CurrentMD™ Cardiology

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

Presented by Carole A. Warnes, MD
Mayo Clinic

• Describe some of the common residua & sequelae among adult patients with repaired congenital heart disease
• Delineate some of the recent advances in the care of patients with adult congenital heart disease

Presented by Rick Nishimura, MD, MACC, MACP
Mayo Clinic

• Describe the conventional framework for the management of patients with valvular heart disease
• Apply the new paradigm for the management of patients with valvular heart disease
  • Lower thresholds for intervention
  • Less invasive intervention
• Predict future changes in the management of patients with valvular heart disease

Presented by Biykem Bozkurt, MD, PhD, FHFSA, FACC, FAHA, FESC
Baylor College of Medicine

Treatment of Heart Failure: Changing Paradigms

• Describe the evidence supporting SGLT2i use in patients with HFrEF.
• Identify specific populations and disease phenotypes that would benefit from the use of vericiguat or omecamtiv.
• Identify new approaches and considerations for HF prevention and risk management.

Treatment of Heart Failure: Changing Definitions & Classifications

• Discuss data from recent clinical trials evaluating novel HF prevention strategies
• Contrast the new universal definition of HF with previous classifications
• Explain how changes in the classification of HF translate into tailored prevention and treatment of HF at the individual patient level

Recent Updates in HFpEF

• Explain how recent data and guidelines change the treatment paradigm for patients with HFmrEF
• Describe recent updates to guidelines for the diagnosis and treatment of patients with HFpEF
• Discuss how recent clinical trial data may inform the use of SGLT2 inhibitors in the treatment of patients with HFpEF

Presented by Neil Stone, MD, MACP, FACC, FAHA, FNLA
Northwestern University – Feinberg School of Medicine

• Describe the advantages of using randomized controlled trial (RCT) data for clinical decisions.
• Describe how incremental discoveries led to the current state of lipid-lowering therapy.
• Identify 10 “pearls” from RCTs for reducing atherosclerotic vascular disease (ASCVD) risk in your patients.

Presented by George Bakris, MD, MA, FAHA, FASN
and Martha Gulati, MD, MS, 

• Choose appropriate pharmacotherapy for treating hypertension.
• Recognize the role of lifestyle therapy in treating hypertension.
• Diagnose white coat and masked hypertension.
• Determine when combination therapy is necessary for the treatment of hypertension.

• Describe the physiology of the cardiac cycle.
• Label the mechanical events of the cardiac cycle on a time-pressure curve.
• Recognize how abnormalities of the cardiac cycle give rise to different types of heart sounds.
• Describe the relationship of preload and afterload to stroke volume.

• Identify the effect of mitral stenosis on the time-pressure curve.
• Classify the severity of mitral stenosis by auscultatory findings.
• Relate the underlying pathophysiology of mitral stenosis to symptoms.

• Describe the pathophysiology of aortic stenosis.
• Identify the effect of aortic stenosis on left-sided cardiac pressures.
• Relate the underlying pathophysiology of aortic stenosis to physical exam findings and symptomatology.

• Identify the effect of chronic valvular aortic regurgitation on the left ventricle.
• Relate the underlying cardiac pressure abnormalities in severe aortic regurgitation to physical examination 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

• 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

• Summarize the key messages in the new Chest Pain Guideline.
• Describe the implications of the new guideline recommendations on chest pain management in the acute care and ambulatory settings
• Analyze the evidence underlying updated best practices for chest pain management
• Recognize areas of ongoing uncertainty in chest pain assessment

• Summarize the key messages in the new Chest Pain Guideline
• Describe the implications of the new guideline recommendations on chest pain management in the acute care and ambulatory settings
• Outline the role of risk stratification in acute and stable chest pain assessment

• Contrast outcomes associated with coronary artery bypass grafting and functional flow reserve-guided percutaneous interventions for treating patients with multivessel disease.
• Evaluate outcomes for physiologic testing strategies to guide decisions on whether to revascularize patients with stable angina.
• Summarize the advantages of percutaneous intervention for patients with multivessel disease who are not surgical candidates.
• Describe clinical outcomes for patients with resistant hypertension treated with endovascular ultrasound renal denervation.

• Compare early aortic valve replacement with conservative therapy in preventing adverse events among patients with asymptomatic severe aortic stenosis. [AVATAR]
• Review the benefit of posterior left pericardiotomy among patients undergoing open-heart surgery. [PALACS]
• Summarize outcomes from implementation studies for treatment or assessing hypertension. [Remote Program, BP Track, Village BP]
• Describe the implications of recent clinical data concerning SGLT2 inhibitors for managing patients with heart failure. [HF trials]

• 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

• Recognize indicators of Stage D heart failure.
• Identify patients who may benefit from advanced heart failure therapies or referral to a HF specialist.
• Outline essential elements of palliative and end-of-life heart failure care

• Describe the factors considered in heart transplant candidacy evaluation
• Summarize relative and absolute contraindications to heart transplantation

• Describe the initial management of heart transplant rejection based on the symptoms and signs at presentation.
• Describe the presentation and management of cardiac allograft vasculopathy in heart transplant recipients.
• Describe the short-term and longer-term complications of heart transplantation.

• Summarize the mechanisms of action of immunosuppressive agents used in cardiac transplantation
• Describe the risks of immunosuppressive therapy in cardiac transplantation
• Describe the principles of immunosuppressive therapy induction
• Recognize potential drug-drug interactions related to immunosuppressive agents

• Describe the benefit of SGLT2 inhibitors to patients with acute decompensated HF (EMPULSE, CHIEF-HF).
• Review the benefit of SGLT2 inhibitors in patients with HF with preserved vs reduced EF (Emperor-Preserved + late-breaker).
• Identify the implications of recent clinical trial data concerning stem cell therapy on clinical outcomes for patients with heart failure and reduced EF (Dream HF).
• Assess the role of EHR in improving managing for patients with HF (Reveal HF).

• 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
• Identify the patients with atrial fibrillation who should preferentially be treated with warfarin instead of NOACs

• 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

• 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

• >Determine when catheter ablation of AF is 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