FUNDAMENTALS OF CARDIOLOGY A CONCISE REVIEW BOOK FOR THE USMLE STEP 1-2-3 AND GENERAL MED PRACTITIONERS AUTHOR CHIRAG NAVADIA, MD WWW.MEDRX22.COM TABLE OF CONTENTS CHAPTER 1 - EMBRYOLOGY OF HEART Vascular Development Fetal Circulation Septation of Heart Tube CHAPTER 2 - ANATOMY Mediastinum Internal Structures External Structures Cardiac Territories Cardiac Projection Cardiac Muscle fibre Conduction Pathway Coronary Arteries CHAPTER 3 - PHYSIOLOGY Concepts of Preload, Ejection Fraction & Cardiac Output Concepts of Velocity, Area, Resistance and Flow Auto-Regulation of Blood Flow Resistance In Series And Parallel Circuits Blood Pressure Compliance and Elasticity of Vessels Relationship Between Contractility & Preload Action Potential Normal ECG Autoregulation of Blood Pressure Baroreceptor reflex Renin-Angiotension-Aldosterone System Phases of Cardiac Cycle Valvular Problems and Pressure-Volume Loops Ventricular Pressure Testing Heart sounds Murmurs Effect of Posture, Amyl Nitrate & Arterioconstriction on Murmurs Jugular venous pressure CHAPTER 4 – ARTERIAL PATHOLOGY Hypertension Hypertension in Pregnancy Hypertensive Crisis Arteriosclerosis Monckeberg arteriosclerosis Arteriolosclerosis Atherosclerosis Aneurysms Aortic Dissection Coarctation of Aorta Vasculitis Raynaud Phenomenon Tumors CHAPTER 5 – VENOUS PATHOLOGY Venous System of Leg Varicose Veins Deep Venous Thrombosis Superficial Thrombophlebitis Leg Ulcers CHAPTER 6 - CARDIAC PATHOLOGY Ischemic Heart Disease Cardiac Arrest vs Respiratory Arrest Cardiopulmonary Resuscitation Broken Heart Syndrome Heart Failure Left Heart Failure Right Heart Failure High Output Heart Failure Cardiomyopathy Dilated Cardiomyopathy Restrictive Cardiomyopathy Hypertrophic cardiomyopathy Arrhythmogenic Right Ventricular Cardiomyopathy Peripartum Cardiomyopathy Circulatory Shock Myocarditis Pericarditis Constrictive Pericarditis Cardiac Tamponade Valvular Pathology Infective Endocarditis Aortic stenosis Aortic regurgitation Rheumatic Heart Disease Mitral Stenosis Mitral Regurgitation Tricuspid Regurgitation Tricuspid Stenosis Pulmonary Stenosis and Regurgitation CHAPTER 7 - CONGENITAL HEART DISEASE Acyanotic condition Atrial Septal Defect Ventricular Septal Defects Patent Ductus Arteriosus Cyanotic conditions Tetralogy of Fallot Transposition of the great vessels Tricuspid atresia Valvular Defects Coronary Artery Abnormalities Other Congenital Cardiac Pathology CHAPTER 8 - ARRHYTHMIAS Narrow QRS Complex Wide QRS Complex Torsade-de-Pointes Sinus Tachycardia Wolf Parkinson White Syndrome Focal Junctional Tachycardia Multifocal Atrial Tachycardia Premature Atrial Contractions Heart Blocks First Degree AV Block Second Degree AV Block (Mobitz Type 1) Second Degree AV Block (Mobitz Type 2) rd 3 Degree AV Block SA BLOCK Right & Left Bundle Branch Blocks Brugada syndrome CHAPTER 9 – CARDIAC TUMORS Benign tumors Malignant Tumors CHAPTER 10 - CARDIAC PHARMACOLOGY Antiarrhythmic drugs Antihypertensive drugs Antihyperlipidemic drugs Anticoagulants Non Pharmacological Treatments INTRODUCTION Hello dear friends, This is your boy “Chirag Navadia” and I am extremely delighted to present this comprehensive clinical review book of “Cardiology” for the USMLE and all general med practitioners. This book mainly focuses on fundamental clinical concepts of “USMLE step 1-2-3” and “ABIM” exam, that serve as a nidus for your future clinical practice. Book begins with basic “Step 1” concept of anatomy and physiology that will be helpful to any new learner. Students appearing for Step 1 or NCLEX or other basic exams can skip the investigation and management topics from pathology section. After reviewing preclinical stuffs, there is a brief description of “cardiovascular medicine” that systematically describes cause, mechanism, clinical association, investigation of choice and primary managements that will play a vital role for your Step 2-3, IM/FM board exam prep or day- to-day practice. Most of the investigation and managements are referred and shortened in 1-2 lines from reputed cardiology resources like AHA, AMA, Medscape, JACC, NCBI, Pubmed and so on. As this book is not for cardiologist, all contents are selected accordingly to make this book an easy learning guide for med students, interns, nurse practitioners and physician assistants. Meanwhile, you can also read related contents via our “THUNDERNOTES” that are present at the end of particular topic. At the end, I had provided short summary of “Step 1” cardiac pharmacology that describes each drug with its mechanism and common side effects. I want you to end this book with smiling face � . In case, if you don’t like this book or the content you wanted to review is not covered in this book, I am ready to refund your full purchase price as a part of 14-day full money back guarantee. If you can give me your two minutes, please leave 4-5 stars rating on amazon. Best wishes for your brilliant future Sincerely, CHIRAG NAVADIA, MD IMPORTANT NOTICE All printed and/or digital content is for educational and/or learning use only. MEDRX is not responsible for the use of any knowledge, information or facts gained from the printed and/or digital content in the practice of medicine, medical research or any related medical or science applications. In addition, while materials available in this book may be useful for medical coursework examinations and qualifying examinations such as the NCLEX™, USMLE™ and ABIM™, you understand that MEDRX is not affiliated with any other third party and does not (directly or by implication) make any guarantees that the materials provided by us will be tested on these examinations. I worked hard for more than 2800 hours on this book to provide most recent information/managements. 95% of the investigations and management mentioned in this book are from year 2010-2014, however you realize that errors can occur and thus managements mentioned in this book should not be directly use in clinical practice without any guidance. We are not responsible for any harm done to anybody by the managements mentioned in this book. Finally, we want to hear what you would like to improve in our book? This will help us to create even better subsequent editions. If you can give your 2 minutes, please leave us 4-5 star feedback on amazon. If you even think about 1-3 stars, please contact us through our website & we will consider to refund you your full purchase price (book must be purchased from our website or amazon.com official store (not valid on purchases from amazon private sellers or other places). TO THE PUBLISHERS - Certain images were freely available on internet and we had adapted some of them with full credits. Most of the images are taken with permission, however we were unable to reach at all places or don’t know the real owner in few cases. If anybody have any objection for the image use in this book, feel free to contact us through our website and that particular image will be removed immediately. SPEACIAL THANKS To my, Family – for being with me all the time Friends (Zafar, Talli, Chintu, Lesya, Ira, Pasha and others) – for not allowing me to get into depression College professors – for being so strict with me � that encouraged me to study hard Dr. Satani and Dr. Reiyani – for giving me wonderful guidance and motivation for my board exams Dr. Patel and Dr. Prajapati – for giving me wonderful clinical experience Tutors of Kaplan Medical, First Aid Team, Dr. Fischer, and Dr. Goljan – for being an extraordinary tutors in my journey of medicine. Printed in the United States of America Print number: 0 9 8 7 6 5 4 3 2 1 MSRP: $40.00 All Rights Reserved © 2015 Chirag Navadia Certain images were freely available on Internet & belong to their owner. No part of this book may be reproduced in any form by photography, microfilms, xerography or any other mean, or incorporated into any information retrieval system, electronic or mechanical, without the written permission of Chirag Navadia.