1. Cardiology ABIM Review

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

3. Arrhythmias

4. Atrial Fibrillation

6. NASPE 2003 Consensus Paper

7. AF: Etiology ACC 2006 Guidelines

8. AF: Diagnosis ACC 2006 Guidelines

9. AF: Diagnosis ACC 2006 Guidelines

10. AF: Rate vs. Rhythm Control

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

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

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

14. AF: Stroke Prevention

17. Supraventricular Tachycardias

18. ACC 2003 Guidelines

21. AVNRT

22. Atrial Tachycardia

23. Atrial Flutter

24. ACC 2003 Guidelines

27. Ventricular Arrhythmias

28. 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

29. Nonsustained Monomorphic VT

30. Nonsustained Polymorphic VT

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

32. VF with Defibrillation (12-lead ECG)

33. 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

34. 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

35. 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

36. 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 Therapies for VA

37. 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 Therapies for VA

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

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

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

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

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

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

44. Syncope

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

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

47. ACC 2006 Scientific Statement

48. Bradyarrhythmias

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

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

51. Mangrum J and DiMarco J. N Engl J Med 2000;342:703-709 Electrocardiographic Findings Associated with Atrioventricular-Conduction Disturbances

52. Devices

53. Tonino W and Winter J. N Engl J Med 2006;354:956 A 55-year-old woman received a diagnosis of the sick sinus syndrome

54. PPM: Indications ACC 2008 Guidelines

55. PPM: Indications ACC 2008 Guidelines

56. Jarcho J. N Engl J Med 2006;355:288-294 The Cardiac Conduction System and Biventricular Pacing

57. CRT: Indications ACC 2008 Guidelines

58. DiMarco J. N Engl J Med 2003;349:1836-1847 Diagram of a Single-Chamber Implantable Cardioverter-Defibrillator System

59. ICD: Indications ACC 2008 Guidelines

60. Heart Failure

61. ACC 2005 Guidelines HF: Definition

62. ACC 2005 Guidelines HF: Staging System

63. ACC 2005 Guidelines

64. ACC 2009 Focused Update HF: Diagnosis

65. ACC 2009 Focused Update HF: Diagnosis

66. ACC 2005 Guidelines HF: Treatment

67. ACC 2005 Guidelines HF: Treatment

68. ACC 2005 Guidelines HF with Preserved LVSF

69. ACC 2005 Guidelines HF with Preserved LVSF

70. ACC 2009 Focused Update Acute Decompensated HF

71. ACC 2009 Focused Update

74. Pericardial Disease

76. Acute Pericarditis

77. Lange R and Hillis L. N Engl J Med 2004;351:2195-2202 Tests and Treatments for Various Causes of Acute Pericarditis

79. Lange R and Hillis L. N Engl J Med 2004;351:2195-2202 Large Pericardial Effusion

80. Nardell E et al. N Engl J Med 2004;351:279-287 Echocardiographic Features of Tamponade

83. Yurchak P and Deshpande V. N Engl J Med 2003;348:243-249 Simultaneous Left (Yellow) and Right (Green) Ventricular Pressure Tracings Showing the Square-Root Sign

84. Aortic Disease

85. Aortic Dissection ESC 2001 Task Force Report

86. Aortic Dissection ESC 2001 Task Force Report

88. Aortic Dissection ESC 2001 Task Force Report

89. Aortic Dissection ESC 2001 Task Force Report

90. Aortic Dissection 2001 ESC Task Force Report

91. Aortic Dissection ESC 2001 Task Force Report

92. Aortic Dissection ESC 2001 Task Force Report

93. ACC 2005 Guidelines Abdominal Aortic Aneurysm (AAA)

94. AAA ACC 2005 Guidelines

95. AAA

96. ACC 2005 Guidelines AAA

97. ACC 2005 Guidelines AAA

98. Cardiomyopathies

99. AHA 2005 Scientific Statement

100. 2005 AHA Scientific Statement

101. Hypertrophic Cardiomyopathy (HCM) Typically diagnosed by 2-D echo –LV wall thickness ≥ 15 mm –Asymmetric septal hypertrophy (ASH) –Anterior septal motion of mitral valve (SAM)

102. HCM LV outflow tract (LVOT) obstruction diagnosed using Doppler echo –LVOT pressure gradient (PG)  30 mmHg at rest = “obstructive” –LVOT PG < 30 mmHg at rest but  30 mmHg with provocation (Valsalva) = “latent” –LVOT PG < 30 mmHg at rest and with provocation = “nonobstructive”

103. Nishimura R and Holmes D. N Engl J Med 2004;350:1320-1327 Two-Dimensional Echocardiogram from a Patient with Obstructive Hypertrophic Cardiomyopathy

104. ACC 2003 Expert Consensus Document

107. Nishimura R and Holmes D. N Engl J Med 2004;350:1320-1327 Schematic Diagram of a Patient Undergoing Surgical Septal Myectomy

108. ACC 2003 Expert Consensus Document

109. ACC 2006 VA & SCD Guidelines

110. Circulation 2006; 113: 1622-1632