Cardio

SMLE review
Abdulrahman A. Alahmadi
TW: @Abdulrahman95AA
vIHD
vARRYTHMIA
vCHF
vHTN
vPeripheral artery disease
vInfective endocarditis
vValvular heart disease
vPericardial disease
vSyncope
Ischemic heart disease
• 60 YO male patient k/c of DM and HTN presented to ER with neck
pain and sweating for one hour. He has a previous history of
recurrent chest pain which resolve spontaneously after resting.
ECG done and showed non-specific ST segment and T wave
changes. Troponin is normal. What is your next step?
A. Repeat troponin after 6 hours
B. Discharge the patient
C. Do stress ECG test
D. Give aspirin and nitroglycerin
Reperfusion therapy

• PRIMARY PCI PREFERRED

• First medical contact to PCI time of 120 minutes
• Those with absolute contraindications to fibrinolysis.
• FIBRINOLYSIS PREFERRED
• patients in whom there is a long-anticipated delay (greater than
120 minutes) to primary PCI.
IHD mortality reduction:

1-Aspirin

2-Beta blocker

3-ACE inhibitors

4-Statin
ARRYTHMIA
 0= no anticoagulation needed
1= consider anticoagulation
2 or more = DOACs or warfarin
DOACs are preferred over warfarin in all cases
except in valvular AFib or in patients with
prosthetic valve
 Approach
SVT
Stable Unstable

Vagal maneuver (carotid

Electrical cardioversion
massage, Valsalva)

failed

IV adenosine
Congestive heart failure
CHF mortality reduction:

1-ACE inhibitors

2-Beta blocker

3-Spironolactone
Hypertension
HTN

• Choice of antihypertensive drug:

• Non-African American patients: calcium channel blocker (CCB) is preferred in old
patients (>55 YO), while angiotensin-converting enzyme inhibitor (ACE-I) is
preferred in young patients (<55 YO).
• African American patients: thiazide-type diuretic or CCB
• HTN + DM = ACEI
• HTN + CKD = ACEI
• HTN + CHF or CAD = ACEI
• Essential tremor or Hyperthyroidism or Migraine + HTN = Beta blocker
• Beta blockers should not be used as a 1st line except in case of CAD
PERIPHERAL ARTERY DISEASE
 Confirm with ankle brachial
Absent pulse Start heparin
index

Angiography with
revascularization CT angiography
(definitive)
Infective endocarditis
 Most common causative organisms in infective endocarditis

IV drug abusers
Prosthetic valves Native valves
(right side valves)

Less more
than than
60 60
days days

Staph.
Epidermis/staph Strep. Viridans Strep. Viridans Staph aureus
aureus
 Infective endocarditis prophylaxis

• Indications: • Procedures:

1. Previous Hx of IE. 1. Dental work.

2. Unrepaired cyanotic congenital 2. Respiratory procedure involving
heart disease. incision of respiratory mucosa
3. Prosthetic heart valves. (tonsillectomy, adenoidectomy).
3. Skin procedure (surgical procedure
involving infected skin or
musculoskeletal structure.

Drug of choice: Oral Amoxicillin

Valvular heart disease
 Aortic stenosis
• Indications for Aortic valve replacement:
1. Symptomatic AS (syncope, angina, SOB).
2. Asymptomatic patients with left ventricular ejection fraction (LVEF) <50
percent.
3. Patient with severe aortic stenosis going for other cardiac surgery.
4. Patients with very severe AS.
Pericardial diseases
• Cardiac tamponade • Constrictive pericarditis
1. Acute presentation. 1. Chronic presentation.
2. Hypotension. 2. No hypotension.
3. Muffled quiet heart sound. 3. Normal heart sound.
4. JVP waves: prominent X & 4. JVP waves: prominent X & Y.
absent Y.
Syncope
 Approach to syncope
• Typical vasovagal syncope (preceded by symptoms) + normal ECG>>>
Reassurance and education.
• Situational syncope (with coughing, micturition) + normal ECG >>> Reassurance
and education.
• Recurrent unexplained syncope>>> Tilt table testing + Holter monitoring.
• Syncope + murmur or abnormal ECG>>> ECHO.
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