CurrentMD™ Cardiology - Here to Help

Presented by Deepak L. Bhatt, MD, MPH, FACC, FAHA, FSCAI, FESC
Brigham and Women’s Hospital

• Identify major achievements in the emergent care of the patient with ACS
• Define seminal contributions to the CAD prevention field in the past 50+ years
• Describe major challenges and opportunities ahead

Presented by Hugh Calkins, MD, FHRS, FACC, FAHA, FESC
Johns Hopkins School of Medicine

• Define 3 key practice-changing research findings in the field of electrophysiology in the past 40 years
• Describe the biggest challenges to the optimal application of evidence-based treatment in the patient with a cardiac rhythm disorder
• Identify emerging evidence with the potential to change practice in the field of electrophysiology

• Describe normal and abnormal findings on auscultation
• Synchronize the auscultatory findings with the EKG throughout the cardiac cycle.
• Recognize the typical physical findings of disease states, such as myocardial, pericardial and valve disease

• Describe the pathophysiology of aortic stenosis (primarily calcific AS, with a brief mention of rheumatic AS)
• Describe the range of auscultatory findings in a patient with aortic stenosis.
• Describe echocardiographic findings in aortic stenosis
• Identify the factors involved in the recommendation of replacement of the aortic valve in a patient with AS

• Describe the pathophysiology of aortic regurgitation
• Describe the range of auscultatory findings in a patient with aortic regurgitation
• Describe echocardiographic findings in a patient with aortic regurgitation
• Identify the factors involved in the recommendation of repair /replacement of the aortic valve in a patient with AR.

• Describe the epidemiology and natural history of bicuspid aortic valve disease Recognize association between bicuspid aortic valve disease and aortopathy

• Describe the pathophysiology of mitral stenosis (rheumatic MS, with a brief review of signs/symptoms of rheumatic fever, and calcific MS)
• Describe the range of auscultatory findings in a patient with mitral stenosis.
• Describe echocardiographic findings in mitral stenosis (rheumatic and calcific)
• Identify the factors involved in the recommendation of valvuloplasty/repair/replacement of the mitral valve in a patient with MS.

• Describe the pathophysiology and epidemiology of mitral valve prolapse (myxomatous mitral valve disease versus fibroelastic deficiency)

• Describe the pathophysiology of mitral regurgitation
• Describe the range of auscultatory findings in a patient with mitral regurgitation.
• Describe echocardiographic findings in mitral regurgitation
• Identify the factors involved in the recommendation of repair/replacement of the mitral valve in a patient with MR.

• Describe the pathophysiology of pulmonic stenosis
• Describe the range of auscultatory findings in a patient with pulmonic stenosis.
• Describe echocardiographic findings in patients with PS Identify the factors involved in the recommendation of repair/replacement of the pulmonic valve in a patient with PS.

• Describe the pathophysiology of pulmonic regurgitation
• Describe the range of auscultatory findings in a patient with pulmonic regurgitation.
• Describe echocardiographic findings in patients with PR Identify the factors involved in the recommendation of repair/replacement of the pulmonic valve in a patient with PR.

• Describe the pathophysiology of tricuspid stenosis
• Describe the range of auscultatory findings in a patient with tricuspid stenosis
• Identify the factors involved in the recommendation of valvuloplasty/repair/replacement of the tricuspid valve in a patient with TS.

• Describe the pathophysiology of tricuspid regurgitation
• Describe the range of auscultatory findings in a patient with tricuspid regurgitation.
• Identify the factors involved in the recommendation of repair/replacement of the tricuspid valve in a patient with TR.

• Describe the types of prosthetic valves.
• Identify the factors to consider in the choice of prosthetic valve in the patient with aortic and/or mitral valve disease
• Select the appropriate long term anticoagulation and/or antiplatelet regimen for patients with prosthetic valves based on valve type and patient characteristics

• List key steps in evaluating prosthetic valves, clinically and echocardiographically, and describe the appropriate type and frequency of follow up
• Identify potential complications in patients who have received prosthetic valves and outline appropriate management
• Define appropriate anticoagulation regimens for patients with mechanical prosthetic valves prior to noncardiac surgery

• Describe clinical findings in the patient with endocarditis
• Describe the diagnostic evaluation for the patient with suspected endocarditis
• Outline management of the patient with infective endocarditis

• List traditional risk factors that increase a patient’s chance of developing atherosclerotic cardiovascular disease (ASCVD)

• Review non-traditional risk factors for ASCVD

• Describe how to estimate the 10-year risk of cardiovascular disease based on a patient’s risk factors
• Understand the clinical implications of subclinical ASCVD (e.g., coronary calcium)

• Describe the range of conditions that may present as chest pain
• Identify factors that influence the pre-test probability of coronary artery disease

• Outline testing for patients presenting with chest pain in the outpatient setting
• Outline testing for patients presenting with chest pain to the emergency department

• Review basic tests available to evaluate patients with symptoms/signs suggestive of coronary artery disease (ECG, echocardiography)
• Review non-invasive functional tests available to evaluate patients with symptoms/signs suggestive of coronary artery disease (exercise electrocardiography, stress echocardiography, SPECT, cardiac magnetic resonance stress testing)
• Review non-invasive anatomic tests available to evaluate patients with symptoms/signs suggestive of coronary artery disease (CT coronary angiography)

• Review invasive tests available to evaluate patients with symptoms/signs suggestive of coronary artery disease (coronary angiography, IVUS, FFR/iFR/OCT)

• Describe the pathophysiology of stable ischemic heart disease and the range of clinical presentations/features
• Define angina pectoris and anginal equivalent
• Describe the steps in the progression of CAD from stable ischemic heart disease to acute coronary syndrome
• Describe the role of non-invasive testing in patients with stable ischemic heart disease

• List goals of therapy for a patient with stable ischemic heart disease
• Identify the classes of pharmacologic agents indicated for the management of stable ischemic heart disease
• List the indications for coronary angiography in the evaluation of patients with known or suspected CAD
• Identify the indications for revascularization in a patient with stable ischemic heart disease
• Describe angiographic and other findings that favor revascularization in a patient with stable ischemic heart disease
• Contrast the benefits of percutaneous vs. surgical revascularization in patients with stable ischemic heart disease

• Identify less common causes of angina
• Outline the evaluation and management of atypical/variant angina

• Explore the clinical evidence supporting updated ACC/AHA dual antiplatelet therapy (DAPT) guideline recommendations for patients with stable ischemic heart disease

• Understand the recent changes in the ACC/AHA DAPT guideline recommendations regarding prolonged (>12 months) DAPT after percutaneous coronary intervention and/or myocardial infarction
• Explore risks and benefits associated with prolonged DAPT

• Understand the New York Heart Association classification of heart failure stages
• Understand the American College of Cardiology/ American Heart Association classification of heart failure stages
• Distinguish heart failure with reduced ejection fraction from heart failure with a preserved ejection fraction

• Describe the clinical evaluation of the patient presenting with acute decompensated heart failure.
• Describe the imaging and laboratory evaluation of patients presenting with acute decompensated heart failure
• Recognize indications for hospital admission for patients presenting with acute decompensated heart failure

• Understand when guideline-directed medical therapies need to be adjusted in patients presenting with acute decompensated heart failure
• Know the importance of early recognition and initiation of diuretics and their appropriate dosing in patients with acute decompensated heart failure
• Understand the importance of initiation of guideline-directed medical therapies before hospital discharge

• Describe the clinical evaluation of patients presenting with chronic stable heart failure with reduced EF
• Describe the imaging and laboratory evaluation of patients presenting with chronic HfrEF

• Understand indication for beta-blockers use per the most recent ACC/AHA/HFSA guidelines
• Understand indication for mineralocorticoid receptor antagonist use per the most recent ACC/AHA/HFSA guidelines

• Understand indication for ARNI/ACEi/ARB use per the most recent ACC/AHA/HFSA guidelines
• Understand indication for SGLT2i use per the most recent ACC/AHA/HFSA guidelines

• Describe the clinical evaluation of patients presenting with chronic stable heart failure with preserved EF.
• Describe the imaging and laboratory evaluation of patients with chronic HfpEF
• Identify contemporary treatment strategies for a patient with HFpEF

• Describe various etiologies of dilated CM
• Describe the association between sleep-disordered breathing and DCM

• Describe the pathophysiology of hypertrophic cardiomyopathy
• Identify the diagnostic findings in a patient with HCM
• Provide evidence-based guidance to patients and families regarding genetic testing for HCM
• Identify patients with HCM who need ICD
• Formulate a treatment plan for asymptomatic HCM patient

• Describe the pathophysiology of restrictive and other non-dilated cardiomyopathies.
• Identify 2 classic electrocardiographic findings in a patient with restrictive CM
• Outline the diagnostic evaluation for a patient with suspected cardiac amyloidosis
• Identify the different types of amyloidosis
• Describe the treatment options for the patient with amyloid heart disease

• Know the definition, risk factors, and symptoms of PPCM
• Understand management options for PPCM
• Understand risk factors associated with worse outcomes
• Understand long-term outcomes

• Name the 3 most common chemotherapeutic agents associated with CM

• Describe the clinical presentation of stress-induced cardiomyopathy (Takotsubo)
• Assess the sudden cardiac death risk in a patient with non-compaction cardiomyopathy.
• Identify 3 EKG abnormalities associated with ARVD/ARVC.

• Recognize the definitions and pathobiology of obstructive sleep apnea (OSA), central sleep apnea (CSA), and complex sleep apnea and their differential rates among those with heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF)
• Discuss screening methods for inpatients and outpatients with heart failure (HF) who are at risk for sleep apnea (SA)
• Describe current treatment options for SA in patients with HF