Acute decompensated heart failure is a high-yield medicine shelf emergency where management depends on two key questions: Is the patient congested, and is the patient adequately perfusing?

In this episode, Chris and Mars review:

• Classic signs of pulmonary and systemic congestion
• Intravenous loop diuretics for volume overload
• Nitrates and noninvasive positive pressure ventilation in hypertensive pulmonary edema
• How to recognize cardiogenic shock
• Why norepinephrine is the preferred first-line vasopressor in hypotensive cardiogenic shock
• When to add an inotrope such as dobutamine or milrinone
• Cardiorenal syndrome and why a rising creatinine does not always mean diuresis should stop
• Common triggers for acute heart failure decompensation

Episode pearl: Congested but perfusing? Decongest. Hypotensive with end-organ hypoperfusion? Think cardiogenic shock.

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, immediate answers and explanations, and daily individual and medical school leaderboards.

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

ST-elevation myocardial infarction, or STEMI, is an acute coronary emergency caused by coronary plaque rupture and thrombotic occlusion leading to transmural myocardial ischemia. The key is rapid recognition and immediate reperfusion.

In this episode, Chris and Mars review:

• Classic STEMI presentation and important atypical symptoms
• How to localize infarction using the E C G
• Why treatment should not wait for troponin or echocardiography
• Emergency reperfusion with percutaneous coronary intervention
• When fibrinolytic therapy may be considered
• Antiplatelet therapy, anticoagulation, statins, and nitroglycerin
• Recognition and management of right ventricular infarction
• Why nitrates can be dangerous in preload-dependent right ventricular infarction
• Major post-MI complications, including ventricular arrhythmias, papillary muscle rupture, interventricular septal rupture, and left ventricular free wall rupture

Episode pearl: In a clear STEMI, do not let additional testing delay reperfusion. Opening the occluded coronary artery is the priority.

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, immediate answers and explanations, and daily individual and medical school leaderboards.

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

Chronic heart failure with reduced ejection fraction, or HFrEF, is a form of systolic heart failure caused by impaired left ventricular contractility and an ejection fraction of 40% or less.

In this episode, we review:

• The classic symptoms and physical exam findings of HFrEF
• Common causes, including ischemic heart disease and dilated cardiomyopathy
• The role of echocardiography and BNP
• The major disease-modifying medications for chronic HFrEF
• Why loop diuretics improve symptoms but not mortality
• When to consider an ICD or cardiac resynchronization therapy

Medicine Shelf Prep is sponsored by Scrub Battle.

Download Scrub Battle: CK on the iOS App Store for five new high-yield clinical questions every day, immediate explanations, and daily individual and medical school leaderboards.

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

Vasospastic Angina, also called Prinzmetal angina, is caused by transient coronary artery spasm and classically presents with chest pain at rest, often at night or early in the morning.

In this episode, we review:

• The classic presentation of vasospastic angina
• Why transient ST-segment elevation can occur
• How to distinguish it from stable angina and acute coronary syndrome
• The role of coronary angiography and acetylcholine provocation testing
• First-line treatment with calcium channel blockers
• Why beta blockers may worsen coronary vasospasm
• Important triggers including smoking and stimulant use

Medicine Shelf Prep is sponsored by Scrub Battle.

Download Scrub Battle: CK on the iOS App Store for five new high-yield clinical questions every day, immediate explanations, and daily individual and medical school leaderboards.

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

Unstable angina is an acute coronary syndrome caused by myocardial ischemia without detectable myocardial injury. In this episode of Medicine Shelf Prep, Chris and Mars break down the classic presentation, how to distinguish unstable angina from stable angina and NSTEMI, the role of serial high-sensitivity troponins and ECGs, and the key management decisions you need to know for the Medicine Shelf Exam.

Key topics include:

• Rest pain, new-onset severe angina, and crescendo angina
• Unstable angina versus NSTEMI
• ECG and serial high-sensitivity troponin testing
• Aspirin, anticoagulation, statins, nitrates, and beta blockers
• When invasive coronary angiography is needed
• Common Medicine Shelf Exam traps

Medicine Shelf Prep is sponsored by Scrub Battle.

Get five new high-yield clinical questions every day, review immediate explanations, and compete against classmates and other medical schools. Download Scrub Battle: CK from the iOS App Store and use offer code MEDICINE1 for your first month free

Non–ST-Elevation Myocardial Infarction

Rapidly review how to recognize an NSTEMI, interpret ECG and troponin findings, distinguish it from unstable angina and type two myocardial infarction, initiate treatment, and identify patients who need urgent coronary angiography. Plus, learn the critical shelf-exam trap: fibrinolysis is not used for NSTEMI.

Get five new high-yield clinical questions every day, review immediate explanations, and compete against classmates and other medical schools. Download Scrub Battle: CK from the iOS App Store and use offer code MEDICINE1 for your first month free.

Chronic Coronary Syndrome

Learn to recognize stable angina, distinguish it from acute coronary syndrome, select the appropriate diagnostic test, choose first-line medications, and determine when revascularization is indicated.

Medicine Shelf Prep is sponsored by Scrub Battle. Get five new clinical questions daily, immediate explanations, and medical-school leaderboards.

Download Scrub Battle: CK

Use offer code MEDICINE1 for your first month free. This introductory offer is limited to the first 500 users and is not a free trial.

Chest pain questions are won or lost in the first few decisions. Chris and Mars review how to assess stability, interpret an ECG, recognize inferior, posterior, and right ventricular infarctions, use serial troponins, and distinguish acute coronary syndrome from other life-threatening causes of chest pain.

Medicine Shelf Prep is sponsored by Scrub Battle. Download Scrub Battle: CK from the iOS App Store:

Scrub Battle: CK

Use code Medicine1 for your first month free. Limited to the first 500 users.