Internal Medicine EOR Cardiovascular Exam(Smarty PANCE)
What is stable angina? Predictable chest pain with exertion relieved by rest or nitroglycerin within 5
minutes - due to fixed coronary stenosis (>70%)
What are the classic characteristics of cardiac chest Substernal pressure/heaviness, radiation to jaw/left arm, provoked by
pain? exertion/cold/emotion, relieved by rest/nitroglycerin
What is the difference between stable and unstable Stable: predictable, exertional, relieved by rest; Unstable: new-onset, crescendo
angina? pattern, at rest (part of ACS)
What is Prinzmetal's (variant) angina? Coronary vasospasm causing angina at rest, typically at night, with transient ST
elevation - responds to calcium channel blockers
What is first-line treatment for stable angina? Antiplatelet therapy (aspirin), beta-blocker, sublingual nitroglycerin PRN, statin,
risk factor modification
What is the mechanism of action of nitroglycerin in Venodilation reduces preload, coronary vasodilation improves myocardial oxygen
angina? supply, decreases oxygen demand
When should coronary angiography be performed for High-risk features on stress test, refractory symptoms despite medical therapy, or
stable angina? Canadian Class III-IV angina
What diagnostic test is preferred for diagnosing stable Exercise stress ECG (first-line for intermediate pretest probability), or stress
angina in patients who can exercise? echo/nuclear if baseline ECG abnormal
CARDIAC ARRHYTHMIAS/CONDUCTION DISORDERS CARDIAC ARRHYTHMIAS/CONDUCTION DISORDERS
What is atrial fibrillation and its most dangerous Irregularly irregular rhythm with absent P waves - most dangerous complication
complication? is thromboembolic stroke
What is the CHA2DS2-VASc score used for? Risk stratification for stroke in atrial fibrillation to determine need for
anticoagulation (score ≥2 males, ≥3 females warrants anticoagulation)
What medications are used for rate control in atrial Beta-blockers (metoprolol), non-dihydropyridine calcium channel blockers
fibrillation? (diltiazem, verapamil), digoxin
What is the most common type of supraventricular Atrioventricular nodal reentrant tachycardia (AVNRT) - narrow complex regular
tachycardia (SVT)? tachycardia
What is the acute treatment for stable SVT? Vagal maneuvers first, then adenosine 6mg rapid IV push (12mg if no response),
followed by calcium channel blockers or beta-blockers
What ECG finding defines first-degree AV block? PR interval >200 ms (>5 small boxes) - benign, requires no treatment
What is the treatment for symptomatic third-degree Permanent pacemaker placement - medical emergency if hemodynamically
(complete) heart block? unstable
, Internal Medicine EOR Cardiovascular Exam(Smarty PANCE)
What is the definition of bradycardia and when does it Heart rate <60 bpm - only treat if symptomatic (hypotension, altered mental
require treatment? status, syncope, chest pain)
What is the characteristic ECG finding in atrial flutter? Sawtooth flutter waves (F waves) at rate 250-350 bpm, usually with 2:1 AV
conduction (ventricular rate ~150 bpm)
What defines wide-complex tachycardia and most QRS >120ms - assume ventricular tachycardia until proven otherwise (treat as
common cause? VT)
CARDIOMYOPATHY CARDIOMYOPATHY
What are the three main types of cardiomyopathy? Dilated (most common), Hypertrophic (most common genetic), Restrictive (least
common)
What is dilated cardiomyopathy and its most common Enlarged ventricles with systolic dysfunction (EF <40%) - causes: idiopathic,
causes? alcohol, viral myocarditis, chemotherapy
What is hypertrophic cardiomyopathy (HCM)? Asymmetric septal hypertrophy with LV outflow obstruction - most common cause
of sudden cardiac death in young athletes
What physical exam finding is characteristic of HCM? Harsh systolic crescendo-decrescendo murmur at LLSB that increases with
Valsalva and decreases with squatting
What is the treatment for hypertrophic cardiomyopathy? Beta-blockers or non-dihydropyridine CCBs, avoid dehydration/vasodilators, ICD
for high-risk patients
What is restrictive cardiomyopathy? Impaired ventricular filling due to rigid ventricles - causes: amyloidosis,
sarcoidosis, hemochromatosis, radiation
What ECG finding is classic for hypertrophic Left ventricular hypertrophy with deep Q waves in lateral leads (I, aVL, V5-V6)
cardiomyopathy?
CONGESTIVE HEART FAILURE CONGESTIVE HEART FAILURE
What is heart failure with reduced ejection fraction EF ≤40% with systolic dysfunction - treated with guideline-directed medical
(HFrEF)? therapy (GDMT)
What are the four pillars of GDMT for HFrEF? ACE inhibitor/ARB/ARNI, Beta-blocker, Mineralocorticoid receptor antagonist
(MRA), SGLT2 inhibitor
What are the classic symptoms of left-sided heart Pulmonary congestion, Orthopnea, Paroxysmal nocturnal dyspnea, Exertional
failure? Use mnemonic POPE dyspnea
What are the classic symptoms of right-sided heart Peripheral edema, jugular venous distension, hepatomegaly, ascites, weight gain
failure?
What is stable angina? Predictable chest pain with exertion relieved by rest or nitroglycerin within 5
minutes - due to fixed coronary stenosis (>70%)
What are the classic characteristics of cardiac chest Substernal pressure/heaviness, radiation to jaw/left arm, provoked by
pain? exertion/cold/emotion, relieved by rest/nitroglycerin
What is the difference between stable and unstable Stable: predictable, exertional, relieved by rest; Unstable: new-onset, crescendo
angina? pattern, at rest (part of ACS)
What is Prinzmetal's (variant) angina? Coronary vasospasm causing angina at rest, typically at night, with transient ST
elevation - responds to calcium channel blockers
What is first-line treatment for stable angina? Antiplatelet therapy (aspirin), beta-blocker, sublingual nitroglycerin PRN, statin,
risk factor modification
What is the mechanism of action of nitroglycerin in Venodilation reduces preload, coronary vasodilation improves myocardial oxygen
angina? supply, decreases oxygen demand
When should coronary angiography be performed for High-risk features on stress test, refractory symptoms despite medical therapy, or
stable angina? Canadian Class III-IV angina
What diagnostic test is preferred for diagnosing stable Exercise stress ECG (first-line for intermediate pretest probability), or stress
angina in patients who can exercise? echo/nuclear if baseline ECG abnormal
CARDIAC ARRHYTHMIAS/CONDUCTION DISORDERS CARDIAC ARRHYTHMIAS/CONDUCTION DISORDERS
What is atrial fibrillation and its most dangerous Irregularly irregular rhythm with absent P waves - most dangerous complication
complication? is thromboembolic stroke
What is the CHA2DS2-VASc score used for? Risk stratification for stroke in atrial fibrillation to determine need for
anticoagulation (score ≥2 males, ≥3 females warrants anticoagulation)
What medications are used for rate control in atrial Beta-blockers (metoprolol), non-dihydropyridine calcium channel blockers
fibrillation? (diltiazem, verapamil), digoxin
What is the most common type of supraventricular Atrioventricular nodal reentrant tachycardia (AVNRT) - narrow complex regular
tachycardia (SVT)? tachycardia
What is the acute treatment for stable SVT? Vagal maneuvers first, then adenosine 6mg rapid IV push (12mg if no response),
followed by calcium channel blockers or beta-blockers
What ECG finding defines first-degree AV block? PR interval >200 ms (>5 small boxes) - benign, requires no treatment
What is the treatment for symptomatic third-degree Permanent pacemaker placement - medical emergency if hemodynamically
(complete) heart block? unstable
, Internal Medicine EOR Cardiovascular Exam(Smarty PANCE)
What is the definition of bradycardia and when does it Heart rate <60 bpm - only treat if symptomatic (hypotension, altered mental
require treatment? status, syncope, chest pain)
What is the characteristic ECG finding in atrial flutter? Sawtooth flutter waves (F waves) at rate 250-350 bpm, usually with 2:1 AV
conduction (ventricular rate ~150 bpm)
What defines wide-complex tachycardia and most QRS >120ms - assume ventricular tachycardia until proven otherwise (treat as
common cause? VT)
CARDIOMYOPATHY CARDIOMYOPATHY
What are the three main types of cardiomyopathy? Dilated (most common), Hypertrophic (most common genetic), Restrictive (least
common)
What is dilated cardiomyopathy and its most common Enlarged ventricles with systolic dysfunction (EF <40%) - causes: idiopathic,
causes? alcohol, viral myocarditis, chemotherapy
What is hypertrophic cardiomyopathy (HCM)? Asymmetric septal hypertrophy with LV outflow obstruction - most common cause
of sudden cardiac death in young athletes
What physical exam finding is characteristic of HCM? Harsh systolic crescendo-decrescendo murmur at LLSB that increases with
Valsalva and decreases with squatting
What is the treatment for hypertrophic cardiomyopathy? Beta-blockers or non-dihydropyridine CCBs, avoid dehydration/vasodilators, ICD
for high-risk patients
What is restrictive cardiomyopathy? Impaired ventricular filling due to rigid ventricles - causes: amyloidosis,
sarcoidosis, hemochromatosis, radiation
What ECG finding is classic for hypertrophic Left ventricular hypertrophy with deep Q waves in lateral leads (I, aVL, V5-V6)
cardiomyopathy?
CONGESTIVE HEART FAILURE CONGESTIVE HEART FAILURE
What is heart failure with reduced ejection fraction EF ≤40% with systolic dysfunction - treated with guideline-directed medical
(HFrEF)? therapy (GDMT)
What are the four pillars of GDMT for HFrEF? ACE inhibitor/ARB/ARNI, Beta-blocker, Mineralocorticoid receptor antagonist
(MRA), SGLT2 inhibitor
What are the classic symptoms of left-sided heart Pulmonary congestion, Orthopnea, Paroxysmal nocturnal dyspnea, Exertional
failure? Use mnemonic POPE dyspnea
What are the classic symptoms of right-sided heart Peripheral edema, jugular venous distension, hepatomegaly, ascites, weight gain
failure?
