Intermediate probability of CAD

1. Can exercise, ECG shows LVH and ST depression

a. Stress Echo or Nuclear Stress
2. Can exercise, normal ECG
a. Stress ECG
i. Imaging is added to increase sensitivity, but on boards just stress ECG
3. Cannot exercise, normal ECG
a. Nuclear stress or dobutamine stress

TIMI risk score

- Predict future death, MI, and severe ischemia

- Useful in helping to decide whether to use early invasive or ischemia-guided strategy

PCI in SA

- Improves symptoms
- Does not improve survival
- Does not reduce cardiovascular events

NSTEMI – ACS presentation // negative stress test

- Does not matter if you are intervened on

- 1 month to 1 year: ASA and Plavix (P2Y12 Inhibitor)

Reduced EF

- Beta blocker + ACEi/ARB/ARNi

- Advanced: Add spironolactone
- Don’t forget: Bidil, Entresto, and Ivrabidine

ECG – HfrEF scheduled for cardiac resynchronization

- Biventricular pacemaker
o Typically for….LBBB

Who gets an ICD?? Major indication

- HFrEF <35% on optimal medical therapy

LV Outflow tract obstruction with HCOM

- Change the size of the ventricle

- Bigger ventricle, less obstruction
- Best way to elicit??
o Squat->stand, intensify the murmur

AFIB

- Chadsvasc
- >=2 on anticoagulation

Look at EKGs for Pericarditis

Brugada Syndrome: RBB syndrome with downsloping ST elevation (V1/V2)

Mid-systolic murmur:

Holosystolic: tricuspid (other are TR, MR, and VSD)

- Increase w/ inspiration, increase venous return

Endocarditis: major criteria

- New regurgitant murmur (AI, MR, TR)

- Positive blood cultures

Prophylaxis prior to dental procedures:

- Prosthetic Aortic Valve

Immediate surgery??

- Stanford A
o Any dissection that involves ascending aorta, does not matter where it starts
24yo presents with palpitations

- Narrow complex regular tachycardia

- AVNRT??
- Vagal maneuvers first
- IV Adenosine next
- Give more if you didn’t get a response

Diastolic murmurs

- Mitral stenosis
- ASD – systolic! Low pressure L->R so you should not. Diastolic rumble =/= murmur