Medicine Shelf Prep!

Aortic regurgitation causes blood to leak backward from the aorta into the left ventricle during diastole.

In this episode, Chris and Mars review:

• Chronic versus acute aortic regurgitation
• Volume overload and eccentric hypertrophy
• The classic decrescendo diastolic murmur
• Wide pulse pressure and water-hammer pulses
• Austin Flint murmur
• Echocardiographic diagnosis
• When severe chronic AR requires surgery
• Aortic dissection and infective endocarditis as causes of acute AR
• Why acute severe AR can rapidly cause pulmonary edema and cardiogenic shock

Medicine Shelf Prep is sponsored by Scrub Battle.

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Mitral stenosis is obstruction of blood flow across the mitral valve, most commonly due to rheumatic heart disease.

In this episode, Chris and Mars review:

• Opening snap and the classic apical diastolic rumble
• Left atrial enlargement and pulmonary congestion
• Pulmonary hypertension and right-sided heart failure
• Why atrial fibrillation can rapidly worsen symptoms
• Stroke and systemic embolic risk
• Echocardiographic diagnosis
• Warfarin for atrial fibrillation with rheumatic mitral stenosis
• When percutaneous balloon mitral commissurotomy is preferred
• Why severe disease becomes especially important during pregnancy

Medicine Shelf Prep is sponsored by Scrub Battle.

Download Scrub Battle: CK in the iOS App Store for five new high-yield clinical questions every day.

Use promo code MEDICINE1 for your first month free. Introductory offer limited to the first 500 users.

Aortic stenosis is a fixed obstruction of left ventricular outflow caused by narrowing of the aortic valve.

In this episode, Chris and Mars review:

• Calcific and bicuspid aortic stenosis
• The classic murmur and carotid radiation
• Pulsus parvus et tardus
• Why severe disease causes dyspnea, angina, and exertional syncope
• Echo criteria for severe aortic stenosis
• Aortic stenosis versus hypertrophic cardiomyopathy
• When aortic valve replacement is indicated
• Surgical versus transcatheter valve replacement
• Heyde syndrome

Episode pearl: Severe aortic stenosis plus symptoms means the patient needs valve replacement—not simply more medical therapy.

Medicine Shelf Prep is sponsored by Scrub Battle.

Download Scrub Battle: CK in the iOS App Store for five new high-yield clinical questions every day.

Use promo code MEDICINE1 for your first month free. Introductory offer limited to the first 500 users.

Constrictive pericarditis occurs when a rigid, scarred pericardium prevents normal ventricular filling, producing predominantly right-sided heart failure despite preserved systolic function.

In this episode, Chris and Mars review:

• Kussmaul sign, rapid y descent, and the pericardial knock
• Common causes including cardiac surgery, prior pericarditis, radiation, and tuberculosis
• Septal bounce and ventricular interdependence
• Constrictive pericarditis versus restrictive cardiomyopathy
• Echocardiography, cardiac C T, M R I, and invasive hemodynamics
• Diuretics for congestion
• Transient inflammatory constriction
• Pericardiectomy as definitive treatment for chronic symptomatic disease

Episode pearl: Restrictive cardiomyopathy is a stiff myocardium. Constrictive pericarditis is a heart trapped inside a stiff pericardium.

Medicine Shelf Prep is sponsored by Scrub Battle.

Download Scrub Battle: CK in the iOS App Store for five new high-yield clinical questions every day.

Use promo code MEDICINE1 for your first month free. Introductory offer limited to the first 500 users.

Cardiac tamponade is a life-threatening form of obstructive shock caused by pericardial pressure preventing normal cardiac filling.

In this episode, Chris and Mars review:

• The physiology of impaired diastolic filling
• Why rapid fluid accumulation is especially dangerous
• Beck triad and why all three findings are not required
• Pulsus paradoxus
• Electrical alternans
• Echocardiographic right atrial and right ventricular collapse
• Pericardial effusion versus true tamponade
• Intravenous fluids as temporary support
• When urgent pericardiocentesis or surgical drainage is required
• Why tamponade can cause pulseless electrical activity arrest

Episode pearl: Tamponade is not defined by how much fluid surrounds the heart. It is defined by whether that fluid is preventing the heart from filling.

Medicine Shelf Prep is sponsored by Scrub Battle.

Download Scrub Battle: CK in the iOS App Store for five new high-yield clinical questions every day.

Use promo code MEDICINE1 for your first month free. Introductory offer limited to the first 500 users.

Pericardial effusion is an abnormal accumulation of fluid around the heart. The critical question is whether that fluid is causing cardiac tamponade and impaired ventricular filling.

In this episode, Chris and Mars review:

• Major causes of pericardial effusion
• Why the rate of fluid accumulation matters
• Low-voltage E C G and electrical alternans
• Echocardiographic diagnosis
• Right atrial and right ventricular collapse
• Pericardial effusion versus cardiac tamponade
• When observation is appropriate
• When pericardiocentesis or surgical drainage is required

Episode pearl: The size of an effusion alone does not determine its danger. A rapidly accumulating small effusion can cause tamponade while a slowly developing large effusion may remain stable.

Medicine Shelf Prep is sponsored by Scrub Battle.

Download Scrub Battle: CK in the iOS App Store for five new high-yield clinical questions every day.

Use promo code MEDICINE1 for your first month free. Introductory offer limited to the first 500 users.

Dressler syndrome is a delayed, immune-mediated pericarditis that occurs after myocardial infarction, usually weeks after the initial cardiac injury.

In this episode, Chris and Mars review:

• Dressler syndrome versus early post-MI pericarditis
• Why timing is the key shelf clue
• Positional pleuritic chest pain, friction rub, fever, and pericardial effusion
• How to distinguish pericarditis from recurrent myocardial ischemia
• Why aspirin is preferred after myocardial infarction
• The role of colchicine
• Pericardial effusion, tamponade, recurrence, and constrictive pericarditis

Episode pearl: Pericarditis within days of an MI is usually local inflammation. Pericarditis several weeks later suggests the immune-mediated process of Dressler syndrome.

Medicine Shelf Prep is sponsored by Scrub Battle.

Download Scrub Battle: CK in the iOS App Store for five new high-yield clinical questions every day.

Use promo code MEDICINE1 for your first month free. Introductory offer limited to the first 500 users.

Acute pericarditis is inflammation of the pericardium classically presenting with sharp, pleuritic chest pain that improves when sitting forward.

In this episode, Chris and Mars review:

• Classic positional chest pain and the pericardial friction rub
• Diffuse ST elevation and P R depression
• The four diagnostic criteria for acute pericarditis
• How to distinguish pericarditis from STEMI and myocarditis
• First-line treatment with aspirin or an NSAID plus colchicine
• Uremic and post-MI pericarditis
• High-risk features that warrant hospitalization
• Pericardial effusion, cardiac tamponade, and recurrent pericarditis

Episode pearl: Diffuse ST elevation plus positional pleuritic chest pain should make you think acute pericarditis—then look for an effusion and signs of tamponade.

Medicine Shelf Prep is sponsored by Scrub Battle.

Download Scrub Battle: CK in the iOS App Store for five new high-yield clinical questions every day.

Use promo code MEDICINE1 for your first month free. Introductory offer limited to the first 500 users.

Myocarditis is inflammation of the heart muscle that can present with chest pain, heart failure, arrhythmias, or cardiogenic shock.

In this episode, Chris and Mars review:

• The classic post-viral presentation
• Why myocarditis can mimic myocardial infarction
• Troponin, E C G, echocardiography, and cardiac M R I findings
• Myocarditis versus pericarditis
• When endomyocardial biopsy is indicated
• Fulminant and giant-cell myocarditis
• Heart-failure and arrhythmia management
• Exercise restriction and return to activity
• Dilated cardiomyopathy and sudden cardiac death as important complications

Episode pearl: Elevated troponin means myocardial injury—not necessarily myocardial infarction. In the right clinical setting, think myocarditis.

Medicine Shelf Prep is sponsored by Scrub Battle.

Download Scrub Battle: CK in the iOS App Store for five new high-yield clinical questions every day.

Use promo code MEDICINE1 for your first month free. Introductory offer limited to the first 500 users.

Restrictive cardiomyopathy is a diastolic heart failure syndrome caused by stiff, noncompliant ventricles that cannot fill normally.

In this episode, Chris and Mars review:

The classic *big atria, small ventricles** pattern

* Amyloidosis, sarcoidosis, hemochromatosis, and other major causes

* Kussmaul sign and right-sided heart failure findings

* How to distinguish restrictive cardiomyopathy from constrictive pericarditis

* Echocardiography and cardiac M R I

* Why diuresis must be used cautiously

* Cause-specific treatment including tafamidis, plasma-cell therapy, immunosuppression, and iron reduction

Episode pearl: Restrictive cardiomyopathy is a myocardial filling problem. When you see biatrial enlargement with nondilated ventricles and preserved systolic function, think restriction—and then determine the cause.

Medicine Shelf Prep is sponsored by Scrub Battle.

Download Scrub Battle: CK in the iOS App Store for five new high-yield clinical questions every day.

Use promo code MEDICINE1 for your first month free. Introductory offer limited to the first 500 users.