Top 100 High-Yield Cardiology Points (2025)

 Top 100 High-Yield Cardiology Points (2025)

                             (🟥 Facts / 🟩 Treatments)

1) Acute Coronary Syndromes (ACS) — 10

1. 🟥 High-sensitivity troponin (hs-cTn) is preferred for rapid rule-in/rule-out of MI.

2. 🟩 Give aspirin immediately (162–325 mg chew), then 75–100 mg daily.

3. 🟥 For STEMI, door-to-balloon ≤90 min (≤120 min if transfer) saves myocardium.

4. 🟩 Primary PCI is first-line reperfusion; fibrinolysis only if PCI delay is excessive.

5. 🟥 NSTEMI patients with high risk (e.g., GRACE) benefit from early invasive strategy.

6. 🟩 Use a P2Y12 inhibitor (ticagrelor/prasugrel preferred in most) + aspirin (DAPT).

7. 🟥 Radial access lowers bleeding and vascular complications vs femoral.

8. 🟩 Start high-intensity statin in all ACS unless contraindicated.

9. 🟥 Shorter DAPT (3–6 mo) can be reasonable after PCI in high-bleeding-risk patients.

10. 🟩 At discharge: checklist—DAPT, statin, beta-blocker (if indicated), ACEi/ARB/ARNI (LV dysfunction), SGLT2i (HF), cardiac rehab.

(Key sources: 2025 ACC/AHA ACS Guideline & slide set.) 

2) Chronic Coronary Disease (CCD) & Secondary Prevention — 10

11. 🟥 Beta-blockers are not for routine long-term use after MI if LVEF >50% and no other indication.

12. 🟩 First-line antianginal: either beta-blocker or nondihydropyridine CCB; add long-acting nitrates/rano as needed.

13. 🟥 LDL-C goal is “lower is better,” with thresholds guiding add-ons in very-high risk.

14. 🟩 Add ezetimibe, then PCSK9 inhibitor if LDL-C remains above threshold on max statin.

15. 🟥 Cardiac rehab reduces mortality and rehospitalization.

16. 🟩 Refer all eligible CCD/ACS patients to supervised rehab programs.

17. 🟥 Long-term single antiplatelet therapy is standard after PCI once DAPT completed.

18. 🟩 Use PPI with DAPT in patients at ↑ GI-bleeding risk.

19. 🟥 Inclisiran/bempedoic acid can lower LDL-C when statins insufficient or intolerant.

20. 🟩 Consider inclisiran or bempedoic acid per shared decision when targets unmet.

(Key sources: 2023 CCD Guideline; 2022 ACC Non-statin ECDP.) 

3) Lipids — 10

21. 🟥 High-intensity statin reduces major events ~25% per mmol/L LDL-C lowering.

22. 🟩 Aim ≥50% LDL-C reduction with high-intensity statin; check lipids 4–12 wks after start/titrate.

23. 🟥 Very-high-risk ASCVD often needs LDL-C <55–70 mg/dL (1.4–1.8 mmol/L).

24. 🟩 Add ezetimibe → PCSK9 mAb if above threshold; consider bempedoic acid/inclisiran.

25. 🟥 Lp(a) ≥50 mg/dL (≈≥125 nmol/L) indicates higher ASCVD risk.

26. 🟩 Measure Lp(a) at least once; intensify LDL-lowering if elevated.

27. 🟥 Hypertriglyceridemia (≥500 mg/dL) raises pancreatitis risk.

28. 🟩 Use fibrate or high-dose omega-3 ethyl esters to lower TG in severe cases.

29. 🟥 Non-HDL-C/ApoB track atherogenic particle burden.

30. 🟩 Use ApoB (<65–80 mg/dL) as adjunct target in very-high risk when available.

(Key sources: ACC non-statin ECDP; CCD guideline; ACC Lp(a) review.) 

4) Heart Failure (HF) — 10

31. 🟥 HFrEF cornerstone is 4-pillars: ARNI (or ACEi/ARB), evidence beta-blocker, MRA, SGLT2 inhibitor.

32. 🟩 Start all four rapidly at low doses; uptitrate every 2–4 weeks as tolerated.

33. 🟥 SGLT2 inhibitors benefit across EF spectrum, including HFpEF.

34. 🟩 Use dapagliflozin/empagliflozin in HFrEF/HFmrEF/HFpEF unless contraindicated.

35. 🟥 ARNI reduces CV death/HF hospitalization vs ACEi in HFrEF.

36. 🟩 Prefer sacubitril/valsartan over ACEi/ARB when feasible (washout if switching from ACEi).

37. 🟥 Iron deficiency (ferritin <100, or 100–299 with TSAT <20%) worsens HF outcomes.

38. 🟩 Give IV iron (e.g., ferric carboxymaltose) to symptomatic HF with iron deficiency.

39. 🟥 GDMT should continue during hospitalization and at discharge unless unstable.

40. 🟩 For persistent symptoms: add vericiguat (worsening HF) or consider ivabradine (sinus HR ≥70 on max beta-blocker).

(Key sources: 2022 HF Guideline; 2024 ACC HF ECDPs.) 

5) Atrial Fibrillation (AF) — 10

 

41. 🟥 Early rhythm control improves outcomes in many newly diagnosed AF patients.

42. 🟩 Consider antiarrhythmic or catheter ablation early for symptomatic patients.

43. 🟥 DOACs preferred over warfarin for non-valvular AF stroke prevention.

44. 🟩 Dose DOACs strictly by label (renal function, age/weight/drug interactions).

45. 🟥 CHA₂DS₂-VASc guides stroke prevention; bleeding scores don’t preclude OAC alone.

46. 🟩 Anticoagulate men with score ≥2, women ≥3 (consider at 1 in men/2 in women per risk).

47. 🟥 Avoid chronic OAC + antiplatelet combo for stroke prevention (except short courses after PCI).

48. 🟩 After PCI in AF: minimize triple therapy; shift to OAC + single antiplatelet, then OAC alone.

49. 🟥 Lifestyle (weight loss, exercise, ↓ alcohol) reduces AF burden and progression.

50. 🟩 Target ≥10% weight loss if BMI >27; ≥210 min/wk exercise; manage sleep apnea.

(Key sources: 2023 ACC/AHA/ACCP/HRS AF Guideline; 2024 ESC AF.) 

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6) Ventricular Arrhythmias & Brady — 10

51. 🟥 Ischemic cardiomyopathy with LVEF ≤35% after ≥3 mo GDMT has high SCD risk.

52. 🟩 Implant ICD for primary prevention when appropriate criteria met.

53. 🟥 Sustained monomorphic VT often due to scar-related substrate.

54. 🟩 Amiodarone/sotalol for suppression; catheter ablation for recurrent VT.

55. 🟥 Torsades de pointes associated with QT prolongation and hypokalemia/magnesemia.

56. 🟩 Stop QT-prolonging meds; IV magnesium; pace/isoproterenol if brady-dependent.

57. 🟥 Symptomatic high-grade AV block requires permanent pacing.

58. 🟩 Implant pacemaker; consider His-bundle/left bundle pacing in HF to avoid dyssynchrony.

59. 🟥 LQTS/CPVT are genetic causes of malignant arrhythmias in the young.

60. 🟩 Beta-blockers first-line; ICD for survivors of cardiac arrest or high-risk features.

(General ACC/AHA EP standards; aligned with AF & HF docs and established device guidance.)

7) Hypertension (2025 update) — 10

61. 🟥 New 2025 ACC/AHA BP guideline emphasizes PREVENT risk and home BP monitoring.

62. 🟩 Treat to <130/80 mmHg for most at elevated CVD risk; use validated home devices.

63. 🟥 First-line classes: thiazide-like diuretics, ACEi/ARB, and CCBs.

64. 🟩 Start 2 drugs (single-pill combo) if BP ≥20/10 mmHg above target.

65. 🟥 Resistant HTN often due to suboptimal diuretic and sodium excess.

66. 🟩 Add spironolactone; address adherence, sleep apnea, and dietary sodium.

67. 🟥 CKD, diabetes, and CAD require careful renin-angiotensin blockade.

68. 🟩 Prefer ACEi/ARB in albuminuric CKD; combine thoughtfully with CCB/thiazide-like.

69. 🟥 Pregnancy: ACEi/ARB contraindicated.

70. 🟩 Use labetalol, nifedipine, or methyldopa; treat severe BP promptly.

(Key sources: 2025 ACC/AHA Hypertension Guideline; PREVENT tools.) 

8) Peripheral Artery Disease (PAD) — 10

71. 🟥 PAD signals systemic atherosclerosis with high MACE risk.

72. 🟩 High-intensity statin + antiplatelet; supervised exercise therapy.

73. 🟥 ABI <0.90 confirms PAD; toe pressures helpful in diabetics.

74. 🟩 Cilostazol improves claudication walking distance (avoid in HFrEF).

75. 🟥 After lower-extremity revascularization, graft patency and MACE preventi 75. es.

76. 🟩 Many benefit from rivaroxaban 2.5 mg bid + aspirin (dual-pathway) if bleeding risk acceptable.

77. 🟥 Smoking cessation dramatically improves outcomes.

78. 🟩 Offer pharmacotherapy + counseling; consider varenicline/bupropion/NRT.

79. 🟥 Critical limb-threatening ischemia needs urgent revascularization.

80. 🟩 Multidisciplinary limb-salvage pathways; optimize antithrombotics and wound care.

(Key source: 2024 AHA/ACC PAD Guideline.) 

9) Valvular & Aortic Disease — 10

81. 🟥 Severe symptomatic aortic stenosis (AS) has poor prognosis without intervention.

82. 🟩 Choose TAVR vs SAVR via Heart Team based on age, anatomy, surgical risk, and durability.

83. 🟥 Primary MR with symptoms or LV changes benefits from timely repair.

84. 🟩 Consider transcatheter edge-to-edge repair in appropriate degenerative/functional MR anatomy.

85. 🟥 Bioprosthetic valves: early thromboembolic risk exists post-implant.

86. 🟩 Short-term VKA (3–6 mo) reasonable early after bioprosthetic surgery (patient-specific).

87. 🟥 Aortic disease thresholds vary with genetics, size index, and growth rate.

88. 🟩 Control BP (beta-blocker/ARB in Marfan/HTAD); operate at guideline diameters.

89. 🟥 Endocarditis prophylaxis is selective (e.g., prior IE, prosthetic valves, certain congenital lesions).

90. 🟩 Give dental prophylaxis (amoxicillin) only for indicated high-risk groups.

(Key sources: 2020 ACC/AHA VHD Guideline; 2022 ACC/AHA Aortic Disease; 2025 ESC/EACTS VHD context.) 

10) Diagnostics, Prevention & “Don’t Miss” — 10

91. 🟥 PREVENT (multisociety) is the current ASCVD risk estimator for adults.

92. 🟩 Use PREVENT to guide statins/BP targets and shared decisions.

93. 🟥 Coronary CT angiography (CCTA) is highly sensitive for CAD in low-to-intermediate risk chest pain.

94. 🟩 Prefer CCTA for many stable chest pain evaluations; functional testing if obstructive disease likely.

95. 🟥 Cardio-renal-metabolic overlap amplifies risk.

96. 🟩 Deploy SGLT2i/GLP-1 RA in diabetes with ASCVD/HF/CKD per indications.

97. 🟥 Vaccination (influenza/COVID) reduces CV events in high-risk patients.

98. 🟩 Recommend annual flu shot; follow current respiratory vaccine guidance.

99. 🟥 Cardiac rehab is underused but broadly beneficial across CAD/HF.

100. 🟩 Proactively enroll eligible patients; address barriers (transport, cost, awareness).