Every student should take an advanced cardiac life support (ACLS) class before their sub-internship / externship. Although you may find that by the time you arrive at a code there are already approximately 302934 people there, you should know your algorithms and understand the logic of the person running the code...one day it could be you. Below are links to the ACLS algorithms based on the most recent American Heart Association (AHA) guidelines.
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Cardiology was a great course at Penn. With a well organized course and some helpful resources, you can master the ECG (EKG), understand the electrical and mechanical physiology and gain a basic understanding of the pathophysiology of cardiac disease.
- An excellent readable compliment to your course.
- Basically the title says it all.
- Another great EKG source, take your pick.Go: Home
SHELF / USMLE Step 2 Practice Questions > Internal Medicine > Cardiology
85 Case based vignette style practice questions from the American College of Physicians (ACP) with answers & thorough explanations - DOWNLOAD the .pdf
Want more great practice questions for the Medicine Shelf Exam? Go with MKSAP for Students 3 
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Med-Spot 6.24.07: Guidelines for Cardiac Clearance for Non-Cardiac Surgery
Case Scenario:
R.J. is a 76-year-old man who is scheduled for a right hip arthroplasty in two weeks. He presents at the request of his orthopedic surgeon for a medical consultation before surgery. He had an inferior MI one year ago for which he received antithrombolytic therapy with complete resolution of his symptoms. He has never smoked, has no history of cerebrovascular disease or diabetes, has a normal ejection fraction, and normal renal function. R.J. usually walks one to two miles in the morning, but his function has been severely limited over the past two months because of hip pain. He is taking hydrochlorothiazide (Esidrix) and simvastatin (Zocor). Although his primary care physician prescribed a beta blocker after his MI, R.J. stopped taking it after a bout of bronchitis two weeks ago. He is asymptomatic from a cardiac and respiratory standpoint. His vital signs are normal except for a blood pressure of 157/92 mm Hg. His physical examination is within normal limits, and electrocardiography demonstrates Q waves inferiorly. Should he undergo cardiovascular stress testing before surgery, and is he a candidate for perioperative beta blockade or other medical therapy?
To answer this question use the figure below referring to the 2 tables below the figure when necessary (see end of post for answer).
| TABLE 1: Clinical Predictors of Increased Perioperative Cardiovascular Risk | ||
| Major Unstable coronary syndromes Acute or recent* MI with evidence of important ischemic risk by clinical symptoms or noninvasive study Unstable or severe† angina (Canadian class III or IV‡) Decompensated heart failure Significant arrhythmias High-grade atrioventricular block Symptomatic ventricular arrhythmias in the presence of underlying heart disease Supraventricular arrhythmias with uncontrolled ventricular rate | Intermediate Mild angina pectoris (Canadian class I or II‡) Previous MI by history or pathologic Q waves Compensated or prior heart failure Diabetes mellitus (particularly insulin-dependent) Renal insufficiency | Minor Advanced age (older than 75 years) Abnormal electrocardiography results (e.g., left ventricular hypertrophy, left bundle branch block, ST-T abnormalities) Rhythm other than sinus (e.g., atrial fibrillation) Low functional capacity (e.g., inability to climb one flight of stairs with a bag of groceries) History of stroke Uncontrolled systemic hypertension |
Table 2: Cardiac Risk Stratification for Noncardiac Surgical Procedures |
| High (reported cardiac risk often >5 percent) |
| Emergent major operations, particularly in patients older than 75 years |
| Aortic and other major vascular surgery |
| Peripheral vascular surgery |
| Anticipated prolonged surgical procedure associated with large fluid shifts and/or blood loss |
| Intermediate (reported cardiac risk generally 1 to 5 percent) |
| Carotid endarterectomy |
| Head and neck surgery |
| Intraperitoneal and intrathoracic surgery |
| Orthopedic surgery |
| Prostate surgery |
| Low† (reported cardiac risk generally <1> |
| Endoscopic procedures |
| Superficial procedures |
| Cataract surgery |
| Breast surgery |
Resolution of the Case:
Hip arthroplasty is an intermediate-risk surgery. Based on the Lee revised cardiac risk index (Table 3),11 the patient in the case scenario receives 1 point for CAD, putting him at low risk. Because his functional status was good before his recent hip problems and he is having no cardiovascular symptoms, after referring to Figure 12 and considering the results of the CARP study, the physician decides in collaboration with the patient that cardiovascular stress testing is not necessary. Because he was taking beta blockers before his recent illness and should remain on them because of his CAD whether or not he is having surgery, the physician chooses to resume them. However, the patient would not otherwise be a candidate for beta blockade. Continuing statin therapy would neither harm nor benefit him for his current surgery.
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Med-Spot on Med-Source 6.13.07 - Differential Diagnosis: Chest Pain, the Quick & Dirty
Because half of your service will be ROMIs you should commit this list to memorization ... or at least keep it handy.
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SHELF / USMLE Step 2 Practice Questions > Internal Medicine > Cardiology
Q1) A 54 y/o male is discharged from the hospital 3 days after undergoing stenting of the left anterior descending coronary artery for acute coronary syndrome. Serum cholesterol was high on admission. Telemetry showed frequent PVCs w. occasional couplets. At discharge, he is asymptomatic, and left ventricular function, bp & plasma glucose levels are normal. The patient went home on clopidogrel, aspirin, metoprolol & symvastatin. Which of the following meds would likely prevent future cardiac events?
a) folic acid
b) vit. E
c) ramipril
d) isosorbide mono
a) metoprolol
b) colchicine
c) predisone
d) indomethacin
e) reteplase
a) bicuspid aortic valve w. mild to mod. stenosis
b) congenitally abnl. pulm. valve w. mod stenosis
c) physiologic murmur of pregnancy
d) mitral valve regurg. related to mitral valve prolapse
e) bicuspid aortic valve w. mod. regurgitation.
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Med-Spot 4.20.07
Open heart surgery may soon be performed on the beating heart without the need for bypass, or human hands for that matter. Researchers at Carnegie Mellon have developed a robot that is able to crawl over the surface of the beating heart in vivo and inject dye, place pace makers and perform other minor surgeries. So far the robot, named HeartLander, has successfully been used in porcine operations. If all goes well, scientists hope to see HeartLander touch down in humans around 2013.
See the HeartLander research page here.
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Med-Spot - 5.11.07: ipods & pacemakers
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