MOST

COMMON
CARDIOLOGY
IM
FLASH CARD
 MOST COMMON
UNDERLYING CAUSE
MYOCARDIAL ISCHEMIA
AND INJURY
 OBSTRUCTION OF
CORONARY ARTERIES BY
ATHEROSCLEROSIS
 MOST
MYOCARDIAL
PERFUSION
OCCURS DURING
THIS TIME
DIASTOLE
 MOST COMMON
CAUSE OF ANTERIOR
CHEST
MUSCULOSKELETAL
PAIN
COSTOCHONDRAL AND
CHONDROSTERNAL
SYNDROMES
 MOST COMMON
PRESENTING COMPLAINT
OF AORTIC
DISSECTION
SUDDEN ONSET
OF SEVERE
SHARP PAIN
TYPICAL PAIN IN
PERICARDITIS
- RETROSTERNAL AND IS AGGRAVATED BY
COUGHING, DEEP BREATHS, OR CHANGES IN
POSITION – ALL OF WHICH LEAD TO
MOVEMENTS OF PLEURAL SURFACES
- WORSE IN THE SUPINE POSITION
- RELIEVED BY SITTING UPRIGHT AND
LEANING FORWARD
 CHEST PAIN THAT
REACHES ITS PEAK
INTENSITY
IMMEDIATELY
• AORTIC DISSECTION (LOOK FOR
TALL, MALE W/
HYPEREXTENSIBLE JOINTS)
• PULMONARY EMBOLISM
• PNEUMOTHORAX
 MOST COMMON
PREVENTABLE CAUSE OF
DEATH AMONG
HOSPITALIZED PATIENTS
PULMONARY
EMBOLISM
 IN ITS MOST SEVERE
FORM, POSTPHLEBITIC
SYNDROME CAUSES?
 SKIN ULCERATION
(ESPECIALLY IN MEDIAL
MALLEOLUS OF LEG)
THE TWO MOST COMMON
AUTOSOMAL DOMINANT
GENETIC MUTATIONS FOR
PROTHROBOTIC STATES
• FACTOR V LEIDEN: CAUSES
RESISTANCE TO ACTIVATED PROTEIN-C
(WHICH INACTIVATES FACTORS V AND
VIII)
• PROTHROMBIN GENE MUTATION:
INCREASES PROTHROMBIN
 MOST COMMON ACQUIRED
CAUSE OF THROMBOPHILIA
AND ASSOCIATED WITH
VENOUS / ARTERIAL
THROMBOSIS
 ANTIPHOSPHOLIPID-
ANTIBODY SYNDROME
(APAS)
MOST COMMON GAS
EXCHANGE
ABNORMALITIES IN
PULMONARY
EMBOLISM
 ARTERIAL HYPOXEMIA
AND AN INCREASED
ALVEOLAR ARTERIAL O2
TENSION GRADIENT
USUAL CAUSE OF DEATH
FROM PULMONARY
EMBOLISM
PROGRESSIVE
RIGHT HEART
FAILURE
MOST COMMON
SYMPTOM OF
DVT
 CRAMP OR
“CHARLEY
HORSE” IN THE
LOWER CALF
MOST COMMON
SYMPTOM FOR
PE
 UNEXPLAINED
BREATHLESSNES
S
SUDDEN, SEVERE
CALF
DISCOMFORT
SUGGESTS…
 RUPTURED
BAKER’S CYST
VIRCHOW’S
TRIAD
 • ENDOTHELIAL
INJURY
•
HYPERCOAGULABILI
TY
• STASIS
CLASSIC SIGNS
OF PE
• TACHYCARDIA
• LOW-GRADE FEVER
• NECK VEIN
DISTENTION
 MOST
FREQUENT
SYMPTOM OF
PE
DYSPNEA
MOST FREQUENT
SIGN OF PE
TACHYPNEA
LEG PAIN + FEVER +
CHILLS
USUALLY INDICATES
CELLULITIS (NOT
DVT)
HALLMARKS OF
MASSIVE PE
• DYSPNEA
• SYNCOPE
• HYPOTENSION
USEFUL RULE-OUT TEST:
> 95% OF PATIENTS
WITH A NORMAL D-DIMER
(<500NG/ML) DO NOT HAVE
PE
D-DIMER
MOST FREQUENTLY CITED
ABNORMALITY IN PE (IN
ADDITION TO SINUS
TACHYCARDIA)
 S1 Q3 T3 SIGN
(SPECIFIC, BUT
INSENSITIVE)
MOST COMMON
ABNORMALITY
IN PE ON ECG
 T-WAVE
INVERSION IN
LEADS V1 TO V4
 PRINCIPAL
IMAGING TEST
FOR THE
DIAGNOSIS OF PE
CHEST CT WITH
IV CONTRAST
 HAS BECOME A
SECOND- LINE
DIAGNOSTIC TEST
FOR PE
LUNG SCANNING
 BEST KNOWN
INDIRECT SIGN OF
PE ON
TRANSTHORACIC
ECHO
MCCONNELL’S SIGN:
HYPOKINESIS OF THE RV FREE
WALL WITH NORMAL MOTION OF
THE RV APEX
DEFINITIVE DIAGNOSIS OF
PE DEPENDS UPON
VISUALIZATION OF AN
INTRALUMINAL FILLING
DEFECT IN MORE THAN ONE
PROJECTION
 PULMONARY
ANGIOGRAPHY
 FOUNDATION FOR
SUCCESSFUL
TREATMENT OF DVT
AND PE
ANTICOAGULATI
ON
MAJOR ADVANTAGE OF
UNFRACTIONATED
HEPARIN
SHORT HALF-
LIFE
MAJOR DISADVANTAGE
OF UNFRACTIONATED
HEPARIN
ACHIEVING TARGET APTT IS
EMPIRICAL & MAY REQUIRE
REPEATED BLOOD
SAMPLING AND HEPARIN
 MOST SERIOUS
ADVERSE EFFECT
OF
ANTICOAGULATIO
N
HEMORRHAGE
MAJOR BLEEDING
FROM
WARFARIN: BEST
MANAGED
WITH
PROTHROMBIN
COMPLEX
CONCENTRATE
 WARFARIN
EMBRYOPATHY =
MOST COMMON WITH
EXPOSURE DURING
6TH TO 12TH
WEEK OF
GESTATION
 TWO PRINCIPAL
INDICATIONS FOR
INSERTION INFERIOR
VENA
CAVAL (IVC) FILTERS
• ACTIVE BLEEDING THAT
PRECLUDES
ANTICOAGULATION

• RECURRENT VENOUS
THROMBOSIS DESPITE
ANTICOAGULATION
 THE ONLY FDA-
APPROVED INDICATION
FOR PE FIBRINOLYSIS
MASSIVE PE
 TWO
DETERMINANTS OF
ARTERIAL
PRESSURE
CARDIAC OUTPUT
AND
PERIPHERAL
RESISTANCE
MOST COMMON CAUSE
OF DEATH IN
HYPERTENSIVE
PATIENTS
CARDIAC
 SECOND MOST
FREQUENT CAUSE OF
DEATH IN THE WORLD
STROKE
STRONGEST RISK
FACTOR FOR
STROKE
ELEVATED BP
MOST COMMON
ETIOLOGY OF
SECONDARY
HYPERTENSION
PRIMARY RENAL
DISEASE
 INDICATIVE OF
PRIMARY RENAL
DISEASE
PROTEINURIA > 1000
MG/DAY AND AN
ACTIVE URINE
SEDIMENT
 GOLD STANDARD FOR
EVALUATION AND
IDENTIFICATION OF RENAL
ARTERY LESIONS
 CONTRAST
ARTERIOGRAPH
Y
 MOST COMMON
CONGENITAL
CARDIOVASCULAR CAUSE
OF HYPERTENSION
COARCTATION
OF THE AORTA
THE MAXIMUM PROTECTION
AGAINST COMBINED
CARDIOVASCULAR
ENDPOINTS IS ACHIEVED
WITH:
• SBP <135-140 MMHG
• DBP <80-85 MMHG
 DEFINITION
OF RESISTANT
HPN
BP PERSISTENTLY >140/90
MMHG DESPITE TAKING
THREE OR MORE
ANTIHYPERTENSIVE
AGENTS, INCLUDING A
DIURETIC
PROTOTYPIC LESION IN
INFECTIVE
ENDOCARDITIS
VEGETATION
IN IE, THE FOLLOWING ARE
INDEPENDENTLY
ASSOCIATED WITH
INCREASED RISK OF
EMBOLIZATION
• ENDOCARDITIS CAUSED BY S.
AUREUS
• VEGETATIONS > 10MM IN
DIAMETER
• INFECTION INVOLVING THE
MITRAL VALVE
50% OF ENDOCARDITIS CASES
ASSOCIATED WITH INJECTION
DRUG USE ARE LIMITED TO
TRICUSPID
VALVE
DIAGNOSIS OF IE IS
ESTABLISHED
WITH CERTAINTY
HISTOLOGICALL
Y AND
MICROBIOLOGIC
ALLY
OPTIMAL METHOD FOR DIAGNOSIS
OF PROSTHETIC VALVE
ENDOCARDITIS, DETECTION OF
MYOCARDIAL ABSCESS, VALVE
PERFORATION OR INTRACARDIAC
FISTULA
TRANSESOPHAGE
AL
ECHOCARDIOGRA
PHY
 MAJOR
INDICATION FOR
SURGERY IN IE
MODERATE TO SEVERE
CHF DUE TO VALVE
DYSFUNCTION
 PERIVALVULAR
INFECTION IS MOST
COMMON WITH
AORTIC VALVE
INFECTION
 TEST OF CHOICE TO
DETECT PERIVALVULAR
ABSCESS
 TEE WITH
COLOR DOPPLER
 MOST COMMON
LOCATION OF
PERICARDIAL CYSTS
 RIGHT
CARDIOPHRENIC
ANGLE
MOST COMMON
TUMOR OF
THE
PERICARDIUM
MALIGNANT NEOPLASMS FROM
THE MEDIASTINUM
(BRONCHUS,
BREAST, LYMPHOMA,
MELANOMA)
 MOST COMMON
PRIMARY MALIGNANT
PERICARDIAL TUMOR
MESOTHELIOMA
MOST COMMON TYPE OF PRIMARY
CARDIAC TUMOR IN ALL AGE
GROUPS, MOST COMMONLY IN THE
3RD – 6TH DECADE, WITH FEMALE
PREDILECTION
 MYXOMA
(MOSTLY
SPORADIC)
MOST COMMON TYPE/
CHARACTERISTICS OF
MYXOMA
SPORADIC, SOLITARY,
LOCATED IN THE LEFT
ATRIUM, OFTEN
PEDUNCULATED
 MOST COMMON
CLINICAL
PRESENTATION OF
MYXOMAS
MIMICS MITRAL
VALVE DISEASE
MOST COMMON
TUMORS OF THE
VALVES
 PAPILLARY
FIBROELASTOMA
S
 MOST COMMON
CARDIAC TUMORS
IN INFANTS/
CHILDREN
RHABDOMYOMA
S AND FIBROMAS
 ALMOST ALL
PRIMARY CARDIAC
MALIGNANCIES
ARE
SARCOMAS, COMMONLY IN
RIGHT SIDE (BUT TUMORS
METASTATIC TO HEART ARE
MORE COMMON)
MOST OFTEN INVOLVED
IN METASTASIS TO THE
HEART
 PERICARDIUM >
MYOCARDIUM
> ENDOCARDIUM OR
CARDIAC VALVES
THANK YOU
HAPPY ARAL