Changes

* Systolic Dysfunction/HFrEF

* Systolic Dysfunction/HFrEF

** H&P: History of CAD, hypertension, valvular disease, dilated cardiomyopathy (EtOH, Chagas, Coxsackie B), or MI. '''Dyspnea (most sensitive)''', PND, orthopnea, cough, hemoptysis, fatigue; '''S3 (most specific)''', displaced PMI, crackles, signs of right heart failure (S4, JVD, edema)

** H&P: History of CAD, hypertension, valvular disease, dilated cardiomyopathy (EtOH, Chagas, Coxsackie B), or MI. '''Dyspnea (most sensitive)''', PND, orthopnea, cough, hemoptysis, fatigue; '''S3 (most specific)''', displaced PMI, crackles, signs of right heart failure (S4, JVD, edema)

** Dx: LVEF < 40%, enlarged cardiomediastinal silhouette on CXR, elevated BNP

** Dx: Clinical. Supported by TTE (LVEF < 40%), CXR (enlarged cardiomediastinal silhouette on CXR), and labs (elevated BNP)

** Tx: ACEI/ARBs, ARNIs, β blockers, SGLT2 inhibitors, Spironolactone, and LVAD all have mortality benefit; Digoxin and diuretics don't have any mortality benefit but help with symptoms and decrease hospitalizations. For acute exacerbations use LMNOP (lasix, morphine, '''nitrates''', oxygen, positioning).

** Tx: ACEI/ARBs, ARNIs, β blockers, SGLT2 inhibitors, Spironolactone, and LVAD all have mortality benefit; Digoxin and diuretics don't have any mortality benefit but help with symptoms and decrease hospitalizations. For acute exacerbations use LMNOP (lasix, morphine, '''nitrates''', oxygen, positioning).

* Non-systolic Dysfunction/HFpEF

* Non-systolic Dysfunction/HFpEF

==Unstable Angina/NSTEMI==

==Unstable Angina/NSTEMI==

*Tx: NSTEMI with '''high risk features (refractory pain, TIMI score ≥ 3)''' should get PCI. '''No role for thrombolytic therapy in NSTEMI'''

*Tx: NSTEMI with '''high risk features (refractory pain, TIMI score ≥ 3)''' should get PCI. '''No role for thrombolytic therapy in NSTEMI'''

** MONA BAsH—'''morphine/metoclopramide (for pain/nausea), oxygen (if SpO2 <95%/breathless), nitrates, ASA, β-blockers (''if LVEF < 40%, HTN, tachycardic''), Antiplatelet (if doing angioplasty/stenting, prasugrel or ticagrelor are preferred agents), (spironolactone?), Heparin (LMWH)'''.  

** MONA BAsH—'''morphine/metoclopramide (for pain/nausea), oxygen (if SpO2 <95%/breathless), nitrates, ASA, β-blockers (''if LVEF < 40%, HTN, tachycardic, no heart failure''), Antiplatelet (if doing angioplasty/stenting, prasugrel or ticagrelor are preferred agents), (spironolactone?), Heparin (LMWH)'''.  

** Send home on 12 months DAPT (if stending/angioplasty performed), ACEI/ARB, and statin.

** Send home on 12 months DAPT (if stending/angioplasty performed), ACEI/ARB, and statin.

! Group !! Intervention

! Group !! Intervention

|-

|-

| 21+ w/ ASCVD or LDL > 190 || High dose statin

| 21+ '''w/ ASCVD''' or LDL > 190 || High dose statin

|-

|-

| 40+ w/ LDL 70-189 w/o diabetes || Calculate 10-yr ASCVD risk:  

| 40+ w/ LDL 70-189 w/o diabetes || Calculate 10-yr ASCVD risk:  

*H&P: Possible history of recent MI, improved when leaning forward, can have pleuritic chest pain, cardiac rub

*H&P: Possible history of recent MI, improved when leaning forward, can have pleuritic chest pain, cardiac rub

*Dx: Can show calcifications on CXR

*Dx: Can show calcifications on CXR

*Tx: '''High-dose aspirin for post-MI acute pericarditis, otherwise NSAIDs and colchicine for normal pericarditis'''.  

*Tx: '''High-dose aspirin''' for post-MI acute pericarditis, otherwise '''NSAIDs and colchicine''' for normal pericarditis.

 

==[[Cardiac Tamponade]]==  

==[[Cardiac Tamponade]]==  

*H&P: Beck's triad

*H&P: Beck's triad