Blueprints in Cardiology [USMLE Steps 2,3] - E. Awtry, et al., (Blackwell, 2003) WW

269 Pages·2003·61.3 MB·English

USMLE

STEPS 2&3

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Melanie Maytin
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BLUEPRINTS IN
CARDIOLOGY
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BLUEPRINTS in

CARDIOLOGY

Editor
Eric H. Awtry, MD, FACC

‘Asia Profesor of Medicine
sna Urveniy Shu of Metin
Director of Fducation, Section of Cadilegy
os Medea! Caner,

Dostio, Mascdrtts,

Authors
Arjun V. Gururaj, MD.

“Teaching Fellow in Interal Medicine
oman Universi Selo of Mine
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[Dwsion of Carselogy

Tsim Metal Center

Biotin, Minaachnoests

Blackwell
Publishing

Melanie Maytin, MD
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Fell, Sone vitogy
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Boon, Mamehacre

Michael W. Tsang, MD
“echng Reo in Med
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Benoy |. Zachariah, MD, MRCP
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Faculty acvisor
Joseph Loscalzo, MD, PhD
Wade Picton or ine
Tener Umer Short Nese
(Gharmen,Bepedina of Modine
Bowens Mowalenees
© 2000 5 Blhckvel Science
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ira uf Congress Catslegingin Pais Data

Bluyrints in eandilogy /edion, Eric H. Avie autkers, Mae
Maytin.. [etal
sem CBlucprats sexes)
ISBN 0-532-096287 (oh)
1 Heart Diwies—Oulines, lhl, et 2. Cardiclogy--Ouiny fa ee
IDNLM _ 1. Hear Disezer Outlines. 2. Cardology—Ourines, WG 18-2 D658 2002] 1, Away, Ere
1 Naytin, Melanie, I. Hlvepris
RS? 558 2002

20013
A eotalogee record for ths tiles avuble tothe British Library

Acquisifons: Noney Daly

Development: Angela Gagliano

Production: Debra Lally

Cover design: Hanaus Desigo

Typescticr: SNP Bester Ijpeseter Led, Hong Kong

rinted snd nd by Capital City Pres fa Verve, USA,

Fer farter information on Rlacesell Publishing, vst cnr website

swwichlaclellcences

Notice: The indicarrs and dosages ofall drugs in this book have heen recommend! in the esedica Hrerarure

and corfortn tn the practices of the peneral community. The, medications deseribed and treatment prescriptions
suggested do not necessarily have specific approval bythe Food end Lirug Administration for use in the diseases
and dasages for which they ste vecamuaended, The puckage insert for each drug should be consulted for use and
Aosage as appraved hy the FDA. Recanse staslards for usage change, i is advisable 10 keep abreast of revised
recommenclatiens, particully those cancerning new drugs
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Preface

Acknowledgments
Reviewers
Abbreviations
Signs and Symptoms
Important Cardiovasculer Formulas
History and Physical Kxamination
1 Chest Pain
2 Dyspnea
3. Palpitations
4 Physical Examination of the Cardiovascular
System
Diagnostic Modalities
5 The Flectrocardiogram
6 Stress ‘Testing
7 Echocardiography

8 Cardiac Catheterization
9 Diagnostic Modalities for Archythmnias a
10 Other Invaging Modalities 4
TI Coronary Artery Disease st
11 Coronary Artery Disease—Pathophysiology 53
12 Dyslipidemia 37
13. Chronic Stable Angina 6

14 Unstable Angina ard Non-S'V Elevation
Myocardial Infarction

15. ST Elevation Myocardial Infarction

16 Complications of Myocardial Infarction

IV Heart Failure 81
17 Cardiovascular Hemodynamics 83
18 Mechanisms of Heart Failure 87
19 Clinical Manifestations and Treatment of
Heart Failure 0
20. Myocarditis o
21 "The Cardiomyopathies 9
Vi Archythmias 105
22 Mechanisms of Arrhythmogenesis, 107
23° Tachyarthythmias ur
24 Bradyarhythmiias (Bradycardia and
Heart Block) 117
25. Syncope 122
26 Sudden Cardiac Death 127
27° Pacemakers and Implantable Cardioverter
Defibrillators BI
VI Valvular Heart Disease 135

28 Rheumatic Fever BF
vit

vor

Ix

‘Blueprints in Cardiology | vik

29 Disorders of the Aortic Valve
30 Disorders of the Mitral Va

31 Infective Endocarditis
32 Prosthetic Heart Valves
Pericardial Diseases

33. Pericarditis

34 Cardise Tamponade

35. Constrietive Pericarditis

‘Vascular Di

36 Llypertension

37 Peripheral Arterial Disorders
38 Diseases of the Aorta

39 Carotid Arterial Disease

40 Deep Venous Thrombosis and Pulmonary
Embolie Disease

41 Pulmonary Ilypertension
Congenital Heart Disease
42 €

diac Shunts

genital C

43. Cyanotie Congenital Heart Disease

Other

44 Pregnancy and Cardiovascular Disease
45° Traumatic Heart Dis
46 Cardice Tumors

Questions
Answers

Index

M1
145
150
157
161
163
Preface

“Tacky malcal mainces are fased with the seemingly insurrwountable ash of
tering an ever-expanding boxy of knosfedge. Not only is the silent exacted £2
‘understand the pathophysiologial hess uf discasc, hur al to recognize the diverse
inthe clinial setting, letermine che approyste tests with which to fully ewabuste
the disease, inverpret she rests of these rests, ard apply all ofthis infurmasem «©
the development of an appropriate treasment plan. ‘These sills are then testes
both ar the hedside snd in a series of USMLE. exarinations.

While no stident car be expected! te know every aspect of maslicine, certain
fundamental principles must be identified and learned, This can be difcule given
the corrent state of inforragtion awverlaad. Tu we specialty ic this trer than in the
field of cardiology: The part covers de
vast aray of mercasingly more comples diayrastic modalities and the development
of innumerable phansavslegieal und non-pharuiacolugical Userepies. In iion,
a veritable tidal wave of clinical rials has been performed, aimee! ar derermining
the appropnte rs of these diggnostie and therapeutic options.

ln this new addition to the Elusprint series, we have attempted to cover the
core competencies in cardiology. We have discussed those skills that are essential
1 success in clinieakroterions Gnehuding key eariaesyrmproms ane! physical find
ing, 8 well asthe interpretation of cerdiae tests), and have cewered a broad array
cf cardiac diseeders that consistntly appear on the hoard examinations. Alchough
memorization of specific facts isan essential component ofthe leemning process,
‘ve serongly fe thar arrue understanding of disease requires knowledge uf disease
process, Throughout the text, we briefly review the pathophysiology of eardiac
tiseases and use this tev.ew a6 a guide to understanding the clinieal presentation
and treaement of these diseases

We hope thar yom find Blueprints ie Coils informative and useful. We
weloome feedhack and sipgestians yon may have abour this beok or any in the
lupin: cries. Send ta Bhebdeclscicem.

der have witnessed the introduction of a

rie IL Awery
Aajun Ve Gururg
‘Melanie Mayan
Michael W. Lang.
Benoy J. Zachariah
Joseph Losialeo
eee
imam aan

Acknowledgments

Th my wife, Sardhya Wahi-Curara, MD, MPHL, and mp parents for all their
support
AG.

Tomy wife Nina and daughter Reshini for their support ard patience while T was
working on this hook,

2,
“i [LALA. for keeping me on track and for undersanding when T wasn’. To 1.

for affoning me the opportunity. Te DL. tel MTS, for being consumeaate
mentors and wonderful fiends, and for always pushing, mie to “rise the bar”

AM,

T would like to thank che students and residents uf Boston Medies! Center, whose
cothusiasm for leaming wake teaching so enjoyable and projects such this
so rewarding, Te my co-audhers un editor: char you for your insight, expertise,
and eouuniuient (© dis project. Fnally, [would like eo e'ank any wife Kyle an
children Jake, Nicholas, and Zachary for their endless support, patience, and
encounigement,

iA
—

=
seuss Reviewers

Brian L. Dunfee
“Temple University
Chess of 202
Phitadetgh

Deborah Lam
Nexthwestern University
Chess of 2002

Evanston, Minos

Saced Sadeghi, MD

PCYS resident

epariment of Internal Mectcn

Keck School af Medicine at University of Southern Califcenia
University of Southern California Medical Center

Los Angeles, Califounia

. Pennsphania

Peadnys Mitron MD.
Toternal Medicine PGYL

‘Thomas Jefferson Universicy Hospital
Dhiba, Penasyhes