Cardiology Board Review Course

• Describe the etiology and pathophysiology of restrictive and other non-dilated cardiomyopathies and use this information to effectively diagnose and manage patients
• Describe the etiology and pathophysiology of hypertrophic cardiomyopathy (HCM) and use this information to select appropriate testing and evaluate patients
• Define the genetic makeup of HCM and properly advise patients and family members on proactive testing
• Formulate a management plan for patients with HCM with symptoms, including medical, interventional, and/or surgical options as needed
• Assess the potential for sudden cardiac death and implications for ICD placement in patients with non-compaction cardiomyopathy and HCM

• Define the stages of hypertension, describe methods for measurement of BP, and discuss indications for treatment
• Design appropriate management strategies for patients with hypertension that include lifestyle modifications and a step-wise approach to medical therapy based on patient characteristics
• Define resistant hypertension and select appropriate treatment strategies
• List the potential secondary causes of hypertension and apply to diagnosis and management of patients with hypertension that appears to be resistant
• Recognize that malignant hypertension is a medical emergency and select appropriate treatment approaches based on patient characteristics

• Describe the different etiologies and underlying physiological principles of pulmonary hypertension
• Develop a comprehensive approach to diagnosing, determining the etiology, and evaluating the patient with pulmonary hypertension, including interpretation of hemodynamic findings
• Develop appropriate management strategies for patients with pulmonary hypertension, including selection of medical therapies

• Recognize the presentation and select appropriate testing and management strategies for patients with acute pericarditis
• Recognize the presentation and select appropriate testing and management strategies for patients with pericardial effusion and tamponade
• Recognize the presentation and select appropriate testing and management strategies for patients with pericardial constriction, including differentiation between constrictive pericarditis and restrictive cardiomyopathy
• Review diagnosis and treatment of pericardial cysts, tumors, and metastatic disease

• Identify potential signs and symptoms of peripheral vascular disease and select appropriate diagnostic tests to assess presence and severity
• Select optimal treatment strategies for symptomatic patients with peripheral vascular disease
• Diagnose and select appropriate treatment strategies for acute arterial occlusion
• Assess risk factors for abdominal aortic aneurysm, identify patients for screening, and develop management plans that include appropriate surveillance and optimal timing of intervention
• Determine the role of surgical versus endovascular treatment of abdominal aortic aneurysms and describe potential complications and appropriate follow-up

• Describe the different etiologies of thoracic aortic aneurysms and develop management plans that include appropriate surveillance intervals and optimal timing of intervention, including the implications of genetic testing
• Recognize, diagnose, and describe appropriate management of acute aortic syndromes
• Recognize the presentations of the vasculitides involving the great vessels and select appropriate management plans

• Recognize and diagnose venous thromboembolism (VTE) and pulmonary embolism (PE), using the appropriate algorithm for VTE diagnosis based on a pretest probability of disease assessment strategy
• Design a management plan for the stable patient with VTE and PE, selecting the appropriate length of treatment for patients with provoked and unprovoked thrombotic events, including the use of the newer oral anticoagulants
• Design a management plan for the unstable patient with pulmonary embolism, with consideration of guideline-based indications for thrombolytic therapy, inferior vena cava (IVC) filter placement, and surgical intervention
• Recognize and appropriately manage other diseases of the veins and lymphatics, including lymphedema
• Describe antiphospholipid antibody syndrome and its diagnosis and treatment

• Diagnose acute stroke and select treatment strategies based on patient characteristics and clinical circumstances
• Select appropriate diagnostic and management plans for patients with asymptomatic carotid lesions, selecting medical or interventional approaches based on patient risk factors
• Select appropriate diagnostic and management plans for patients with symptomatic carotid lesions, comparing the risks and benefits of carotid endarterectomy vs carotid stenting
• Diagnose renal vascular disease and select appropriate therapy

• Identify cardiovascular disease risk factors in patients without known CAD and use them to predict the risk of future coronary events
• Select appropriate noninvasive testing to risk stratify patients without known CAD, including stress testing and CT scanning
• Apply management strategies to the primary and secondary prevention of CAD, including therapies to reduce risk factors and appropriate counseling on lifestyle changes
• Initiate appropriate lipid lowering therapies to reduce risk of future events, recognizing potential side effects and drug-drug interactions

• Recognize the clinical presentation and characterize the symptoms of patients with known or suspected CAD
• Outline the principles of appropriate medical management and apply them to the selection of adjunctive therapies for patients with stable CAD, including those with diabetes
• Apply principles of appropriate medical management to selection of adjunctive therapies for patients who have undergone revascularization for stable CAD, including type and duration of antiplatelet agents
• Recognize unusual causes of myocardial ischemia, including coronary dissection, coronary spasm, and Takotsubo syndrome
• Define the indications for and appropriate type(s) of non-invasive testing for the initial evaluation and follow-up of patients with known or suspected coronary artery disease

• Discuss indications and risks of coronary angiography in the evaluation of patients with known or suspected CAD
• Recognize the indications for revascularization for patients with stable CAD and understand the principles to guide revascularization decisions, including the role of fractional flow reserve measurement
• Compare the risks and benefits of PCI vs CABG vs medical therapy and use this information to select appropriate interventions for specific patient subsets
• Recognize the indications for revascularization in diabetic patients with CAD and select the appropriate intervention

• Identify patients with known or suspected CAD or other cardiac diseases who are at risk of cardiac complications during non-cardiac surgery and manage appropriately
• Identify appropriate type(s) of noninvasive testing to be used in patients with known or suspected CAD who are at risk of cardiac complications during non-cardiac surgery
• Select and adjust appropriate adjunctive medical therapies for the perioperative period to reduce the risk of cardiac complications during and after non-cardiac surgery, including anticoagulating agents

• Describe initial evaluation and triage of patients presenting with acute coronary syndromes (ACS), including the incorporation of risk stratification scores
• Identify patients for an early invasive vs selective therapy in NSTEMI based on assessment of risk factors
• Select the optimal reperfusion therapy for patients with STEMI based on patient characteristics, clinical circumstances, and current guideline recommendations
• Describe the optimal use of pharmaco-invasive therapy after thrombolysis in STEMI and apply to specific clinical scenarios

• Describe initial evaluation and triage of patients presenting with acute coronary syndromes (ACS), including the incorporation of risk stratification scores
• Identify patients for an early invasive vs selective therapy in NSTEMI based on assessment of risk factors
• Select the optimal reperfusion therapy for patients with STEMI based on patient characteristics, clinical circumstances, and current guideline recommendations
• Describe the optimal use of pharmaco-invasive therapy after thrombolysis in STEMI and apply to specific clinical scenarios

• Recognize and diagnose mechanical complications of myocardial infarction (MI)
• Select appropriate management strategies for patients with mechanical complications of MI
• Analyze post-infarction conduction abnormalities and develop appropriate treatment strategies

• Describe the classification and mechanisms of atrial fibrillation/flutter and its diagnosis
• Use current risk scoring systems and clinical characteristics to evaluate stroke risk in patients with atrial fibrillation and determine the need for anticoagulation
• Select appropriate stroke prevention regimens for patients with atrial fibrillation, taking into account patient characteristics, clinical history, and comorbidities
• Describe the mechanisms and uses of the newer oral anticoagulant agents in patients with atrial fibrillation
• Describe the different etiologies of supraventricular tachycardia (SVT) and use clinical, electrophysiological, and other diagnostic criteria to evaluate patients and diagnose accurately

• Compare the benefits of rhythm control vs rate control in different types of patients with atrial fibrillation
• Describe and choose among pharmacologic agents for rate control for specific types of patients with atrial fibrillation
• Describe and choose among treatment options for rhythm control in atrial fibrillation, including medications, cardioversion, and ablation, for specific types of patients
• Select appropriate management options for patients with new onset atrial fibrillation, including in the postoperative setting
• Recognize and manage potential complications that may occur following atrial fibrillation ablation
• Select appropriate management options for patients with re-entrant SVT, including management of patients with accessory pathways

• Differentiate between the wide complex tachycardias (VT vs SVT) and describe appropriate therapeutic options for each
• Diagnose the different etiologies and mechanisms of ventricular arrhythmias effectively using clinical, electrophysiological, and other diagnostic criteria
• Select appropriate management options for the different types of ventricular arrhythmias

• Identify the major channelopathies, and discuss their clinical presentations, diagnosis, and treatment
• Select appropriate management options for the patient with an identified channelopathy

• Identify the classification and mechanisms of action of antiarrhythmic agents
• Apply knowledge of drug mechanism of action, toxicity, interactions, and metabolism to the selection and use of antiarrhythmic agents in specific types of patients

• Describe appropriate testing and management of patients presenting with syncope, including tilt table testing
• Describe appropriate testing and management of the patient who presents with out-of-hospital cardiac arrest (secondary sudden cardiac prevention)

• List the indications for pacemaker implantation, identify pacemaker nomenclature, and perform appropriate device selection for specific patients
• List the indications for ICD implantation for primary prevention and select appropriate patients for this intervention
• List the indications for CRT implantation and select appropriate patients for this intervention
• Discuss the ethics of device therapies and apply to patient management decisions
• Interpret pacemaker electrocardiography accurately and use the findings to guide patient management

• Apply current AHA guidelines for prophylaxis to prevent infective endocarditis
• Describe diagnosis and management of a patient with suspected or known endocarditis
• Recognize complications of endocarditis and select appropriate treatment strategies, including need for and timing of surgical intervention
• Describe the epidemiology and management of cardiovascular implantable electronic device (CIED) infections

• Recognize the pathophysiology and presentation of aortic stenosis, select appropriate testing, and interpret the findings accurately
• Design a plan of care including timing and type of interventions for patients with aortic stenosis
• Recognize the pathophysiology and presentation of mitral stenosis, select appropriate testing, and interpret the findings accurately
• Design a plan of care including timing and type of interventions for patients with mitral stenosis

• Recognize the pathophysiology and presentation of aortic regurgitation, select appropriate testing, and interpret the findings accurately
• Design a plan of care including timing and type of interventions for patients with aortic regurgitation
• Recognize the pathophysiology and presentation of mitral regurgitation, select appropriate testing, and interpret the findings accurately
• Design a plan of care including timing and type of intervention for patients with mitral regurgitation
• Recognize the presentation, select appropriate testing, and choose effective management options for patients with tricuspid regurgitation

• Describe the types of prosthetic valves and compare their relative benefits for specific types of patients and applications
• Select the appropriate long term anticoagulation regimen for patients with prosthetic valves based on valve type and patient characteristics
• Describe the appropriate type and frequency of follow-up for patients who have received prosthetic valves
• Diagnose complications in patients who have received prosthetic valves and manage appropriately
• Define appropriate anticoagulation regimens for patients with prosthetic valves prior to noncardiac surgery, based on type of valve and patient characteristics

• Explain the physiologic changes that occur with pregnancy
• List the contraindications to pregnancy for patients with cardiac disease
• Select appropriate management strategies for pregnant patients with myocardial, valvular, or aortic disease, arrhythmias, or hypertension
• Identify medical therapies that are contraindicated in the pregnant patient with heart disease
• Develop anticoagulation regimens for pregnant patients with mechanical prostheses and manage appropriately

• Describe the anatomy, pathophysiology, clinical presentation, appropriate imaging, and treatment of left to right shunts
• Describe the anatomy, pathophysiology, clinical presentation, and treatment of congenital valve abnormalities, including pulmonary stenosis and Ebstein’s anomaly
• Describe the anatomy, pathophysiology, clinical presentation, and treatment of coarctation of the aorta
• Recognize the cardiovascular implications of genetic syndromes

• Describe the anatomy, pathophysiology, clinical presentation, complications, and treatment of Eisenmenger’s syndrome
• Describe the anatomy, pathophysiology, clinical presentation, and treatment of tetralogy of Fallot
• Describe the anatomy, pathophysiology, clinical presentation, and treatment of congenital great vessel diseases, including d-transposition and l-transposition
• Describe the anatomy, pathophysiology, clinical presentation, and treatment of single ventricle, including postoperative complications of the Fontan procedure

• Describe the noninvasive and invasive hemodynamics of valve, myocardial and pericardial diseases
• Apply results of noninvasive and invasive hemodynamics to clinical decision making in cardiology in specific patient case scenarios

• Describe the evaluation of patients presenting with chronic stable heart failure and reduced EF
• Use recent guidelines to select appropriate medical therapies for patients with stable heart failure with reduced EF

• Recognize the patient with decompensated systolic heart failure
• Use recent guidelines to select appropriate medical therapies for patients with decompensated heart failure
• Determine which patients benefit from further non-medical therapy, such as devices and cardiac transplantation

• Describe the pathophysiology of patients with heart failure and preserved ejection fraction (HFpEF)
• Develop appropriate management strategies for the patient with stable heart failure with preserved EF

• Compare and contrast the various device and surgical treatment options for patients with heart failure
• Recognize the indications for left ventricular assist devices (LVAD) and heart transplantation
• List the possible complications after LVAD and heart transplantation and describe their management
• Select an appropriate immunosuppressive regimen following heart transplantation and describe the management of potential complications

• Describe the steps in progression of CAD from stable angina to unstable angina to myocardial infarction
• Recognize unusual causes of angina (spasm, dissection, etc) and describe their diagnosis and management

• Apply statistical and epidemiological analysis to cardiovascular testing such as incidence, prevalence, and Bayes theory
• Perform standard calculations including use of 2×2 tables to calculate sensitivity, specificity, and positive and negative predictive values
• Discuss relative vs absolute risk and perform calculations to obtain risk ratios, odds ratios, and number needed to treat
• Assess the significance of cardiovascular studies, including evaluation of treatment and subgroup analyses
• Interpret the results of meta-analyses

Basic Principles of Cardiovascular Pharmacology

• Q&A

Cardiotoxicy, Herbal Supplements, and Pharmacogenomics

• List common drug-drug interactions associated with cardiovascular drugs and describe cardiotoxic agents
• Discuss the effects of herbal therapies and dietary supplements on cardiovascular physiology and potential interactions with cardiovascular medications

Terminology, Pharmacokinetics, Drug-Drug Interactions, and Overdoses

• Describe the effects and actions of cardiovascular drugs and their pharmacokinetics
• Recognize potential adverse effects of cardiovascular drugs, including diagnosis and treatment of overdose

• New Staging System for Valve Disease

• Describe the normal and abnormal findings on inspection and palpation
• Describe the normal and abnormal findings on auscultation
• Recognize the typical physical findings of disease states, such as myocardial, pericardial and valve disease
• Describe the normal and abnormal findings on inspection and palpation
• Describe the normal and abnormal findings on auscultation
• Recognize the typical physical findings of disease states, such as myocardial, pericardial and valve disease

• Describe and compare the physics, clinical utility, and relative contraindications for CT, MRI, and nuclear imaging in cardiology
• Apply results of CT, MRI, and nuclear imaging to clinical decision making in cardiology in specific patient case scenarios

• Understand how an ABI is interpreted
• Evaluate the pulse volume recording (PVR) waveforms on a vascular report

• Discuss the following diseases: Raynauds, Polyarteritis Nodosa, and Kawasaki Disease

• Evaluate for white coat hypertension
• Explore the use of ambulatory blood pressure monitoring
• Understand the different hypertension thresholds for treatment based on society guidelines

Understanding the Action Potential in the Human Heart

• Describe the molecular basis of the action potential of the human heart
• Describe the contractile elements of the myocardium at the molecular and cellular level

Genetics 101

• Describe the basic principles of inheritance and apply them to the interpretation of inheritance patterns for familial cardiovascular disease syndromes, recognizing potential pitfalls in diagnosis
• Describe the key principles of molecular genetics testing in cardiovascular disease
• Identify current applications of pharmacogenomics to cardiovascular disease

• Identify the most important cardiovascular (CV) risks with cancer therapies
• Outline approches to CV toxicity surveillance
• Formulate a management plan for CV for side effects of cancer therapies

• Identify the most important cardiovascular (CV) risks with cancer therapies
• Outline approches to CV toxicity surveillance
• Formulate a management plan for CV for side effects of cancer therapies

• Review the effect of the autonomic nervous system on myocardial performance
• Explain the effect of loading conditions on myocardial performance and apply these effects to the Starling curve and pressure volume loops