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Preview The Curriculum
Physical Examination
Cardiac murmurs and other pertinent exam findings- 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
Aortic Valve Disease
Aortic Valve Stenosis- 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
Aortic Valve Regurgitation
- 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.
Bicuspid aortic valve disease
- Describe the epidemiology and natural history of bicuspid aortic valve disease Recognize association between bicuspid aortic valve disease and aortopathy
Mitral Valve Disease
Mitral Valve Stenosis- 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.
Mitral Valve Prolapse
- Describe the pathophysiology and epidemiology of mitral valve prolapse (myxomatous mitral valve disease versus fibroelastic deficiency)
Mitral Valve Regurgitation
- 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.
Pulmonic Valve Disease
Pulmonic valve stenosis- 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.
Pulmonic valve regurgitation
- 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.
Tricuspid Valve Disease
Tricuspid Valve Stenosis- 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.
Tricuspid Valve Regurgitation
- 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.
Prosthetic Heart Valves
Medical Management- 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
Prosthetic valve dysfunction and complications
- 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
Cardiovascular Infections
Infective Endocarditis- 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
Cardiovascular Risk Factors
Conventional Risk Factors - Obesity, Physical Inactivity, and Tobacco Use- List traditional risk factors that increase a patient’s chance of developing atherosclerotic cardiovascular disease (ASCVD)
Non-Conventional (hs-CRP, Lp(a), genetic markers) Risk Assessment
- Review non-traditional risk factors for ASCVD
Risk Assessment
- 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)
Chest Pain
Etiologies- Describe the range of conditions that may present as chest pain
- Identify factors that influence the pre-test probability of coronary artery disease
Evaluation
- Outline testing for patients presenting with chest pain in the outpatient setting
- Outline testing for patients presenting with chest pain to the emergency department
Testing and Imaging
Non-invasive Testing Modalities Available for Patients with Suspected or Known Coronary Artery Disease- 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)
Invasive Testing Modalities Available for Patients with Suspected or Known Coronary Artery Disease
- Review invasive tests available to evaluate patients with symptoms/signs suggestive of coronary artery disease (coronary angiography, IVUS, FFR/iFR/OCT)
Stable Ischemic Heart Disease
Clinical Features and Evaluation- 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
Management
- 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
Other Forms (e.g. Prinzmetal variant angina)
- Identify less common causes of angina
- Outline the evaluation and management of atypical/variant angina
Optimal DAPT Duration in Coronary Artery Disease
Minimum Post-PCI DAPT Duration in Stable Ischemic Heart Disease- Explore the clinical evidence supporting updated ACC/AHA dual antiplatelet therapy (DAPT) guideline recommendations for patients with stable ischemic heart disease
Prolonged DAPT After PCI or ACS
Acute Coronary Syndrome (coming soon)
ST-elevation myocardial infarction (STEMI)- Describe the pathophysiology of STEMI and the range of clinical presentations/features
- Identify the benefits of pre-hospital activation of the cardiac catheterization laboratory with STEMI
- Describe initial evaluation/triage of patients presenting with STEMI
- Describe initial therapies (beyond reperfusion therapy) for patients with STEMI
- Describe the use of fibrinolysis for reperfusion, reviewing indications and contraindications
- Review details related to fibrinolysis, including timing, available agents, concomitant therapies, and complications
- Describe the use of a pharmaco-invasive strategy after fibrinolysis in STEMI.
- Describe the use of primary PCI for reperfusion, reviewing indications
- Compare reperfusion strategies (fibrinolysis vs. primary PCI)
- Review details related to primary PCI, concomitant therapies, and complications
Non-ST-elevation ACS (NSTEMI and UA)
- Describe the pathophysiology of NSTE-ACS and the range of clinical presentations/features
- Describe initial evaluation/triage of patients presenting with NSTE-ACS
- Describe initial therapies for patients with NSTE-ACS
- Understand the differences between an invasive and conservative approach for NSTE-ACS
- Outline the role of risk scores for early risk stratification of patients with NSTE-ACS
Complications
- Review potential complications with acute coronary syndrome (arrhythmias, heart failure, shock, mechanical complications, other).
Other Myocardial Infarctions (type 2, 3, 4a, 4b, 5)
- Describe other types of myocardial infarction
- Recognize unusual causes of myocardial ischemia, including coronary dissection, coronary spasm, and Takotsubo syndrome
- Understand adjunctive therapies that should be initiated in patients with a recent acute coronary syndrome
Secondary Prevention (coming soon)
Risk Factor Modification and Post-Discharge Lifestyle and Medical Care- Outline known secondary prevention therapies recommended for patients with a) recent ACS or b) stable ischemic heart disease, with or without revascularization
- Outline non-pharmacologic strategies to help reduce cardiovascular risk
- Review current guideline-directed medical therapy and treatment targets for those with ASCVD and hypertension, hypercholesterolemia, and/or diabetes mellitus
Cardiac Rehabilitation
- Review indications and benefits of phase 2 cardiac rehabilitation
- Identify the recommended options for noninvasive follow up of a patient with known coronary artery disease
Preoperative Risk Stratification (coming soon)
Risk Assessment, Preoperative Testing, Perioperative Management- Identify patients with known or suspected CAD or other cardiac diseases who are at risk of cardiac complications during non-cardiac surgery
- Identify the 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 use in the perioperative period to reduce the risk of cardiac complications during and after non-cardiac surgery, including anticoagulating agents
Overview
Classification- 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
Acute Decompensated Heart Failure
Evaluation- 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
Management
- 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
Heart Failure with Reduced Ejection Fraction (HFrEF)
Evaluation- 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
Management - Pt 1
- 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
Management - Pt 2
- 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
Heart Failure with Preserved Ejection Fraction (HFpEF)
Evaluation and Management- 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
Cardiomyopathies
Dilated- Describe various etiologies of dilated CM
- Describe the association between sleep-disordered breathing and DCM
Hypertrophic
- 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
Restrictive/Infiltrative and amyloidosis
- 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
Peripartum Cardiomyopathy (PPCM)
- 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
Chemotherapy-Related (cardio-oncology)
- Name the 3 most common chemotherapeutic agents associated with CM
Other (takotsubo, non-compaction, ARVD)
- 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.
Management of Patients with Heart Failure and Complex Sleep Apnea
Sleep Apnea in Patients With Heart Failure- 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
Myocarditis (coming soon)
Learning Objectives- Define myocarditis, identify the common causes, and general monitoring/treatment strategy
- Understand the presentation and treatment strategies for Giant Cell Myocarditis
- Recognize and understand treatment strategies for myocarditis in patients treated with immune checkpoint inhibitors
Devices for Monitoring and Managing Heart Failure (coming soon)
Hemodynamic Monitoring- Understand indications for right heart catheterizations
- Define the indications for an implanted PA monitor and use of sensors including HeartLogic, OptiVol
- Use of biomarkers (BNP and NT-proBNP) as an adjunct to remote monitoring for volume assessment
ICD and CRT/CRT-D
- Describe indications for ICD
- Describe indications for CRT
- Describe benefits of CRT with regards to outcomes
Advanced Heart Failure (coming soon)
Learning Objectives- Describe stage D HF
- Understand when referral to a HF specialist is needed
- Describe options for end-stage HF- VAD, TXP, home inotropes/palliation, hospice
Mechanical Circulatory Support (coming soon)
Percutaneous VAD - Short Term Support- Identify the indications for short-term left ventricular assist devices (LVAD).
- Describe contraindications to temporary MCS
- List the possible complications after percutaneous LVAD
Durable VAD - Long Term Support
- Identify the indications for long-term left ventricular assist devices (LVAD).
- Describe contraindications to long-term MCS
- List the possible complications after durable LVAD
Cardiac Transplantation (coming soon)
Evaluation- Identify the indications for cardiac transplantation
- Describe contraindications to transplant
Treatment
- Understand the basics of induction therapy
- Describe a typical immunosuppressive regimen
Complications
- Describe typical short and long term complications of transplant
- Outline the management of complications post-heart transplantation
Overview
Range of Presentations and Mechanisms (disorders of impulse formation, disorders of impulse conduction, reentry)- Identify the symptoms of arrhythmia
- Describe the clinical presentation of arrhythmia
- Recognize the basic general mechanisms of arrhythmia
Electrocardiography and Invasive EP Testing
- Interpret the indications and findings on 12 lead ECG
- Interpret the indications, options, and findings on ambulatory electrocardiography studies
- Identify the (broad) indications for invasive electrophysiology testing, limitations, and appropriate use
Antiarrhythmic Drugs (AADs)
- Review the classification of antiarrhythmic medication classes 0-IV & multichannel blockers
- Describe the mechanism of action of each of the major classes of antiarrhythmic agents
- Describe the efficacy and safety concerns surrounding these drugs
Cardioversion
- List the indications for cardioversion
- Determine when the pill-in-the-pocket antiarrhythmic therapy is appropriate
- Identify the rationale and recommendations for TEE prior to cardioversion
AF Ablation (catheter-based and surgical)
- Determine when catheter ablation of AF indicated
- List the benefits and risks of AF ablation and determine when surgical ablation is appropriate
- Contrast long term efficacy of pulmonary vein isolation vs antiarrhythmic drug therapy in the patient with paroxysmal atrial fibrillation
Cardiac Implantable Electronic Devices (CIEDs): Pacing)
- Describe the current pacemaker options (e.g., leadless, single, dual, triple-chamber)
- Outline the indications for permanent pacemaker implantation in a patient with AV block.
- Outline the indications for permanent pacemaker implantation in a patient with sinus node dysfunction
Cardiac Implantable Electronic Devices (CIEDs): Implantable Cardioverter
- Describe defibrillator device options (transvenous, subcutaneous)
- Describe the advantages and disadvantages of each device
- Describe the long-term risks of having a defibrillator
Supraventricular Arrhythmias
Appropriate and inappropriate Sinus- List 4 physiologic causes of sinus tachycardia
- Contrast the EKG criteria for a PAC with aberrant conduction vs PVC
Atrial fibrillation
- Define the 4 types of atrial fibrillation
- Use current risk scoring systems to evaluate stroke risk in patients with atrial fibrillation
- Calculate the CHA2DS2 VASc score based on patient description
- Describe the mechanisms of action of the direct oral anticoagulants (DOACs)
- Identify the patients who should not be treated with DOACs (who should still get VKA)
- Summarize the recommendations for the evaluation of a patient with device-detected atrial fibrillation
- Compare the benefits of rhythm vs rate control in patients with atrial fibrillation
- Outline the pharmacologic and procedural options to achieve rhythm control in a patient with AFib
- Describe the pharmacologic options for rate control in patients with atrial fibrillation
- Select appropriate management options for patients with postoperative atrial fibrillation
- Describe the approach for emergent management of a patient with AFib who is hemodynamically unstable
Typical and atypical Atrial flutter
- Describe the EKG criteria for atrial flutter
- Describe clinical factors associated with atypical versus typical atrial flutter
Long RP (Atrial tachycardia, sinus node reentry, atypical AV nodal reentry, AVRT with slowly conducting accessory pathway)
- Describe the differences in mechanism and treatment of those tachycardias (AT, sinus node reentry, AVRNT)
- Contrast the EKG characteristics among them
Short RP (AV nodal entry and AV reentry)
- Describe the EKG criteria for SVT List the underlying etiologies of supraventricular tachycardia (SVT)
- Outline the clinical evaluation of a patient with SVT
Current Concepts in Pacing for the Non-EP Cardiologist
Introduction and Overview of Pacing
Pacing for Bradycardia due to Sinus and AV Node Dysfunction
Cardiac Resynchronization Therapy for Heart Failure
Ventricular Arrhythmias (coming soon)
Premature ventricular complexes Ventricular tachycardia, and fibrillation Cardiac causes Evaluation and Treatment Acquired and inherited long QT syndromes Caused by Structural Heart Defects (HCM, ARVC) Caused by Electrical Defects (Brugada syndrome, CPVT, early repolarization syndrome) Epidemiology and causes Evaluation and treatment Pacemaker and defibrillator programming
Bradyarrhythmias and Atrioventricular Shock (coming soon)
Sinus bradycardia/sinus arrhythmia & Sick sinus syndrome
Syncope (coming soon)
Vascular causes (orthostatic hypotension, reflex-mediated, neurally mediated (vasovagal), carotid sinus hypersensitivity)
Arrhythmia Syndromes (coming soon)
Cardiac Arrest and Sudden Cardiac Death (coming soon)
Pacemakers and Implantable Cardioverter Defibrillators (coming soon)
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