Coronary heart disease, heart failure, valvular heart disease, rhythm disorders, hypertension and therapy — condensed for 4th year students.
Cardiology is based on a few key tools and on what to do when faced with cardinal symptoms: chest pain, dyspnea, syncope.
Trace of electrical activity: wave P (auricular), complex QRS (ventricular), wave T (repolarization). We analyze rhythm, frequency, axis, conduction (PR, QRS, QT) and repolarization (ST segment). The ECG detects ischemia, rhythm and conduction disturbances, hypertrophies.
| Symptom | Approach |
|---|---|
| Chest pain | Eliminate emergencies: ACS, pulmonary embolism, aortic dissection, pericarditis. |
| Dyspnea | Assess for heart failure (NYHA) vs respiratory cause. |
| Syncope | Distinguish between cardiac (serious) and vagal origin. |
ECG = P-QRS-T (rhythm, conduction, repolarization). Echocardiography gives LVEF. When faced with chest pain, always eliminate the 4 emergencies: ACS, pulmonary embolism, aortic dissection, pericarditis.
Coronary artery disease results from atherosclerosis of the coronary arteries; the imbalance between oxygen supply and need creates myocardial ischemia.
Major factors: age, tobacco, hypertension, diabetes, dyslipidemia, heredity. The atherosclerotic plaque can rupture and cause coronary thrombosis.
Exertion pain, retrosternal, constrictive, calmed by rest and trinitrin. Explorations: Stress ECG, stress ultrasound, coronary angiography.
| Type | Features |
|---|---|
| SCA ST+ (STEMI) | ST elevation, complete occlusion → emergency reperfusion (angioplasty or thrombolysis). Elevated troponin. |
| ACS ST− (NSTEMI / unstable angina) | T depression/abnormalities; risk stratification, antithrombotic treatment and coronary angiography. |
The universal definition of IDM is based on the elevation of troponin + a clinical, ECG or imaging argument.
Stable angina = exercise pain calmed by rest. SCA ST+ = absolute emergency of reperfusion (time is muscle). Troponin = necrosis marker. Control of risk factors = prevention.
Heart failure (HF) is the inability of the heart to provide a flow rate adapted to the needs of the body.
Acute decompensation of the left IC: sudden respiratory distress, orthopnea, laryngeal crackles, foamy expectoration. Emergency (diuretics, nitrates, oxygen).
Circulatory failure due to major drop in cardiac output (often extensive MI): hypotension, signs of hypoperfusion (marbling, oliguria, confusion). Severe prognosis.
Left IC = dyspnea/crackles; Right IC = jugular edema/turgor. BNP confirms the IC. OAP and cardiogenic shock are life-threatening emergencies of left heart failure.
Valvulopathies are stenoses (narrowings) or leaks (insufficiency); each has a characteristic breath.
| Valvulopathy | Breath & key points |
|---|---|
| Aortic stenosis | Ejection systolic murmur at the aortic focus; angina, syncope, dyspnea on exertion. |
| Aortic regurgitation | Diastolic murmur; widening of the voltage differential. |
| Mitral stenosis | Diastolic turnover; risk of AF and embolism; often post-rheumatic. |
| Mitral regurgitation | Apex systolic murmur radiating to the axilla. |
Late complication of strep throat A. Joint, cardiac (carditis, valvular heart disease), cutaneous and neurological involvement (Jones criteria). Prevention through treatment of streptococcal throat.
Mechanical (durable but requiring lifelong anticoagulation) or biological (without prolonged anticoagulation but less durable). Monitoring: clinical, ultrasound, INR, prevention of endocarditis.
Stenosis vs leak, systolic vs diastolic murmur. RAA = sequelae of streptococcal angina (Jones criteria), to be prevented. Mechanical prosthesis = lifelong anticoagulation + prevention of endocarditis.
Beyond the valves and coronaries, the heart can be reached in its three layers.
Bacterial graft on the endocardium (often valvular). Table: fever + breath, embolic and immunological signs. Diagnosis: blood cultures + ultrasound (vegetations). Any fever in a valvular/prosthesis wearer should be mentioned.
Myocarditis: inflammation of the myocardium (often viral). Cardiomyopathies: dilated, hypertrophic (risk of sudden death in young people), restrictive.
Pericarditis: positional pain + rubbing + diffuse concave ST. Tamponade = emergency. Endocarditis = fever + breath (blood cultures + echo). Hypertrophic cardiomyopathy = cause of sudden death in young people/athletes.
We distinguish between rhythm disorders (abnormal focus of excitation) and conduction disorders (blockage of propagation).
| Trouble | ECG |
|---|---|
| BAV 1st degree | Constant lengthening of the PR. |
| BAV 2nd degree | Some P blocked (Mobitz I / II). |
| BAV 3rd degree (complete) | Atrioventricular dissociation → risk of syncope, pacemaker. |
| Branch blocks | Widened QRS (right or left). |
AF = frequent arrhythmia, risk of stroke (anticoagulation according to CHA₂DS₂-VASc). Ventricular fibrillation = defibrillation. Complete BAV = pacemaker. Branch block = wide QRS.
Hypertension is a major risk factor; Vascular pathology includes arterial and venous emergencies.
BP ≥ 140/90 mmHg. Most often essential. Impact on target organs (heart, brain, kidney, eye). Thehypertensive emergency associates very high BP and organ suffering. TheHTAP (pulmonary) is distinct.
TVP (painful, hot, enlarged calf) → risk ofpulmonary embolism (dyspnea, pain, tachycardia). Virchow triad; anticoagulant treatment.
HBP ≥ 140/90, monitor target organs; hypertensive emergency = high BP + organ damage. Aortic dissection and acute limb ischemia = emergencies. DVT → pulmonary embolism (anticoagulation).
Knowing the main families, their mechanism and their main indications is essential in cardiology.
| Class | Action & use |
|---|---|
| Antiplatelet agents | Aspirin, clopidogrel: coronary heart disease, prevention. |
| Anticoagulants | Heparins, AVK (INR), DOAC: AF, DVT/PE, prostheses. |
| Thrombolytics | Dissolution of the clot (STEMI, severe PE). |
Antiaggregants (coronary) vs anticoagulants (AF, DVT, prostheses) vs thrombolytics (STEMI/EP). The IEC/ARB II – beta-blocker – diuretic quartet is at the heart of the treatment of HF and hypertension. AVK = INR monitoring.
Educational summary of the Cardiology module (4th year) — summary produced from the official program. Revision document: it does not replace detailed lessons, recommendations and teacher handouts.
Program source: univ.ency-education.com — 4th year course, Cardiology.