obtained when echocardiography is indeterminate 10. What other testing may be useful in select patients 11. How is aortic regurgitation classified 12. How is aortic regurgitation managed 13. Is there any medical therapy for aortic regurgitation Bibliography and Suggested Readings 31 - Mitral Regurgitation 1. What are the causes of mitral regurgitation? 2. How does primary mitral regurgitation affect the left ventricle 3. What are the other effects of primary mitral regurgitation on the heart and lungs 4. What are the clues to mitral regurgitation on physical examination 5. How is the diagnosis of mitral regurgitation confirmed 6. How is the severity of mitral regurgitation classified 7. How are the stages of mitral regurgitation classified 8. Are there effective medical therapies for chronic primary mitral regurgitation 9. What is the definitive therapy for primary mitral regurgitation, and when should it be employed 10. What percutaneous options are available to patients with primary mitral regurgitation 11. How is secondary mitral regurgitation managed 12. What percutaneous options are available to patients with secondary mitral regurgitation 13. What is mitral valve prolapse 14. What is the classic auscultatory finding in mitral valve prolapse 15. What is the natural history of asymptomatic mitral valve prolapse Bibliography and Suggested Readings 32 - Mitral Stenosis 1. What is the usual cause of mitral stenosis 2. What is the pathophysiology of mitral stenosis 3. What are the typical symptoms of mitral stenosis 4. What are the signs of mitral stenosis at physical examination 5. How is the diagnosis made 6. What are the four states of mitral stenosis 7. Is there effective medical management for mitral stenosis 8. What is the definitive management for severe mitral stenosis Bibliography and Suggested Readings 33 - Transcatheter Aortic Valve Replacement 1. What is transcatheter aortic valve replacement 2. How is risk assessed for patients in whom aortic valve replacement is being considered 3. What options are there for low- and intermediate-risk patients 4. Who is excluded from undergoing transcatheter aortic valve replacement 5. What are the indications for aortic valve replacement 6. What are the current recommendations regarding when to choose transcatheter aortic valve replacement over surgical aortic valv... 7. What testing is needed prior to transcatheter aortic valve replacement 8. What vascular approaches are commonly used in transcatheter aortic valve replacement 9. What valves are currently being used for transcatheter aortic valve replacement in the United States 10. What antiplatelet regimen is used after transcatheter aortic valve replacement 11. What are the possible complications of transcatheter aortic valve replacement 12. Can transcatheter aortic valve replacement be performed in patients with aortic insufficiency 13. Can patients with prior aortic valve replacement undergo transcatheter aortic valve replacement Bibliography and Suggested Readings 34 - Endocarditis and Endocarditis Prophylaxis 1. What are believed to be the first steps in the development of infective endocarditis 2. What are risk factors for developing infective endocarditis 3. Has the incidence or mortality from endocarditis decreased over the past 3 decades 4. How often does routine tooth brushing and flossing cause transient bacteremia 5. True or false: Prospective randomized placebo-controlled trials have demonstrated that antibiotic prophylaxis before dental or... 6. What are the four conditions identified as having the highest risk of adverse outcome from endocarditis, for which prophylaxis... 7. In the American Heart Association guidelines, for those patients with conditions listed in Question 6, which dental procedures... 8. For what other procedures may prophylaxis be considered in patients with high-risk lesions 9. In patients who need antibiotic prophylaxis, what is the recommended regimen prior to dental procedures 10. Is endocarditis prophylaxis recommended in patients treated with coronary stents, pacemakers, or defibrillators; those underg... 11. What factors should raise the suspicion for endocarditis 12. Which patients can present with endocarditis in an atypical manner 13. In which patients is right-sided endocarditis frequently seen 14. When should echocardiography be ordered in cases of suspected endocarditis 15. When is repeat imaging indicated in patients with infective endocarditis 16. What is the procedure for obtaining blood cultures in cases of suspected endocarditis 17. What is the role of other imaging modalities (besides echocardiography) in the diagnosis of infective endocarditis 18. What is the most common overall organism reported to cause endocarditis 19. What is the most common organism causing subacute native valve endocarditis 20. What is the most common organism causing endocarditis in intravenous drug abusers 21. What is the most common organism causing early prosthetic valve endocarditis 22. What is Enterococcus faecalis endocarditis often associated with 23. What is the most common cause of culture-negative endocarditis 24. How does one diagnose endocarditis caused by fastidious and non-culturable agents 25. What are the Duke criteria for the diagnosis of endocarditis 26. What are among the complications of endocarditis 27. What are poor prognostic factors in patients presenting with infective endocarditis 28. What are generally accepted indications for surgery in patients with left-sided infective endocarditis 29. What are the indications for surgery in patients with right-sided endocarditis 30. How is infective endocarditis of cardiac implantable electronic devices managed 31. Are patients with mechanical prosthetic heart valves more likely to develop endocarditis than those with bioprosthetic heart ... 32. What are Osler nodes 33. What are Janeway lesions 34. What is marantic endocarditis 35. What is Libman-Sacks endocarditis Bibliography and Suggested Readings PART V ARRHYTHMIAS 35 - Atrial Fibrillation 1. What is the difference between atrial fibrillation and atrial flutter 2. How common is atrial fibrillation 3. What are the primary goals of atrial fibrillation management 4. What is the current classification of atrial fibrillation 5. What are the most common etiologic factors contributing to atrial fibrillation 6. What is the CHA2DS2-VASc score, and how is it used 7. What can be used to assess a patient’s bleeding risk on anticoagulation 8. What are the different medication alternatives to warfarin 9. What are the alternatives to anticoagulation for the prevention of stroke and systemic embolism with atrial fibrillation 10. What options exist for rate control of atrial fibrillation 11. What is the optimal target heart rate for rate control in atrial fibrillation 12. What are the reasons to pursue maintenance of sinus rhythm in patients with atrial fibrillation 13. Are anticoagulation recommendations different for patients with paroxysmal versus persistent atrial fibrillation 14. When is anticoagulation indicated around the time of cardioversion 15. What can be done if cardioversion for atrial fibrillation is unsuccessful 16. What are some common side effects with amiodarone 17. Why do some patients taking propafenone have a pronounced beta-blocking effect 18. What are some risk factors for torsades de pointes associated with antiarrhythmic drug therapy 19. What is the target of atrial fibrillation catheter ablation 20. What are the indications for atrial fibrillation catheter ablation 21. When is it appropriate to stop anticoagulation after atrial fibrillation catheter ablation 22. What are some complications of atrial fibrillation catheter ablation 23. What is “pre-excited” atrial fibrillation Bibliography, Suggested Readings, and Websites 36 - Supraventricular Tachycardia 1. What does the term supraventricular tachycardia mean? 2. How common is supraventricular tachycardia in the general population 3. What is the most common cause of paroxysmal supraventricular tachycardia 4. What factors are part of the generic workup for supraventricular tachycardia 5. What are the causes of narrow complex regular tachycardias (regular referring to fixed R-R intervals—the time or distance betw... 6. What are the causes of narrow complex irregular tachycardias (tachycardias with irregular R-R intervals) (Fig. 36. 2.) 7. How should one go about figuring out the diagnosis of a narrow complex tachycardia 8. What is the initial treatment for acute conversion of supraventricular tachycardia 9. What pharmacologic therapies are used for acute conversion of supraventricular tachycardia 10. What therapies are used for patients who are hemodynamically unstable from supraventricular tachycardia 11. What are the success and complication rates for ablation of supraventricular tachycardia 12. Which drugs should be considered for treatment of idiopathic sinus tachycardia 13. Which drug is most commonly implicated in cases of drug-induced atrial tachycardia 14. What is the most common ventricular response rate in patients who develop atrial flutter 15. Which is more common, AV nodal reentrant tachycardia or accessory pathway–mediated reentrant tachycardia 16. What is the most common cause of focal atrial tachycardia 17. What is concealed conduction 18. For what arrhythmia should AV nodal blocking agents not be administered 19. Do patients with atrial flutter require anticoagulation before cardioversion 20. Can supraventricular tachycardia cause a wide QRS complex tachycardia 21. What is accessory pathway–mediated reentrant tachycardia with antidromic conduction 22. Which factors make the diagnosis of a wide QRS complex more likely to be ventricular tachycardia than supraventricular tachyc... Bibliography and Suggested Readings 37 - Ventricular Arrhythmias 1. What is the differential diagnosis of a wide complex tachycardia 2. What is the definition of ventricular tachycardia 3. What is the pathophysiologic substrate of ventricular tachycardia 4. What is the most common underlying heart disease predisposing to ventricular tachycardia 5. Can ventricular tachycardia occur in other nonischemic heart diseases 6. Can ventricular tachycardia occur in the absence of structural heart disease 7. What are channelopathies, and how do they relate to ventricular arrhythmias 8. What is idiopathic ventricular fibrillation 9. What electrocardiogram features favor ventricular tachycardia (over supraventricular tachycardia with bundle branch block) as ... 10. What is torsades de pointes 11. What is accelerated idioventricular rhythm 12. What is ventricular flutter 13. What critical decisions must be made in the management of sustained ventricular tachycardia 14. What methods are used to terminate sustained ventricular tachycardia 15. After the acute episode of ventricular tachycardia is terminated, what are the next management strategies 16. How is catheter ablation of ventricular tachycardia performed 17. When is catheter ablation used to treat ventricular tachycardia 18. How can autonomic modulation treat ventricular tachycardia Bibliography and Suggested Readings 38 - Cardiac Pacing for Bradycardia, Heart Block, and Heart Failure 1. What is sick sinus syndrome? 2. What are the three types of atrial ventricular blocks 3. What is bifascicular or trifascicular block 4. When is permanent cardiac pacing indicated 5. When is pacing indicated for asymptomatic bradycardia 6. Is pacing indicated for neurocardiogenic syncope 7. What are the indications for pacing after myocardial infarction 8. What other medical condition could require permanent pacing 9. What are the components of a pacing system 10. What is a leadless pacemaker system 11. What is the accepted pacing nomenclature for the different pacing modalities 12. What are potential complications associated with pacemaker implantation 13. What is pacemaker syndrome 14. What is twiddler syndrome 15. What is pacemaker-mediated tachycardia 16. What is permanent para-Hisian pacing 17. Can right ventricular pacing be deleterious 18. What is cardiac resynchronization therapy 19. When is cardiac resynchronization therapy indicated 20. Do all patients with dyssynchrony respond to cardiac resynchronization therapy 21. What is multipoint pacing in cardiac resynchronization therapy 22. What is anodal stimulation Bibliography and Suggested Readings 39 - Implantable Cardiac Defibrillator 1. What are the components of an implantable cardioverter defibrillator? 2. What are the types of implantable cardioverter defibrillators 3. How does the implantable cardioverter defibrillator work 4. How does implantable cardioverter defibrillator therapy improve survival 5. What are the current class I indications for implantable cardioverter defibrillator implantation for primary prevention of sud... 6. What are the current class I indications for implantable cardioverter defibrillator implantation for secondary prevention of s... 7. What other special populations may benefit from implantable cardioverter defibrillator therapy 8. What is defibrillator threshold testing 9. What is antitachycardia pacing 10. How common are inappropriate shocks in patients with implantable cardioverter defibrillators 11. What is a subcutaneous defibrillator 12. What is a wearable implantable cardioverter defibrillator Bibliography and Suggested Readings 40 - Cardiac Arrest and Resuscitation 1. Why was the airway, breathing, compression (“ABC”) sequence of cardiopulmonary resuscitation changed to compression, airway, breathing? 2. What factors constitute “high-quality cardiopulmonary resuscitation” 3. What is the first step to do if you are alone and come across an unresponsive adult victim with no signs of breathing 4. In patients with respiratory arrest (with a perfusing rhythm), how often are breaths delivered 5. What is the most common cause of airway obstruction in the unconscious adult patient 6. How many joules (J) are indicated for the treatment of ventricular fibrillation or pulseless ventricular tachycardia when usin... 7. In order, what are the preferred routes of drug administration 8. What are the two most important components of resuscitation for cardiac arrest 9. In a patient with ventricular fibrillation or pulseless ventricular tachycardia, after the first unsuccessful shock, which two... 10. After several unsuccessful shocks, and treatment with epinephrine, what other drugs (and their doses) should be considered 11. If the patient is in torsades de pointes, in addition to defibrillation, what medication can be considered 12. After administering a drug via a peripheral intravenous line, what steps should be taken to promote delivery of the drug to t... 13. Can one shock a hypothermic patient who is in ventricular fibrillation/ventricular tachycardia 14. If a person who was in ventricular fibrillation/ventricular tachycardia is successfully defibrillated, assuming he or she has... 15. What are the treatable causes of pulseless electrical activity 16. What drugs can be considered in a patient with pulseless electrical activity 17. In bradycardic patients, such as those with heart block, what are the primary treatments if they are symptomatic and sufferin... 18. Is transcutaneous pacing recommended for the treatment of a patient in asystole 19. In a symptomatic yet stable patient with a regular narrow complex tachyarrhythmia, what drug is recommended as a first-line a... 20. What is the dosing regimen for adenosine, and what are its primary side effects 21. After return of spontaneous circulation, what intervention has been shown to improve neurologic recovery in comatose patients... Bibliography and Suggested Readings PART VI PRIMARY AND SECONDARY PREVENTION 41 - Hypertension 1. What is the prevalence of hypertension in men and women across various age groups 2. What are the “stages of hypertension” 3. What are the four primary complications of hypertension 4. What are the goals of hypertension treatment 5. What are the steps in managing a patient with newly diagnosed hypertension 6. What are the recommended antihypertensive drugs in African American hypertensive patients 7. What are the recommended antihypertensive drugs in hypertensive patients with chronic kidney disease 8. Is systolic or diastolic blood pressure more powerful as a predictor of cardiovascular complications of hypertension 9. What does the term pulse pressure refer to 10. What is the recommended initial diagnostic workup for a hypertensive patient 11. What findings in a patient with newly diagnosed hypertension suggest kidney involvement 12. What findings in a patient with newly diagnosed hypertension suggest neurologic involvement 13. What findings in a patient with newly diagnosed hypertension suggest cardiac involvement 14. What is resistant hypertension, and how prevalent is it 15. What is secondary hypertension 16. What are the most common causes of secondary hypertension among patients with treatment-resistant or uncontrolled hypertensio... 17. What is the secondary cause of hypertension suggested by these findings and scenarios 18. A 32-year-old man complains of intermittent episodes of headaches, palpitations, and profuse sweating. Over the past year, he... 19. How important are nonpharmacologic strategies in hypertension treatment 20. True or false: beta-blockers are preferred initial antihypertensive agents in hypertensive patients with no known hypertensiv... 21. Are alpha-blockers effective in preventing cardiovascular complications of hypertension, and when is it appropriate to use th... 22. When are angiotensin-converting enzyme inhibitors or angiotensin receptor blockers specifically recommended in hypertensive p... 23. What is the prevalence of hypertension among African Americans and Hispanic Americans compared with non-Hispanic whites 24. What are the goals for hypertension treatment in African Americans recommended by the International Society of Hypertension i... Bibliography and Suggested Readings 42 - Hyperlipidemia 1. What is dyslipidemia 2. Who should be screened for dyslipidemias 3. What are important secondary causes of dyslipidemias 4. What are the suggested low-density lipoprotein cholesterol goals based on the 2013 American College of Cardiology/American Hea... 5. What are the outcomes ascertained by the 2013 American College of Cardiology/American Heart Association atherosclerotic cardio... 6. Should a lipid panel be checked after starting a patient on statin therapy 7. What are the four groups in whom statin therapy should be considered based on the 2013 American College of Cardiology/American... 8. In addition to the four statin benefit groups defined previously, when could statin initiation be considered 9. What are high-, moderate-, and low-intensity statins 10. How often do statins cause elevations of liver function tests 11. How often do statins cause musculoskeletal side effects 12. Do statins increase the risk of diabetes 13. What is the difference between myopathy, myalgia, myositis, and rhabdomyolysis 14. What are other strategies and non-statin agents considered for management of low-density lipoprotein cholesterol–related athe... 15. When used in combination with a statin in treatment after an acute coronary syndrome, which agent can provide additional redu... 16. What are proprotein convertase subtilisin kexin 9 inhibitors 17. When does triglyceride reduction become the initial goal of therapy and why 18. What are the components of therapy for elevated triglyceride levels 19. What are recommended treatment goals for low high-density lipoprotein cholesterol 20. What factors make up metabolic syndrome 21. What is a lipoprotein 22. What is lipoprotein (a) 23. What is non–high-density lipoprotein cholesterol 24. What is apolipoprotein B 25. What is the importance of low-density lipoprotein particle number and particle size 26. What is vertical auto profile and nuclear magnetic resonance Bibliography and Suggested Readings 43 - Diabetes and Cardiovascular Disease 1. What is the current global burden of diabetes, and what is its impact on the epidemiology of cardiovascular disease 2. What is the impact of diabetes on cardiovascular disease outcomes 3. What effect, if any, does diabetes have on the clinical manifestations and prognosis of peripheral arterial disease and cerebr... 4. What is the overall impact of diabetes on the vascular tree 5. What is the burden of additional cardiovascular risk factors in diabetic patients, and what is their cumulative impact on the ... 6. What characteristics of the atherosclerotic plaque in diabetic patients make it unstable compared with plaque in nondiabetic p... 7. What broad management strategy is advocated for diabetic patients with cardiovascular disease 8. How does the treatment of hyperglycemia and insulin resistance impact outcomes in diabetic patients with cardiovascular diseas... 9. What are the currently recommended strategies for the management of diabetic dyslipidemia 10. What do the current guidelines recommend for management of hypertension in diabetic patients 11. What are the principles of management of chronic coronary artery disease in diabetic patients 12. What strategies for coronary revascularization are currently recommended for the management of multivessel coronary artery di... 13. What alternative pharmacologic therapies should be considered in the diabetic population Bibliography and Suggested Readings 44 - Smoking Cessation 1. Why is smoking cessation of fundamental importance in managing the cardiac patient? 2. Why have cardiologists neglected the treatment of tobacco addiction in the past 3. What should every healthcare professional know about smoking 4. How might smokers with cardiac disease be better helped with cessation 5. What is a good starting point for smoking cessation 6. How can one best use pharmacotherapy to optimize the likelihood of cessation 7. Can nicotine replacement therapy be initiated in the inpatient setting for patients with cardiac disease 8. What if a smoker reports that nicotine replacement therapy has not decreased his or her desire to smoke 9. Can bupropion be useful for smoking cessation 10. Can varenicline be useful for smoking cessation Bibliography and Suggested Readings 45 - Physical Activity, Exercise, and the Heart 1. What is the difference between physical activity and exercise 2. How is physical activity intensity defined 3. How is physical activity measured 4. What are the acute cardiovascular changes that occur with physical activity and exercise 5. What are the chronic cardiovascular changes that occur with exercise 6. What is the training effect 7. Do endurance training and resistance training have similar benefits 8. What is an exercise prescription 9. How much exercise is necessary to maintain or improve cardiovascular fitness 10. What is the effect of exercise on cardiac risk factors 11. What is the effect of physical activity on mortality 12. Is there an age limit on the benefits of physical activity/exercise 13. Is it safe for patients with known coronary artery disease to exercise 14. How soon after a myocardial infarction can a patient begin an exercise program 15. Is exercise safe for patients with heart failure 16. Does exercise benefit patients who are limited by claudication 17. How is an exercise prescription developed for patients with known coronary artery disease 18. Should patients with heart disease perform resistance training 19. What about interval training 20. How can we encourage our patients to engage in regular physical activity or exercise 21. Are there cardiovascular risks of exercise 22. Should patients be screened before enrolling in an exercise program 23. What are the contraindications to participation in an exercise program Bibliography and Suggested Readings PART VII THE HEART IN SPECIFIC POPULATIONS AND CONDITIONS 46 - Cardiac Manifestations of HIV/AIDS 1. How have the cardiac manifestations of human immunodeficiency virus/acquired immunodeficiency syndrome changed over the years 2. What are HIV-related cardiac complications 3. How common is a pericardial effusion in an HIV-infected patient 4. What are the incidence and pathophysiology of HIV-associated myocarditis and cardiomyopathy 5. How is HIV cardiomyopathy treated 6. How is infective endocarditis managed in patients with HIV and AIDS 7. What malignancies can affect the heart in AIDS and HIV 8. Can nutritional deficiencies be responsible for HIV myopathy 9. How common is HIV-associated pulmonary arterial hypertension 10. How should HIV patients be screened for coronary artery disease 11. What is the pathophysiology of accelerated atherosclerosis in HIV patients 12. What are the effects of antiretroviral therapy on cardiovascular risk 13. What is acquired lipodystrophy 14. What dyslipidemias occur with HIV infection, and how are they treated 15. Can cardiothoracic surgery be performed safely in HIV patients 16. What other drugs used in AIDS/HIV treatment can have cardiac complications Bibliography and Suggested Readings 47 - Cardiovascular Complications of Rheumatic Diseases 1. What is the leading cause of mortality in patients with rheumatoid arthritis, and what are the most common cardiac manifestati... 2. What pathophysiologic mechanisms contribute to accelerated atherosclerosis in patients with rheumatoid arthritis 3. What are the most common cardiac manifestations of systemic lupus erythematosus 4. What cardiovascular medications are associated with drug-induced lupus erythematosus 5. Who is at risk for antiphospholipid syndrome, what are its most common cardiovascular manifestations, and how is it typically ... 6. What are the most common cardiac manifestations of systemic sclerosis 7. What are the most common cardiovascular manifestations of ankylosing spondylitis 8. What are the most common cardiovascular complications of polyarteritis nodosa 9. What are the most common cardiovascular manifestations of Takayasu arteritis, and how is it typically treated 10. What is the leading cause of mortality in patients with Kawasaki disease (mucocutaneous lymph node syndrome) 11. What are the most common cardiovascular manifestations of Marfan syndrome 12. How should Marfan syndrome be managed 13. How is vascular (type IV) Ehlers-Danlos syndrome different from the other types 14. What are the most common cardiovascular complications of Behçet syndrome 15. Why are non-aspirin nonselective and cyclooxygenase-2 selective nonsteroidal anti-inflammatory drugs associated with increase... 16. What treatments for rheumatic diseases are associated with cardiotoxicity Bibliography and Suggested Readings 48 - Cardio-Oncology 1. What is type I versus type II cardiotoxicity 2. What is the mechanism of anthracycline-induced cardiotoxicity 3. What is a safe dose of anthracycline 4. What are primary prevention strategies for anthracycline-induced cardiotoxicity 5. How should cardiac function be monitored in patients receiving anthracyclines 6. How long is cardiac monitoring recommended after treatment with anthracyclines 7. How should cardiac function be monitored in patients receiving trastuzumab 8. What tyrosine kinase inhibitor was featured on the cover of TIME magazine as “the magic bullet” against cancer 9. What are tyrosine kinase inhibitors 10. What are the mechanisms of tyrosine kinase inhibitors 11. Is there a “class effect” for cardiovascular side effects of tyrosine kinase inhibitors 12. What are the important effects of vascular endothelial growth factor and blocking vascular endothelial growth factor 13. What is the main side effect of drugs that inhibit vascular endothelial growth factor 14. What drug was suspended from marketing in October, 2013, owing to serious arterial thrombotic events 15. How should the cardiologist manage patients taking tyrosine kinase inhibitors 16. Which tyrosine kinase inhibitors are known to have high cardiovascular toxicity 17. What are the top three causes of death in survivors of childhood cancer 18. What chemotherapy drugs have Food and Drug Administration–mandated specific guidelines for monitoring the QT interval 19. True or false: Thrombocytopenia protects cancer patients from ischemic coronary events 20. What is the minimum platelet count required for performing a coronary angiogram 21. Are antiplatelet agents administered in cancer patients with thrombocytopenia and coronary artery disease 22. How does radiation-induced coronary artery disease differ from age-related atherosclerosis 23. What is the most reproducible technique for measurement of ejection fraction in patients undergoing cancer chemotherapy 24. What causes pericardial effusions in cancer patients, and what is the prognosis for cancer patients with pericardial effusion... 25. What should the cardiologist know about renal cell cancer Bibliography and Suggested Readings 49 - Cocaine and the Heart 1. How common is cocaine use in the United States 2. What are the pharmacologic effects of cocaine 3. What are the typical symptoms after cocaine ingestion 4. What are the consequences of cocaine use 5. How often does acute myocardial infarction occur after cocaine ingestion 6. What else should be considered in the differential diagnosis of chest pain or shortness of breath after cocaine use 7. How does cocaine ingestion lead to acute myocardial infarction 8. Should younger patients with chest pain have a cocaine screening test 9. Are there any specific electrocardiographic findings in patients who use cocaine 10. Should all patients with cocaine-associated chest pain be admitted to the hospital 11. Should all patients with cocaine-associated chest pain have a stress test 12. How should patients with ST-segment elevation or non–ST-segment elevation myocardial infarction be treated in the setting of ... 13. How should patients with cocaine-associated chest pain be treated 14. Should beta-blockers be given to patients with cocaine-associated chest pain 15. How should tachyarrhythmias be treated after cocaine use 16. How should patients be managed after discharge 17. Can patients with heart failure be treated with beta-blockers Bibliography and Suggested Readings 50 - Heart Disease in the Elderly 1. Who are the elderly 2. What are important considerations when treating the elderly 3. What is frailty, and how does it affect decision making 4. What are unique challenges in prescribing medications for the elderly 5. What is the approach to treating hypertension in the elderly 6. What are the current guidelines for initiating statin therapy for primary prevention in the elderly 7. What are the current guidelines for initiating statin therapy for secondary prevention in the elderly 8. How is stable ischemic heart disease managed in the elderly 9. Do elderly patients with acute coronary syndrome present differently from younger patients 10. How should non–ST-segment elevation acute coronary syndrome be managed in the elderly 11. What is the preferred treatment for ST-segment elevation myocardial infarction in the elderly 12. What is the most common arrhythmia in the elderly, and how should it be treated 13. What is the preferred method of stroke prevention in the elderly with atrial fibrillation 14. What is the most common valvular disease in the elderly 15. What is the preferred treatment strategy for symptomatic aortic stenosis 16. How does management of heart failure differ in the elderly Bibliography and Suggested Readings 51 - Heart Disease in Pregnancy 1. What cardiac physiologic changes occur during pregnancy 2. Are there independent vascular changes that occur during a normal pregnancy 3. What are normal cardiac signs and symptoms of pregnancy 4. What are pathologic cardiac signs and symptoms of pregnancy 5. What are normal cardiac examination findings during pregnancy 6. What are pathologic cardiac exam findings during pregnancy 7. What are the cardiac changes that occur during labor and delivery 8. Which women should undergo infective endocarditis prophylaxis at the time of delivery 9. What maternal cardiac tests can be performed safely 10. What are the highest risk maternal cardiac conditions during pregnancy 11. How are the common congenital lesions tolerated during pregnancy 12. Are regurgitant valvular lesions equally risky 13. What are maternal complications seen in pregnant women with cardiac disease What are some predictors of fetal complications 14. How is maternal hypertension treated during pregnancy 15. How are pregnant women anticoagulated during pregnancy 16. Which cardiac arrhythmias can complicate pregnancy 17. How do you treat a pregnant woman with an acute myocardial infarction 18. How do you treat a pregnant woman with cardiac arrest 19. How do women with hypertrophic cardiomyopathy tolerate pregnancy 20. What are the recommendations for patients with Marfan syndrome 21. Which commonly used cardiac medications should be avoided during pregnancy 22. What is peripartum cardiomyopathy Bibliography and Suggested Readings 52 - Heart Disease in Women 1. Are there gender differences in presentation of acute coronary syndromes? 2. Are there gender differences in cardiovascular disease outcomes 3. Are there gender biases in the management of cardiovascular disease 4. What are the differences in anatomic disease and plaque morphology among men and women 5. What is the underlying pathobiology of plaque morphology in women with coronary artery disease 6. Is fractional flow reserve testing useful in women 7. What is microvascular angina 8. What is the significance of spontaneous coronary artery dissection in women 9. What is takotsubo cardiomyopathy 10. What is coronary artery spasm Are there sex-based differences in prevalence and outcomes 11. Does history of depression have an impact on cardiovascular outcomes in women 12. Are there sex differences regarding the effects of antiplatelet therapies 13. How should antiplatelet and anticoagulant therapies be selected in women 14. Is history of preeclampsia relevant in patients presenting with cardiovascular disease 15. What are the observed sex-based differences in patients undergoing transcatheter aortic valve replacement 16. Is estrogen considered to have a role in protection from cardiovascular disease 17. What is peripartum cardiomyopathy, and how can it be recognized 18. What is fibromuscular dysplasia of the coronary arteries Bibliography and Suggested Readings 53 - Sleep Apnea and the Heart 1. How much sleep is typically needed 2. What are the different types of sleep apneas 3. What are important symptoms of obstructive sleep apnea 4. What are important risk factors for sleep apnea 5. How is sleep apnea diagnosed 6. What are the pathophysiologic effects of obstructive sleep apnea in cardiovascular disease 7. What are the cardiovascular sequelae of obstructive sleep apnea 8. Does obstructive sleep apnea predispose to hypertension 9. Is obstructive sleep apnea implicated in uncontrolled hypertension 10. Does treating obstructive sleep apnea actually improve blood pressure control 11. Other than continuous positive airway pressure, do other therapeutic modalities for obstructive sleep apnea improve blood pre... 12. Is arterial stiffness affected by obstructive sleep apnea 13. Have the hemodynamic derangements that occur in obstructive sleep apnea been found to affect myocardial structure or function... 14. Since sleep apnea is associated with increased blood pressure, arterial stiffness, and oxidative stress and may be proinflamm... 15. Does obstructive sleep apnea increase the risk of stroke 16. Do patients with obstructive sleep apnea have worse survival 17. Does sleep apnea predispose to arrhythmias 18. Since sleep apnea predisposes to ventricular arrhythmias during sleep, does it increase the risk of sudden death 19. How are sleep apnea and congestive heart failure related 20. Does sleep apnea lead to pulmonary hypertension 21. Which cardiac patients will benefit from having a sleep evaluation Bibliography and Suggested Readings PART VIII PERIPHERAL VASCULAR AND CEREBROVASCULAR DISEASE 54 - Peripheral Arterial Disease 1. What are the key components of the vascular physical examination 2. How on pulse palpation is the intensity of the pulsation scored 3. Can the location of the patient’s lower extremity claudication help to localize the site of occlusive disease 4. What noninvasive tests are used in the assessment of lower limb claudication 5. What is the ankle-brachial index 6. What are the recommended medical therapies and lifestyle interventions in patients with lower extremity peripheral arterial di... 7. What are the interventional treatment options for patients with claudication 8. What is critical limb ischemia 9. How is critical limb ischemia graded clinically 10. What are the main complications of open and endovascular infrainguinal interventions 11. What are the causes of renal artery stenosis 12. What are American College of Cardiology/American Heart Association class I indications for the referral for diagnostic study ... 13. What are the main indications for renal artery stenosis percutaneous revascularization 14. What are most common types of visceral artery aneurysms 15. In general, when should patients with an infrarenal or juxtarenal abdominal aortic aneurysm undergo repair 16. What are the relative pros and cons of the treatment options for patients with infrarenal abdominal aortic aneurysm that meet... 17. What are the anatomic eligibility criteria for endovascular infrarenal abdominal aortic aneurysm repair 18. What are the primary indications for treatment of extracranial carotid artery occlusive disease 19. What are the relative indications for carotid endarterectomy and carotid stenting 20. What are possible causes of lower limb arterial disease and ischemia or claudication in young patients 21. What is fibromuscular dysplasia 22. What is Buerger disease 23. What is Takayasu arteritis 24. What is May-Thurner syndrome Bibliography and Suggested Readings 55 - Aortic Aneurysm 1. What are the common pathologies affecting the thoracic aorta 2. What is the definition of aneurysm 3. What is the most common pathologic cause of thoracic aortic aneurysm 4. Which genetic conditions predispose patients to aortic aneurysm and dissection 5. List findings in other systems that may help to predict silent thoracic aortic aneurysm 6. How fast does an aortic aneurysm grow 7. What are the survival rates for untreated thoracic aortic aneurysms 8. List the risk factors for rupture of thoracic aortic aneurysms 9. How likely are untreated abdominal aortic aneurysms to rupture 10. How does ruptured abdominal aortic aneurysm present 11. Can a widened mediastinum suggest the presence of thoracic aortic aneurysm 12. What are the best imaging modalities for diagnosing and evaluating aortic aneurysm 13. Should imaging of the thoracic aorta be performed in those discovered to have an abdominal aortic aneurysm 14. Should imaging of the abdominal aorta be performed when thoracic aortic atheromata is detected by transesophageal echocardiog... 15. Can abdominal aortic aneurysm be detected during standard transthoracic echocardiography 16. Is screening for abdominal aortic aneurysm recommended 17. At which diameters is elective repair of thoracic aortic aneurysm indicated 18. When should one operate on a patient with ascending thoracic aortic aneurysms due to aortopathy 19. When is intervention for descending TAA recommended 20. When is intervention for abdominal aortic aneurysm recommended 21. What is the recommended frequency for surveillance imaging of known thoracic aortic dilation 22. What are the complications of endovascular aortic repair 23. What is an endoleak Bibliography and Suggested Readings 56 - Aortic Dissection 1. What is the definition of a dissection? 2. What is the epidemiology of aortic dissection 3. Which genetic conditions predispose patients to aortic dissection 4. What are the best options for imaging thoracic aortic dissections 5. Describe the different types of acute aortic syndromes 6. How does acute aortic syndrome present 7. What are the most common symptoms, signs, and radiographic findings associated with dissection 8. How are aortic dissections classified 9. What is the method for classifying the timing of aortic dissection 10. What are the complications of aortic dissection 11. What are the most reliable symptoms, signs, and radiographic findings associated with dissection 12. What is an intramural hematoma 13. What is a penetrating aortic ulcer 14. Is there a need to distinguish intramural hematoma and penetrating atherosclerotic ulcer from aortic dissection 15. How should aortic dissection be managed medically 16. What are the repair options for aortic dissection 17. What are the indications for repair of type B dissection 18. What are the complications of surgical or endovascular thoracic aortic repair 19. What factors lead to the classification of a type B aortic dissection as “complicated” 20. What is TEVAR 21. What constitutes optimal medical therapy for aortic dissection 22. What are most common sites for traumatic aortic injury Bibliography and Suggested Readings 57 - Carotid Artery Disease 1. Describe extracranial carotid artery anatomy. What are the common causes of carotid artery disease 2. What are the clinical manifestations of carotid artery stenosis 3. What is the difference between transient ischemic attack and stroke 4. How is carotid artery stenosis diagnosed 5. How is degree of carotid stenosis determined by carotid duplex ultrasound 6. Which are the appropriate clinical indications for carotid duplex ultrasound imaging 7. How do cardiac conditions affect the performance and interpretation of carotid duplex ultrasound 8. What is the significance of carotid intima-media thickness measurement 9. What constitutes medical management for treating patients with carotid artery stenosis 10. What are the factors that affect the carotid revascularization strategy for a patient with symptomatic carotid stenosis 11. When is revascularization appropriate in asymptomatic carotid stenosis 12. What are the common clinical manifestations and causes of spontaneous cervical artery dissection, and how do you manage them 13. What are the clinical manifestations of vertebral artery stenosis Bibliography and Suggested Readings 58 - Ischemic Stroke 1. What is a stroke 2. What are the three basic causes of stroke 3. What is a transient ischemic attack 4. Why is prompt recognition of transient ischemic attacks important 5. How common are stroke and transient ischemic attack 6. What types of symptoms can strokes cause 7. How are stroke and transient ischemic attack diagnosed 8. What are the most important risk factors for having a stroke 9. What stroke syndromes are associated with occlusion of the cerebral arteries 10. What are the major etiologies of ischemic stroke 11. What cardiac conditions are considered sources of cardioembolic stroke 12. What are some less common causes of ischemic stroke 13. How do ischemic strokes appear on imaging 14. What are the initial steps if ischemic stroke is suspected 15. What are the US Food and Drug Administration–approved treatments for acute ischemic stroke 16. How much do patients benefit from tissue plasminogen activator 17. What are contraindications to intravenous tissue plasminogen activator 18. How are patients monitored after administration of intravenous tissue plasminogen activator 19. When should intra-arterial therapy be used for acute ischemic stroke 20. What if the patient is not a candidate for intravenous tissue plasminogen activator 21. What are the major clinical concerns in the initial days following an ischemic stroke 22. When is hemicraniectomy recommended 23. What is hemorrhagic transformation (hemorrhagic conversion) 24. What are the goals of hospitalization for an ischemic stroke 25. How can systemic complications of stroke be prevented 26. What is considered a complete ischemic stroke workup 27. How would stroke workup differ for a young person or someone without usual stroke risk factors 28. What is a hypercoagulable workup 29. What is the best strategy to prevent additional strokes 30. What options exist for evaluating cerebral vessels 31. How should carotid stenosis be managed 32. How should intracranial stenosis be managed 33. What if the patient has a patent foramen ovale 34. How well do anticoagulants work to prevent stroke in the setting of atrial fibrillation 35. Do patients who have percutaneous or surgical procedures to treat atrial fibrillation still need anticoagulation 36. What about anticoagulation in patients at high risk for bleeding 37. How soon after a stroke should anticoagulation be started 38. How are antiplatelet agents used after stroke 39. Should aspirin and clopidogrel be used together for stroke prevention 40. Should aspirin be added to anticoagulation 41. What if a patient has a stroke while taking an antiplatelet agent 42. How well do patients recover following ischemic stroke 43. What are additional considerations when stroke patients return for follow-up Bibliography and Suggested Reading 59 - Hemorrhagic Stroke and Cerebral Venous Sinus Thrombosis 1. What are the most common types of stroke 2. What are the major types of hemorrhagic stroke 3. How can you distinguish hemorrhagic from ischemic strokes 4. Why is the location of an intraparenchymal hemorrhage important 5. What is the typical clinical profile of a patient with a hypertensive hemorrhage 6. What is the typical clinical profile of a patient with cerebral amyloid angiopathy 7. How is intracerebral hemorrhage managed 8. What is considered a complete workup for intracerebral hemorrhage 9. What causes subarachnoid hemorrhage 10. How is subarachnoid hemorrhage diagnosed 11. How is subarachnoid hemorrhage managed 12. What unusual electrocardiographic findings may be seen in patients with hemorrhagic stroke 13. What causes cerebral venous sinus thrombosis 14. How is cerebral venous sinus thrombosis diagnosed 15. How is cerebral venous sinus thrombosis managed Bibliography and Suggested Readings PART IX VENOUS THROMBOEMBOLIC DISEASE 60 - DEEP VEIN THROMBOSIS: PROPHYLAXIS AND TREATMENT 1. What three primary factors promote venous thromboembolic disease 2. List the risk factors for thromboembolic disease 3. What is the natural history of venous thrombosis 4. Can patients with deep venous thrombosis be accurately diagnosed clinically 5. Where is the most common origin for thrombi that result in pulmonary emboli 6. How is the diagnosis of lower extremity deep vein thrombosis confirmed 7. When should prophylaxis of deep venous thrombosis be considered 8. What prophylactic measures are available 9. What is the approach to deep vein thrombosis prophylaxis in the hospitalized, medically ill patient 10. Should patients undergoing surgery receive deep vein thrombosis prophylaxis based on specific recommendations for each respec... 11. Are there specific surgical groups that require extended deep vein thrombosis prophylaxis following hospital discharge 12. What treatment regimens are available for the treatment of deep vein thrombosis 13. Which low-molecular-weight heparins are renally excreted 14. When should warfarin be started in the treatment regimens for deep vein thrombosis listed earlier 15. Can the international normalized ratio in patients treated with warfarin be influenced by food and drug intake 16. When should these therapeutic regimens for treating deep vein thrombosis be discontinued and warfarin remain as the sole ther... 17. What is the target international normalized ratio for treating patients with deep vein thrombosis 18. How long should patients with acute deep vein thrombosis be treated with warfarin 19. Does thrombosis of the great saphenous vein usually require full-dose anticoagulation 20. What is the currently preferred name for the superficial femoral vein 21. When can patients with acute deep vein thrombosis ambulate 22. Can patients with acute deep vein thrombosis be treated as outpatients 23. When should catheter-directed thrombolysis be used to treat acute deep vein thrombosis 24. Are inferior vena caval filters indicated for the initial treatment of acute deep vein thrombosis 25. When are gradient elastic stockings recommended as part of the treatment of acute deep vein thrombosis 26. When is a low-intensity international normalized ratio indicated for the treatment of deep vein thrombosis 27. Can direct oral anticoagulants be used for extended treatment of deep vein thrombosis 28. Should compression ultrasound be used at the time of discharge as routine screening in the patient who has undergone total jo... Bibliography, Suggested Readings, and Websites 61 - Pulmonary Embolism 1. Who first described pulmonary embolism? 2. How common are pulmonary emboli, and what is the mortality rate 3. What is Virchow’s triad 4. What percentage of patients with acute pulmonary embolism have clinical evidence of deep venous thrombosis in a lower extremit... 5. What percentage of patients with proximal deep venous thrombosis will develop pulmonary embolism 6. What is the usual cause of death in patients with pulmonary embolism 7. What are the major risk factors for venous thromboembolism 8. What are the symptoms and signs of acute pulmonary embolism 9. If pulmonary embolism is associated with the development of pulmonary hypertension, what additional physical findings may be n... 10. What are four clinical syndromes sometimes (or that can be) seen with acute pulmonary embolism 11. What is the Wells score for suspected acute pulmonary embolism 12. What are the most common findings on electrocardiography in acute pulmonary embolism 13. What are the common chest radiographic findings in patients with acute pulmonary embolism 14. What are typical arterial blood gas findings in patients with pulmonary embolism 15. When should a ventilation/perfusion scan be performed 16. Does a negative computed tomographic angiogram indicate with certainty that pulmonary embolism is not present 17. How does echocardiography aid in the diagnosis of pulmonary embolism 18. What are some of the late complications of pulmonary embolism 19. What is the most appropriate initial therapy for patients with documented acute pulmonary embolism 20. Are the newer oral anticoagulation medications safe and effective 21. How long should a patient with a pulmonary embolism be treated 22. How should one stratify patient risk with acute pulmonary embolism 23. Are there any laboratory investigations that may help in determining the prognosis of patients with pulmonary embolism 24. What is the primary indication for thrombolytic therapy 25. What are some complications and contraindications of thrombolytic therapy 26. Has thrombolytic therapy been shown to improve mortality from pulmonary embolism 27. What is the role of embolectomy, catheter-directed thrombolytic therapy, and catheter-based clot retrieval 28. What are the indications for the placement of an inferior vena cava filter 29. What are some complications of the placement of inferior vena cava filters 30. Can PE be treated on an outpatient basis Bibliography and Suggested Readings 62 - Hypercoagulable States 1. What is hypercoagulability? 2. What are the inherited hypercoagulable disorders 3. What are the acquired hypercoagulable states 4. What is the antiphospholipid syndrome 5. What types of thromboses are due to hypercoagulable states 6. When does one suspect that a patient has a hypercoagulable state 7. When should hypercoagulability be tested for 8. When should occult malignancy or myeloproliferative neoplasm be considered 9. When does one test for hypercoagulability 10. How does the presence of a hypercoagulable state affect treatment decisions 11. What is the recommended target international normalized ratio in patients with arterial thrombosis associated with the antiph... 12. Why is it important to identify an underlying hypercoagulable state in women who have suffered a miscarriage 13. Does mutant methylene tetrahydrofolate reductase cause an inherited thrombophilia Bibliography and Suggested Readings PART X ADDITIONAL TOPICS IN CARDIOLOGY 63 - Adult Congenital Heart Disease 1. What are the three main types of atrial septal defects, and what are their associated anomalies 2. When should an atrial septal defect be closed Which atrial septal defects cannot be closed by a percutaneous device 3. List the four types of ventricular septal defects 4. What are the long-term complications of a small ventricular septal defect in the adult patient 5. When should a ventricular septal defect be closed 6. What are the complications of a bicuspid aortic valve 7. How is hemodynamic severity of coarctation of the aorta assessed in the adult patient 8. In coarctation of the aorta in the adult patient, when should percutaneous stenting be considered 9. Which adult patients with patent ductus arteriosus require percutaneous device closure 10. How is Marfan syndrome diagnosed 11. When should Marfan patients with aortic root dilation be referred for surgery 12. What is tetralogy of Fallot, and what is the main complication seen in the adult 13. What are the three ds of Ebstein anomaly 14. What drug therapy should now be considered in all patients with Eisenmenger’s syndrome 15. When should an Eisenmenger’s patient be phlebotomized 16. Which types of congenital heart disease lesions have particularly poor outcomes in pregnancy 17. What are the two types of transpositions 18. What is meant by a systemic right ventricle 19. What is the difference between an atrial and arterial switch procedure 20. Which patients with adult congenital heart disease require antibiotic prophylaxis Bibliography and Suggested Readings 64 - Cardiac Tumors 1. Which are more common, primary cardiac tumors or metastatic tumors to the heart? 2. What are the most common tumors that metastasize to the heart 3. Are most primary cardiac tumors benign or malignant 4. What are the most common primary cardiac tumors 5. In what chamber do most myxomas occur 6. What are the most common primary malignant tumors 7. What symptoms do cardiac tumors cause 8. What is the workup for suspected cardiac tumors 9. What are the most common tumors affecting the pericardium 10. What is a tumor plop 11. What is lipomatous hypertrophy of the interatrial septum 12. What is the most common valvular tumor 13. What is the Carney complex Bibliography and Suggested Readings 65 - Hypertensive Crisis 1. What is a hypertensive crisis 2. How commonly do these situations occur 3. What are the causes of hypertensive crisis 4. What are the common clinical presentations of hypertensive crisis 5. What historical information should be obtained 6. How should the physical examination be focused 7. What laboratory and ancillary data should be obtained 8. What are the cardiac manifestations of hypertensive emergencies 9. What are the central nervous system manifestations of hypertensive emergency 10. What are the renal manifestations of hypertensive emergencies 11. What are the pregnancy-related issues with hypertensive emergency 12. What are general issues in the treatment of hypertensive urgency 13. What are general issues in treating hypertensive emergencies 14. What specific agents are used for treating patients with hypertensive emergencies 15. Are different agents more helpful for different clinical situations Bibliography and Suggested Readings 66 - Oral Anticoagulation Therapy 1. How does warfarin work? 2. What are the clinical situations in which warfarin is used and at what anticoagulation intensity 3. What is the role of warfarin in preventing transient ischemic attack/stroke in a patient with a history of ischemic stroke 4. How should unfractionated heparin, low-molecular-weight heparin, or fondaparinux and warfarin be overlapped for acute treatmen... 5. What are some of the common drug interactions with warfarin 6. What is the role of pharmacogenomics in warfarin dosing 7. How should warfarin be managed in patients with underlying chronic liver disease 8. How should warfarin be managed in patients who need surgery or invasive procedures 9. How should elevated INRs and significant bleeding in patients taking warfarin be managed 10. What are important patient counseling points for warfarin 11. What are potential advantages and disadvantages of the direct-acting oral anticoagulants apixaban, dabigatran, edoxaban, and ... 12. What are the current US guideline recommendations for direct-acting oral anticoagulants for stroke prevention in nonvalvular ... 13. What are the current US guideline recommendations for direct-acting oral anticoagulants for acute treatment and secondary pre... 14. What are some of the common drug interactions with direct-acting oral anticoagulants 15. How should patients taking direct-acting oral anticoagulants be transitioned to and from other anticoagulants 16. What is the effect of direct-acting oral anticoagulants on coagulation tests, and can they be monitored 17. Can the anticoagulant effect of direct-acting oral anticoagulants be reversed 18. What are the steps in managing a direct-acting oral anticoagulant-treated patient who is bleeding 19. What is idarucizumab 20. What is prothrombin complex concentrate 21. How should direct-acting oral anticoagulants be managed in patients who need surgery or invasive procedures 22. What are the important counseling points for patients taking direct-acting oral anticoagulants Bibliography and Suggested Readings 67 - Pericarditis, Pericardial Constriction, and Pericardial Tamponade 1. The pericardium is not necessary for life. What does it do? Why is it important? 2. What diseases affect the pericardium 3. What is pericarditis What are the clinical manifestations What are the causes 4. Should patients presenting with acute pericarditis be hospitalized Why 5. What is the treatment for acute pericarditis 6. What is recurrent pericarditis How is it treated 7. What is postcardiac injury syndrome 8. What are the pericardial compressive syndromes What are their variants 9. What are the similarities between tamponade and constrictive pericarditis 10. What are the differences between tamponade and constrictive pericarditis 11. What are the physical findings of tamponade 12. What are the physical findings of constrictive pericarditis 13. What is the role of echocardiography in tamponade 14. What is the role of echocardiography in constrictive pericarditis 15. Are other imaging modalities useful in pericardial disease 16. What is the role for medical therapy in constrictive pericarditis Bibliography and Suggested Readings 68 - Preoperative Cardiac Evaluation 1. What is the natural history of perioperative cardiac morbidity? 2. What is the cause of perioperative cardiac morbidity 3. What are the strongest predictors of perioperative cardiac events 4. What is the American College of Surgeons National Surgical Quality Improvement Project risk calculator, and how should it be u... 5. What is the revised cardiac risk index, and how is it used clinically 6. What is the importance of exercise capacity 7. What is the influence of the surgical procedure on the decision to perform further diagnostic testing 8. How do the American College of Cardiology/American Heart Association Guidelines suggest an approach to preoperative evaluation... 9. What is the value of coronary revascularization before noncardiac surgery 10. What is the concern regarding surgery in patients with a previous percutaneous coronary interventions 11. How should antiplatelet agents be managed in the perioperative period 12. How should beta-blockers be managed in the perioperative period 13. How should statins be managed in the perioperative period Bibliography and Suggested Readings 69 - Pulmonary Hypertension 1. What are the definitions of pulmonary hypertension and pulmonary arterial hypertension 2. How and why is pulmonary hypertension classified 3. How do patients with pulmonary hypertension present 4. How is pulmonary hypertension diagnosed 5. What is considered a favorable response to acutely administered vasodilators 6. What population group is most commonly affected by pulmonary arterial hypertension 7. Is pulmonary hypertension a genetic disease 8. What should the clinical evaluation for possible pulmonary hypertension include 9. What treatment for pulmonary hypertension is deemed secondary to left-sided heart disease (group 2 PH) 10. What treatment for pulmonary hypertension is deemed secondary to lung disease and/or alveolar hypoxia (group 3 PH) 11. Is surgical therapy now an option for patients with pulmonary hypertension secondary to chronic recurrent thromboembolism (gr... 12. What is considered conventional therapy for patients with pulmonary hypertension 13. Are calcium channel blockers used in the treatment of pulmonary arterial hypertension 14. What are the approved therapies to treat pulmonary arterial hypertension 15. What is the average survival for a patient with pulmonary arterial hypertension 16. Is transplantation possible in patients with pulmonary arterial hypertension Bibliography, Suggested Readings, and Websites 70 - Syncope 1. What is the derivation of the word syncope 2. What is the underlying mechanism causing syncope 3. Cessation of cerebral blood flow of what duration causes syncope 4. What is the most common type of syncope in the general population 5. What are the common causes of syncope 6. What are the most common causes of syncope in pediatric and young patients 7. What is the most common cause of sudden cardiac death in young athletes 8. What are the important causes of ventricular tachyarrhythmias 9. What is the approach to the patient with syncope 10. How does one properly test for orthostatic hypotension 11. When the etiology of syncope remains unclear, what other testing can be performed 12. During carotid sinus massage, what is considered a diagnostic response 13. What is a tilt-table test 14. How should one decide between using a Holter monitor, an event or ambulatory monitor, or an implantable loop monitor 15. Should a “shotgun” neurologic evaluation—including computed tomography scan, carotid ultrasound, and electroencephalogram—be ... 16. What is long QT syndrome 17. What is Brugada syndrome Bibliography and Suggested Readings 71 - Traumatic Heart Disease 1. What is the most common cause of cardiac injury? 2. List the physical mechanisms of injury in cardiac trauma 3. What is myocardial contusion 4. Which major cardiovascular structures are most commonly involved in cardiac trauma 5. What bedside findings can be seen in patients with suspected major cardiovascular trauma 6. Can an acute myocardial infarction complicate cardiac trauma 7. What is the most common type of myocardial infarction suffered by trauma victims 8. What is the preferred treatment for ST segment elevation acute myocardial infarction in the event of chest trauma 9. What are the causes of shock in patients with cardiac trauma 10. What workup should be considered in a patient with suspected cardiac trauma 11. What are the signs of cardiac tamponade 12. Can a patient suffering from traumatic cardiac tamponade have a normal jugular venous pulse 13. How can one confirm the diagnosis in a patient with suspected pericardial tamponade 14. How is a patient with pericardial tamponade treated 15. What interventions during the resuscitation and management of an unstable trauma patient with a pericardial effusion can prec... 16. What are the mechanisms of injury to the thoracic great vessels 17. How are thoracic arterial lesions managed 18. What are potential late complications of heart trauma 19. What is commotio cordis 20. What are the cardiac complications of electrical or lightning injuries 21. Can a patient develop a trauma-related cardiomyopathy 22. How can the extent of cardiac injury be classified in a trauma patient Bibliography and Suggested Readings