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Cardiology ABIM Review

Cardiology ABIM Review. Nelle Coronary artery disease Valvular heart disease Pregnancy Peripheral arterial disease. Dylan Arrhythmias Heart failure Pericardial disease Aortic disease Myocardial disease. MKSAP Topics. Arrhythmias. Atrial Fibrillation. NASPE 2003 Consensus Paper.

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Cardiology ABIM Review

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  1. Cardiology ABIM Review

  2. Nelle Coronary artery disease Valvular heart disease Pregnancy Peripheral arterial disease Dylan Arrhythmias Heart failure Pericardial disease Aortic disease Myocardial disease MKSAP Topics

  3. Arrhythmias

  4. Atrial Fibrillation

  5. NASPE 2003 Consensus Paper

  6. AF: Etiology ACC 2006 Guidelines

  7. AF: Diagnosis ACC 2006 Guidelines

  8. AF: Diagnosis ACC 2006 Guidelines

  9. AF: Rate vs. Rhythm Control ACC 2006 Guidelines

  10. AF: Rate vs. Rhythm Control ACC 2006 Guidelines

  11. AF: Rate vs. Rhythm Control ACC 2006 Guidelines

  12. AF: Rate vs. Rhythm Control ACC 2006 Guidelines

  13. AF: Stroke Prevention

  14. AF: Stroke Prevention

  15. AF: Stroke Prevention

  16. Supraventricular Tachycardias

  17. ACC 2003 Guidelines

  18. ACC 2003 Guidelines

  19. ACC 2003 Guidelines

  20. AVNRT

  21. Atrial Tachycardia

  22. Atrial Flutter

  23. ACC 2003 Guidelines

  24. ACC 2003 Guidelines

  25. ACC 2003 Guidelines

  26. Ventricular Arrhythmias

  27. Epidemiology of VA & SCD Classification of Ventricular Arrhythmia by Electrocardiography • Nonsustained ventricular tachycardia (VT) • ♥Monomorphic • ♥Polymorphic • Sustained VT • ♥Monomorphic • ♥Polymorphic • Bundle-branch re-entrant tachycardia • Bidirectional VT • Torsades de pointes • Ventricular flutter • Ventricular fibrillation

  28. Nonsustained Monomorphic VT

  29. Nonsustained Polymorphic VT

  30. Ventricular Flutter Spontaneous conversion to NSR (12-lead ECG)

  31. VF with Defibrillation (12-lead ECG)

  32. Epidemiology of VA & SCD Classification of Ventricular Arrhythmia by Clinical Presentation • Hemodynamically stable • ♥Asymptomatic • ♥Minimal symptoms, e.g., palpitations • Hemodynamically unstable • ♥Presyncope • ♥Syncope • ♥Sudden cardiac death • ♥Sudden cardiac arrest

  33. Epidemiology of VA & SCD Classification of Ventricular Arrhythmia by Disease Entity • Chronic coronary heart disease • Heart failure • Congenital heart disease • Neurological disorders • Structurally normal hearts • Sudden infant death syndrome • Cardiomyopathies • ♥Dilated cardiomyopathy • ♥Hypertrophic cardiomyopathy • ♥Arrhythmogenic right ventricular (RV) • cardiomyopathy

  34. VA: Diagnosis • Chemistry panel • Resting ECG • Ambulatory ECG • Holter monitor, event monitor, or ILR • Stress testing • Exercise or pharmacologic • ECG, echoc, or SPECT MPI • Left ventricular function & imaging • TTE, LHC, CCT, or CMR • Electrophysiologic testing

  35. Therapies for VA • Antiarrhythmic Drugs • ♥Beta Blockers: Effectively suppress ventricular ectopic beats & arrhythmias; reduce incidence of SCD • ♥Amiodarone: No definite survival benefit; some studies have shown reduction in SCD in patients with LV dysfunction especially when given in conjunction with BB. Has complex drug interactions and many adverse side effects (pulmonary, hepatic, thyroid, cutaneous) • ♥Sotalol: Suppresses ventricular arrhythmias; is more pro-arrhythmic than amiodarone, no survival benefit clearly shown • ♥Conclusions: Antiarrhythmic drugs (except for BB) should not be used as primary therapy of VA and the prevention of SCD

  36. Therapies for VA • Non-antiarrhythmic Drugs • ♥ Electrolytes:magnesium and potassium administration can favorably influence the electrical substrate involved in VA; are especially useful in setting of hypomagnesemia and hypokalemia • ♥ ACE inhibitors,angiotensin receptor blockers and aldosterone blockers can improve the myocardial substrate through reverse remodeling and thus reduce incidence of SCD • ♥ Antithrombotic and antiplatelet agents:may reduce SCD by reducing coronary thrombosis • ♥ Statins:have been shown to reduce life-threatening VA in high-risk patients with electrical instability • ♥ n-3 Fatty acids:have anti-arrhythmic properties, but • conflicting data exist for the prevention of SCD

  37. Torsades de Pointes Spontaneous conversion to NSR (continuous lead II monitor strip)

  38. Common Forms of the Long-QT Syndrome Roden D. N Engl J Med 2008;358:169-176

  39. Electrocardiographic Patterns in the Three Common Forms of the Long-QT Syndrome Roden D. N Engl J Med 2008;358:169-176

  40. Guidelines for Management of the Long-QT Syndrome Roden D. N Engl J Med 2008;358:169-176

  41. Drugs That May Cause Torsade de Pointes Roden D. N Engl J Med 2004;350:1013-1022

  42. Risk Factors for Drug-Induced Torsade de Pointes Roden D. N Engl J Med 2004;350:1013-1022

  43. Syncope

  44. Causes of Syncope Kapoor W. N Engl J Med 2000;343:1856-1862

  45. Clinical Features Suggestive of Specific Causes of Syncope Kapoor W. N Engl J Med 2000;343:1856-1862

  46. ACC 2006 Scientific Statement

  47. Bradyarrhythmias

  48. Causes of Bradycardia Mangrum J and DiMarco J. N Engl J Med 2000;342:703-709

  49. Electrocardiographic Findings Associated with Sinus-Node Dysfunction Mangrum J and DiMarco J. N Engl J Med 2000;342:703-709

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