Cardiovascular

Cases where a cardiovascular diagnosis is the entry point and the organizing frame of the decision. A single consolidated section with clinical-topic labels, rather than pre-split into sub-volumes — no subtopic here has yet accumulated the depth (3+ cases) that earns its own dedicated volume.

Anticoagulation

Atrial Fibrillation: Same Diagnosis, Divergent Path

Case 0001 · Warfarin/rifampin interaction

Anticoagulation

Mechanical Valve Anticoagulation: When Kidney Failure Complicates the Bridge

Case 0014 · UFH vs. LMWH bridging, severe renal impairment

Heart Failure

Beta-Blockade in HFrEF: A Prescription Her Lungs Get a Vote On

Case 0015 · Beta-blocker selectivity, concurrent asthma

Lipid Management

Statin Intensity in Advanced Age: A Question of Time the Patient May Not Have

Case 0016 · Statin deprescribing, limited life expectancy

Antiarrhythmics

Atrial Fibrillation: The Window Before It Closes

Case 0017 · Rate vs. rhythm control, structural remodeling

Hypertension

Resistant Hypertension: The Fourth Agent for a Long-Haul Driver

Case 0018 · Fourth-agent choice, CKD 3a

Antiplatelet Therapy

Dual Antiplatelet Therapy: A Bifurcated Stent and a Bleed Three Months Old

Case 0019 · DAPT duration post-DES, high bleeding risk

Heart Failure

Diuretic Resistance in Cardiorenal Syndrome: Reaching for a Third Nephron Segment

Case 0020 · Diuretic resistance, cardiorenal syndrome

Hypertension

ACE-Inhibitor Angioedema: Seven Years Later, a Different Target

Case 0021 · ACEI angioedema, ARB rechallenge

Pulmonary Hypertension

Pulmonary Arterial Hypertension: Better on Paper, Unresolved at the Bedside

Case 0022 · WHO functional class, combination-therapy intensity

Antiarrhythmics

Antiarrhythmic Choice in Structural Heart Disease: Two Shocks in Six Weeks

Case 0023 · Antiarrhythmic choice, recurrent ICD shocks, QT risk

Heart Failure

Diuretic Resistance in Acute Heart Failure: Why Metolazone Waits

Case 0024 · Diuretic strategy, ADHF with hyponatremia

Heart Failure

ARNI Timing After MI: The Window Versus the Kidney

Case 0025 · ARNI initiation timing, post-MI renal trend

Hypertension

Chronic Hypertension in Pregnancy: What Timing Decides

Case 0026 · Antihypertensive choice in pregnancy

Antiplatelet Therapy

P2Y12 Inhibitor Selection After NSTEMI: How Much Weight Does a Healed Ulcer Still Carry?

Case 0027 · P2Y12 selection post-NSTEMI, prior GI bleed

Antiarrhythmics

Digoxin in Atrial Fibrillation with HFrEF: An Old Drug's Case for a Second Look

Case 0028 · Digoxin for AF rate control, concurrent HFrEF

Heart Failure

SGLT2 Inhibitor Timing in Decompensated Heart Failure: The Discharge Clock Against an Empty Stomach

Case 0029 · SGLT2 inhibitor initiation timing, ADHF

Anticoagulation

Anticoagulation Bridging Before Elective Surgery: What the Guideline Doesn't Cover

Case 0030 · Perioperative DOAC bridging strategy

Antiarrhythmics

Atrial Fibrillation at Thirty-Four: What a Lifetime of Amiodarone Actually Costs

Case 0031 · Amiodarone vs. catheter ablation, younger patient

Lipid Management

Statin-Associated Muscle Symptoms: What the Genotype Changes, and What It Doesn't

Case 0032 · SAMS, genotype-guided rechallenge

Angina

Refractory Angina: When the Nitrate Isn't an Option

Case 0033 · Nitrate vs. ranolazine, tadalafil interaction

Heart Failure

Ivabradine in HFrEF: Rate Control at the Beta-Blocker's Ceiling

Case 0034 · Ivabradine addition, maximized beta-blocker

Antiplatelet Therapy

Aspirin for Primary Prevention: A Risk Score Just Under the Guideline's Cutoff

Case 0035 · Aspirin primary prevention, borderline ASCVD risk

Angina

Vasospastic Angina With Reduced Ejection Fraction: Two Contraindications, One Patient

Case 0036 · CCB vs. beta-blocker, vasospastic angina + reduced EF

Heart Failure

Spironolactone or Eplerenone: The Fourth Drug He Stopped Without Saying Why

Case 0037 · MRA selection, gynecomastia history

Lipid Management

PCSK9 Inhibitors and Statin Intolerance: Above the Treatment Target, Below the Access Threshold

Case 0038 · PCSK9i threshold, complete statin intolerance

Anticoagulation

Anticoagulation and a New Colon Cancer Diagnosis: When a Routine Interruption Isn't Routine Anymore

Case 0039 · Anticoagulation continuity, new cancer diagnosis + surgery

Antiarrhythmics

Atrial Fibrillation Rate Control: When Beta-Blockade Isn't the Safer Choice

Case 0040 · Verapamil vs. beta-blocker, reactive airway disease

Heart Failure

Sacubitril/Valsartan After a Stable ACE Inhibitor: A Patient Who Isn't Convinced

Case 0041 · ARNI switch, patient reluctance

Reperfusion Strategy

Reperfusion Strategy in STEMI: Fibrinolysis When the Cath Lab Is Two Hours Away

Case 0042 · Thrombolysis vs. primary PCI transfer

Hypertension

Hypertension and Migraine with Aura: The Drug That Treats Both Isn't Automatically the Safer One

Case 0043 · CCB vs. beta-blocker, concurrent migraine with aura

Anticoagulation

Apixaban Dose Reduction: Missing the Criteria by a Kilogram and a Decimal Point

Case 0044 · NOAC dose-reduction criteria, elderly near cutoffs

Antiarrhythmics

Flecainide or Sotalol: Antiarrhythmic Choice Without a Confirmed Diagnosis

Case 0045 · Class IC vs. III, AF without confirmed structural disease

Heart Failure

Empagliflozin or Dapagliflozin: The eGFR Threshold That Splits Them

Case 0046 · SGLT2i agent selection, HFpEF + CKD

Heart Failure

Beta-Blocker Continuation in Decompensating Heart Failure: A Slow Pulse in a Fast Fever

Case 0047 · Continue vs. reduce vs. withdraw, acute decompensation

Lipid Management

Severe Hypertriglyceridemia: What Actually Prevents the Next Attack

Case 0048 · Fibrate vs. omega-3, pancreatitis risk

Pericardial Disease

Recurrent Pericarditis: When Colchicine Keeps Failing on Tolerability, Not Efficacy

Case 0049 · Colchicine tolerability, recurrent pericarditis

Antiarrhythmics

Rate Control in Atrial Fibrillation: The Ejection Fraction That Isn't Quite Reduced

Case 0050 · Diltiazem vs. metoprolol, borderline-reduced EF

Anticoagulation

Antiphospholipid Syndrome: Anticoagulant Choice After an Arterial Stroke

Case 0051 · DOAC vs. warfarin, triple-positive APS

Pulmonary Hypertension

Pulmonary Arterial Hypertension: One More Catheter Before the Next Drug

Case 0052 · RHC-guided vs. empiric escalation, intermediate risk

Heart Failure

Spironolactone Near the Threshold: Completing Quadruple Therapy Under Borderline Hyperkalemia Risk

Case 0053 · MRA initiation threshold, borderline hyperkalemia

Anticoagulation

Anticoagulant Choice at the Extremes of Body Weight: A Genuine Guideline Gap

Case 0054 · DOAC dosing, extreme obesity

Heart Failure

Optimizing the Four Pillars: How Long to Keep Titrating Before Reassessing a Recovering Ejection Fraction

Case 0055 · GDMT optimization duration before ICD reassessment

Hypertension

Hypertension and Essential Tremor: A Beta-Blocker Choice Complicated by Raynaud's

Case 0056 · Beta-blocker class selection, comorbid Raynaud's

Antiplatelet Therapy

Antiplatelet Strategy After Cryptogenic Stroke: A Regimen Choice Just Outside the Trial Window

Case 0057 · Antiplatelet regimen, cryptogenic stroke + incidental PFO

Heart Failure

Heart Failure Quadruple Therapy: Two Patients, Two Different First Steps

Case 0058 · GDMT sequencing order, two patients

Angina

Nitrate-Free Interval Placement: An Early-Morning Swimmer's Angina

Case 0059 · Nitrate tolerance/interval-scheduling strategy

Antiarrhythmics

Amiodarone vs. Dronedarone: Choosing a Rhythm Drug for Thirty More Years of Ladders

Case 0060 · Amiodarone vs. dronedarone, mild structural heart disease

Lipid Management

Statin Initiation vs. an Unexplained Transaminase Elevation: What the Old Label Contraindication Was Meant to Catch

Case 0061 · Statin initiation, unexplained transaminase elevation

Reperfusion Strategy

Impella Before or After the Wire: Timing Mechanical Support in STEMI Cardiogenic Shock

Case 0062 · Mechanical circulatory support escalation timing

Heart Failure

Metoprolol Succinate vs. Carvedilol: The Fourth Pillar for a Choir Director with COPD

Case 0063 · Beta-blocker selection, concurrent COPD

Heart Failure

Torsemide vs. Furosemide: A Piano Tuner Whose Home Diuretic Response Stopped Making Sense

Case 0064 · Loop diuretic switch, erratic oral response

Heart Failure

Hydralazine/Isosorbide Dinitrate: A Guideline Written for a Trial That Wasn't About Him

Case 0065 · Hydralazine/ISDN addition, persistent symptoms despite GDMT

Lipid Management

Ezetimibe vs. PCSK9 Inhibitor: Which Add-On First After a Recent NSTEMI

Case 0066 · Ezetimibe vs. PCSK9i add-on, statin-treated

Reperfusion Strategy

Milrinone vs. Dobutamine: An Inotrope Choice Complicated by Both Kidneys and a Beta-Blocker

Case 0067 · Inotrope selection, cardiogenic shock with renal impairment

Anticoagulation

Full-Dose, Reduced-Dose, or Done: Extended Anticoagulation After an Unprovoked PE

Case 0068 · Extended anticoagulation duration/dosing, unprovoked PE

Hypertension

New Hypertension in a Competitive Shooter: Why the Obvious First Drug Isn't the Right One

Case 0069 · First-line agent selection, competitive-athlete anti-doping constraint

Heart Failure

A Rising NT-proBNP in a Patient Who Feels Fine: What GUIDE-IT Actually Settled

Case 0070 · Natriuretic-peptide-guided therapy vs. clinical reassessment

Angina

Ranolazine vs. More Metoprolol: Refractory Angina Against a Resting Heart Rate of 54

Case 0071 · Ranolazine vs. beta-blocker titration, resting bradycardia

Antiarrhythmics

Digoxin Toxicity Risk After Adding Amiodarone: How Much to Cut, How Soon to Check

Case 0072 · Digoxin dose reduction, new amiodarone interaction

Lipid Management

Stopping a Statin in Advanced Dementia: What a Decade-Old Trial Actually Tested

Case 0073 · Statin continuation vs. discontinuation, limited prognosis

Heart Failure

CRT-D at 148 Milliseconds: A QRS Duration Two Ticks Below the Guideline's Sharpest Line

Case 0074 · CRT-D candidacy, borderline QRS duration

Antiarrhythmics

Ivabradine for Inappropriate Sinus Tachycardia: Real Efficacy Against a Teratogenicity Conversation

Case 0075 · Beta-blocker vs. ivabradine, inappropriate sinus tachycardia

Lipid Management

Clearly Indicated, Genuinely Unaffordable: A PCSK9 Inhibitor Against a High-Deductible Plan

Case 0076 · PCSK9i access/cost barrier, compromise therapy

Anticoagulation

New AF, Old HIT: Why Starting Warfarin Isn't as Simple as Just Avoiding Heparin

Case 0077 · Anticoagulation approach, remote HIT history

Hypertension

Amlodipine Edema: Why the Fix Isn't Just a Diuretic

Case 0078 · Amlodipine-induced edema, dose vs. add-on vs. switch

Anticoagulation

Genotype-Guided Warfarin Dosing: Two Trials, Two Populations, Two Different Answers

Case 0079 · CYP2C9/VKORC1-guided dosing, unpredictable INR response

Heart Failure

Sacubitril/Valsartan in HFpEF: A Trial That Narrowly Missed but Didn't Really Fail

Case 0080 · ARNI initiation in HFpEF, post-PARAGON-HF

Hypertension

Diltiazem vs. Amlodipine for a Proteinuric Kidney: One Thing to Confirm First

Case 0081 · CCB selection, concurrent CKD and proteinuria

Anticoagulation

Holding Apixaban for a Colonoscopy: Why Bridging Isn't the Question It Used to Be

Case 0082 · DOAC interruption strategy, elective high-bleeding-risk procedure

Antiarrhythmics

Sotalol and Borderline Kidneys: When Newer Outpatient Data Still Isn't the Right Fit

Case 0083 · Sotalol initiation threshold, borderline renal function

Lipid Management

Icosapent Ethyl for Residual Risk: The Comparator Arm That Wasn't Inert

Case 0084 · Icosapent ethyl addition, statin-treated persistent hypertriglyceridemia

Antiplatelet Therapy

Recurrent Chest Pain on Clopidogrel: What the Genotype Explained After the Fact

Case 0085 · Clopidogrel resistance, CYP2C19 poor metabolizer

Pulmonary Hypertension

Switching Off Sildenafil: Riociguat Against a Borderline Kidney

Case 0086 · Riociguat switch, borderline renal function

Angina

Adding an Antianginal to a Resting Heart Rate of 58

Case 0087 · Beta-blocker vs. CCB as first add-on, bradycardia risk

Pericardial Disease

Colchicine After MI: COLCOT's Result Against the Trial That Didn't Repeat It

Case 0088 · Post-cardiac-injury syndrome, colchicine/NSAID duration

Reperfusion Strategy

Fibrinolysis in a Combine Cab: Choosing the Bolus a Rural Night Shift Can't Miss

Case 0089 · Reteplase vs. tenecteplase, rural transfer setting

Antiplatelet Therapy

Prasugrel or Ticagrelor for a New Grandfather's NSTEMI

Case 0090 · P2Y12 selection nuance, diabetic ACS

Peripheral Arterial Disease

Cilostazol Against a Borderline Ejection Fraction She Didn't Know She Had

Case 0091 · Cilostazol vs. statin-optimization-alone for claudication

Antiplatelet Therapy

Aspirin Alone or a Bounded Course of Ticagrelor After His Bypass

Case 0092 · Post-CABG antiplatelet strategy, SVG patency

Syncope/Autonomic

Tapering a Beta-Blocker a Patient Feels Is Working, Against a Trial That Says It Doesn't

Case 0093 · Beta-blocker use, cardioinhibitory vasovagal syncope

Cardiomyopathy/Genetics

A Normal Echo, a Positive Gene: What the Guideline Actually Recommends for Her

Case 0094 · Genetic-testing threshold, prophylactic HCM therapy

Cardio-Oncology

A Strain Value Drops Before the Ejection Fraction Does: Her Fourth Chemo Cycle in Question

Case 0095 · Anthracycline cardiotoxicity monitoring, continue-vs-hold

Antiplatelet Therapy

Thirty Days, Three Months, or Somewhere Between: DAPT After a Carotid Stent

Case 0096 · DAPT duration after carotid artery stenting

Hypertension

A Jazz Pianist's Metoprolol and the Question He Almost Didn't Ask

Case 0097 · Beta-blocker selection, erectile-dysfunction concerns

Cardiomyopathy/Genetics

Anticoagulation Without Atrial Fibrillation: What Amyloid Does to the Atria Directly

Case 0098 · Anticoagulation in cardiac amyloidosis, sinus rhythm

Anticoagulation

Two Labels Say the Same Thing, Two Drugs Behave Differently: DOAC Choice in Mild Cirrhosis

Case 0099 · Rivaroxaban vs. edoxaban, hepatic impairment

Lipid Management

Switching Statins for a Feeling Nobody Can Measure

Case 0100 · Lipophilic vs. hydrophilic statin, cognitive complaints

Antiarrhythmics

A Device Nobody Mentioned Turning Off: ICD Deactivation Near the End of Life

Case 0101 · ICD deactivation timing, comfort-focused care

Hypertension

The Beta-Blocker Her Own Chart Almost Called For

Case 0102 · Alpha-before-beta sequencing, pheochromocytoma

Anticoagulation

Anticoagulating a Patient the Old Framework Called 'Auto-Anticoagulated'

Case 0103 · AF anticoagulation, cirrhosis and portal hypertension

Cardiomyopathy/Genetics

The Prescription a Rock Climber's New HCM Diagnosis Doesn't Actually Need Yet

Case 0104 · First-agent threshold, asymptomatic HCM

Cardio-Oncology

A Trial Called SCHOLAR and the Case for Not Stopping Yet

Case 0105 · Trastuzumab cardiotoxicity, continue-vs-hold threshold

Hypertension

The Guideline's Preferred Third Agent, Set Against His Own Gout History

Case 0106 · Fourth-agent selection, resistant hypertension with gout

Anticoagulation

Warfarin Is Still What the Guideline Says. The New Trials Say Something Else.

Case 0107 · LV thrombus, apixaban vs. guideline-named warfarin

Antiarrhythmics

Pill-in-the-Pocket Flecainide: How Much Wall Thickness Is Too Much?

Case 0108 · Flecainide pill-in-pocket candidacy, borderline LVH

Lipid Management

Statin Choice Around a Ritonavir-Boosted HIV Regimen

Case 0109 · Statin choice, ritonavir-boosted ART regimen

Peripheral Arterial Disease

Cilostazol Now, or the Twelve-Week Wait for Supervised Exercise

Case 0110 · Cilostazol vs. supervised exercise, PAD

Hypertension

A New Blood Pressure Diagnosis, an Already-Optimized Tremor Drug

Case 0111 · Beta-blocker selection, essential tremor

Angina

Ranolazine's Glycemic Bonus: Real Effect or the Wrong Reason to Choose It

Case 0112 · Ranolazine, diabetic angina

Antiarrhythmics

Which Beta-Blocker While Graves’ Disease Is Still Being Treated

Case 0113 · Beta-blocker choice, thyrotoxic atrial fibrillation

Hypertension

Escalate Her Labetalol or Add a Second Agent at 36 Weeks

Case 0114 · Labetalol escalation, near-term pregnancy hypertension

Anticoagulation

Anticoagulation Through a Pacemaker Implant, Three Months After a TIA

Case 0115 · Anticoagulation through device implant, recent TIA

Antiarrhythmics

Confirming “Idiopathic” Before Committing Him to Verapamil

Case 0116 · Verapamil, confirming idiopathic fascicular VT

Lipid Management

Restarting Her Statin Around a Cyclosporine-Based Transplant Regimen

Case 0117 · Statin restart, cyclosporine-based transplant regimen

Perioperative Cardiac Risk

Starting a Beta-Blocker Before Surgery He Doesn't Otherwise Need

Case 0118 · Perioperative beta-blocker, stable CAD

Antiplatelet Therapy

Dual Antiplatelet Therapy for a Bioresorbable Scaffold, Two Years In

Case 0119 · DAPT duration, bioresorbable scaffold

Anticoagulation

Reversing Warfarin for Emergency Surgery Around a Mechanical Mitral Valve

Case 0120 · Anticoagulation reversal, mechanical valve, emergent surgery

Cardiomyopathy/Aortopathy

Starting Aortic Root Prophylaxis in Marfan Syndrome: Losartan or Atenolol First

Case 0121 · Beta-blocker vs. ARB, Marfan aortic root prophylaxis

Valvular Disease

Asymptomatic Severe Aortic Stenosis: What the Exercise Test Changed

Case 0122 · TAVR vs. SAVR vs. surveillance, asymptomatic severe AS

Valvular Disease

Referring for Early Mitral Repair Ahead of the Guideline Threshold

Case 0123 · Early mitral repair referral, asymptomatic MR

Valvular Disease

Mechanical or Bioprosthetic: A Valve Choice Shaped by His Job

Case 0124 · Mechanical vs. bioprosthetic valve choice

Valvular Disease

Balloon Valvuloplasty or Replacement: Reading a Borderline Mitral Valve

Case 0125 · Balloon valvuloplasty vs. replacement, rheumatic MS

Valvular Disease

Closer Surveillance for Asymptomatic Aortic Regurgitation, Given the Valve's Cause

Case 0126 · Surveillance interval, asymptomatic aortic regurgitation

Valvular Disease

Endocarditis Prophylaxis After a Repaired, Not Replaced, Mitral Valve

Case 0127 · Endocarditis prophylaxis, repaired mitral valve

Valvular Disease

Paravalvular Leak After TAVR: Close It Now or Watch It

Case 0128 · Paravalvular leak after TAVR, closure threshold

Valvular Disease

Whether to Address the Tricuspid Valve During Mitral Surgery

Case 0129 · Concomitant tricuspid intervention during mitral surgery

Valvular Disease

Valve Surgery Timing for Endocarditis After a Recent Stroke

Case 0130 · Endocarditis surgical timing, recent stroke

Valvular Disease

Empiric Antibiotics for Endocarditis When the Cultures Stay Negative

Case 0131 · Empiric antibiotics, culture-negative endocarditis

Pericardial Disease

Acute Pericarditis With Declining Kidney Function: NSAID Escalation or Early Steroids?

Case 0132 · Acute pericarditis, renal-limited NSAID escalation

Pericardial Disease

Recurrent Pericarditis After Colchicine Failure: When to Start an IL-1 Blocker

Case 0133 · Recurrent pericarditis, IL-1 blocker threshold after colchicine failure

Pericardial Disease

Constrictive Pericarditis or Cardiac Amyloidosis: Treating While Still Diagnosing

Case 0134 · Constrictive pericarditis vs. cardiac amyloidosis, concurrent workup

Coronary Artery Disease

An Incidental Chronic Total Occlusion With Mild Symptoms: Medical Therapy First or CTO-PCI?

Case 0135 · Chronic total occlusion, medical therapy vs. CTO-PCI

Coronary Artery Disease

Silent Ischemia Found on Pre-Operative Testing: Medical Therapy Alone or Further Workup?

Case 0136 · Silent ischemia on pre-operative testing

Coronary Artery Disease

An Intermediate Coronary Stenosis: FFR-Guided Decision or Treat the Angiogram Alone?

Case 0137 · FFR-guided decision, intermediate coronary stenosis

Coronary Artery Disease

Beta-Blocker Continuation or Discontinuation After MI With Preserved Ejection Fraction

Case 0138 · Beta-blocker continuation vs. discontinuation, post-MI with preserved EF

Coronary Artery Disease

Complete Revascularization After STEMI: Deciding the Timing With Rising Creatinine

Case 0139 · Complete revascularization timing after STEMI, rising creatinine

Valvular Disease

Mitral Stenosis Worsening in Pregnancy: Medical Management or Balloon Valvuloplasty Now?

Case 0140 · Mitral stenosis in pregnancy, medical management vs. balloon valvuloplasty

Valvular Disease

Paradoxical Low-Gradient Severe Aortic Stenosis: Correcting Flow Before Trusting the Numbers

Case 0141 · Paradoxical low-gradient severe aortic stenosis

Valvular Disease

Bicuspid Aortic Valve With Borderline Root Growth: Does the Marfan Evidence for Medical Therapy Apply?

Case 0142 · Bicuspid aortic valve, borderline root growth threshold

Valvular Disease

Right-Sided Endocarditis From Injection Drug Use: Why Outpatient Antibiotic Step-Down Isn't the Default Here

Case 0143 · Right-sided endocarditis from injection drug use, OPAT threshold

Valvular Disease

Anticoagulation Bridging for a Mechanical Mitral Valve Before Semi-Urgent Surgery

Case 0144 · Anticoagulation bridging, mechanical mitral valve, semi-urgent surgery

Valvular Disease

Functional Mitral Stenosis From Annular Calcification: Medical Management or Transcatheter Replacement?

Case 0145 · Functional mitral stenosis from annular calcification, elderly patient

Valvular Disease

Secondary Mitral Regurgitation in HFrEF: Optimizing Heart Failure Therapy Before TEER

Case 0146 · Secondary MR in HFrEF, GDMT optimization before TEER

Valvular Disease

Bicuspid Valve Aortic Regurgitation in a Young Adult: Earlier Repair or Continued Surveillance?

Case 0147 · Bicuspid aortic regurgitation, repair timing in a young adult

Valvular Disease

Endocarditis Prophylaxis After Ring-Supported Mitral Repair: Does the Guideline Apply?

Case 0148 · Endocarditis prophylaxis, ring-supported mitral repair

Valvular Disease

Possible Endocarditis With Negative Cultures and a Non-Diagnostic Echo: How Long to Wait?

Case 0149 · Possible endocarditis, negative cultures, non-diagnostic echo

Peripheral Arterial Disease

Asymptomatic Severe Carotid Stenosis: Optimizing Medical Therapy Before the Procedural Conversation

Case 0150 · Asymptomatic severe carotid stenosis, medical therapy optimization

Peripheral Arterial Disease

Acute Limb Ischemia From Atrial Fibrillation: Catheter-Directed Thrombolysis or Surgical Thromboembolectomy?

Case 0151 · Acute limb ischemia from atrial fibrillation, thrombolysis vs. surgery

Peripheral Arterial Disease

A Borderline 5.2cm Aortic Aneurysm: Continued Surveillance or Earlier Repair?

Case 0152 · Borderline abdominal aortic aneurysm, surveillance vs. early EVAR

Peripheral Arterial Disease

Uncomplicated Type B Aortic Dissection: Medical Management Alone or Preemptive TEVAR?

Case 0153 · Uncomplicated type B aortic dissection, medical management vs. TEVAR

Peripheral Arterial Disease

Renal Artery Stenosis With Flash Pulmonary Edema: Confirming Medical Therapy Has Actually Failed

Case 0154 · Renal artery stenosis, confirming medical therapy failure

Venous Disease

Chronic Venous Insufficiency With Compression Non-Adherence: Venoactive Drugs, Earlier Ablation, or Both?

Case 0155 · Chronic venous insufficiency, compression non-adherence

Peripheral Arterial Disease

Acute Mesenteric Ischemia: Which Approach Goes First

Case 0156 · Acute mesenteric ischemia, endovascular vs. surgical revascularization

Peripheral Arterial Disease

Aortoiliac Occlusive Disease: How Long to Trial Medical Therapy Before Bypass

Case 0157 · Aortoiliac occlusive disease (Leriche syndrome), medical therapy duration

Coronary Artery Disease

Three-Vessel Disease in Diabetes: Bypass or Stents

Case 0158 · Multivessel CAD in diabetes, CABG vs. PCI

Coronary Artery Disease

Left Main Disease at an Intermediate Score: PCI or Bypass

Case 0159 · Left main disease, intermediate SYNTAX score, revascularization choice

Coronary Artery Disease

Chest Pain, Open Arteries: How to Choose a First Drug

Case 0160 · INOCA, diagnostic testing vs. empiric therapy

Coronary Artery Disease

First Statin Choice After a Heart Attack: Alone or Combined

Case 0161 · Post-MI statin intensity strategy, initial combination vs. monotherapy

Coronary Artery Disease

Stent Plus Atrial Fibrillation: How Long on Three Drugs

Case 0162 · ACS with atrial fibrillation, triple therapy duration

Coronary Artery Disease

Stable Angina, No Prior Infarct: Is a Beta-Blocker Still First

Case 0163 · Stable angina, beta-blocker necessity without prior MI

Coronary Artery Disease

Moderate Ischemia, Stable Symptoms: Medical Therapy or the Cath Lab First

Case 0164 · Stable CAD, moderate ischemia, revascularization vs. medical therapy

Coronary Artery Disease

P2Y12 Loading Before or After the Angiogram in NSTEMI

Case 0165 · NSTEMI, P2Y12 loading timing, pretreatment vs. deferred

Coronary Artery Disease

Anticoagulant Choice for Primary PCI in STEMI

Case 0166 · Primary PCI in STEMI, bivalirudin vs. heparin

Coronary Artery Disease

De-escalating Antiplatelet Therapy After a Stent: Guided or Standard

Case 0167 · Post-PCI DAPT de-escalation, genotype-guided vs. standard

Coronary Artery Disease

Spontaneous Coronary Artery Dissection: Conservative Care or Revascularization

Case 0168 · SCAD, conservative care vs. revascularization

Coronary Artery Disease

Cardiac Rehabilitation After a Heart Attack: Formal Referral or Home-Based Care

Case 0169 · Cardiac rehab referral threshold, mobility-limited patient

Coronary Artery Disease

Ticagrelor Alone or a Full Year of Dual Antiplatelet Therapy

Case 0170 · Ticagrelor monotherapy vs. standard-duration DAPT

Arrhythmias

An Incidental Mobitz II Block: Pacing Timing and His Existing Beta-Blocker

Case 0171 · Asymptomatic Mobitz II block, pacemaker timing and beta-blocker management

Arrhythmias

Complete Heart Block, Found Incidentally: Permanent Pacing or a Reversible Cause First

Case 0172 · Incidental complete heart block, permanent pacing vs. reversible cause

Arrhythmias

Concealed Long QT Syndrome: Beta-Blocker Now or Watchful Waiting

Case 0173 · LQT1, genotype-positive with a normal resting QTc, beta-blocker timing

Arrhythmias

A Spontaneous Brugada Pattern, No Symptoms: Defibrillator or Further Testing

Case 0174 · Asymptomatic Brugada syndrome, ICD candidacy

Arrhythmias

Reduced Ejection Fraction After Recent Bypass: How Strictly to Wait Before a Defibrillator

Case 0175 · Reduced EF post-CABG, ICD waiting period and GDMT optimization

Arrhythmias

PVC-Induced Cardiomyopathy: Ablation or a Trial of Antiarrhythmic Drugs First

Case 0176 · PVC-induced cardiomyopathy, ablation vs. antiarrhythmic drug trial

Arrhythmias

A Young CPVT Survivor: Choosing a Defibrillator and the Drug That Matters More

Case 0177 · CPVT, S-ICD vs. transvenous, nadolol as primary therapy

Arrhythmias

When Rate-Control Drugs Fail in Atrial Fibrillation: Ablation, and Which Pacemaker

Case 0178 · AF rate-control failure, AV node ablation and conduction system pacing

Arrhythmias

A Wearable Defibrillator After a Heart Attack, Barely Worn: What Comes Next

Case 0179 · Wearable defibrillator post-MI, adherence vs. GDMT optimization

Arrhythmias

Early Repolarization Pattern: A Father's Sudden Death at Thirty-Four

Case 0180 · Early repolarization pattern, family history of sudden cardiac death

Valvular Disease

Failing Bioprosthetic Aortic Valve: Valve-in-Valve or a Second Sternotomy

Case 0181 · Failing bioprosthetic aortic valve, valve-in-valve vs. redo-SAVR

Valvular Disease

Recurrent Mitral Regurgitation After Repair: Four Years Later, Moderate Again

Case 0182 · Recurrent MR after repair, reintervention timing

Valvular Disease

Aortic Stenosis and Mitral Regurgitation Together: Two Patients, Discordant Severity

Case 0183 · Discordant aortic/mitral disease, two patients

Pericardial Disease

Constrictive Pericarditis With Preserved Function: How Early to Operate

Case 0184 · Constrictive pericarditis, pericardiectomy timing

Pericardial Disease

Post-Cardiac Injury Syndrome After Infarction: NSAID, Colchicine, or Aspirin Alone

Case 0185 · Post-cardiac injury syndrome, anti-inflammatory choice post-MI

Coronary Artery Disease

Vasospastic Angina Refractory to Calcium-Channel Blockade: The Second-Line Choice

Case 0186 · Vasospastic angina, CCB-refractory, second-line agent

Coronary Artery Disease

Recurrent In-Stent Restenosis: A Third Procedure or More Medical Therapy First

Case 0187 · Recurrent in-stent restenosis, procedure vs. medical therapy

Valvular Disease

Prosthetic Valve Endocarditis: A Lower Threshold for Surgery, But How Much Lower

Case 0188 · Prosthetic valve endocarditis, surgical threshold

Valvular Disease

Rheumatic Mitral Regurgitation in a Twenty-Six-Year-Old: Repair, Mechanical Valve, or Bioprosthesis

Case 0189 · Rheumatic MR, young adult, repair vs. replacement

Hypertension

Primary Aldosteronism Found During a Resistant-Hypertension Workup: Adrenal Vein Sampling or Empiric Spironolactone

Case 0190 · Primary aldosteronism, AVS vs. empiric spironolactone

Hypertension

Asymptomatic Hypertensive Urgency at 208/116: Same-Day Discharge or Inpatient Titration

Case 0191 · Asymptomatic hypertensive urgency, discharge vs. inpatient titration

179 cases (August 7, 2026). The Cardiovascular section is now complete against its approved 178-pivot list, built across seventeen production batches plus one individually-built case (0059) — the first Pharmacology2000 discipline built out to this depth. Valvular Disease is the largest subtopic (25 cases), followed by Coronary Artery Disease (20), Hypertension (15), Arrhythmias (10), Anticoagulation, Antiarrhythmics, and Heart Failure. Pericardial Disease (7) and Peripheral Arterial Disease (9) round out the mid-sized subtopics; Cardiomyopathy/Genetics, Cardiomyopathy/Aortopathy, Cardio-Oncology, Perioperative Cardiac Risk, Syncope/Autonomic, and Venous Disease remain the smallest, most recently opened. This section remains one consolidated shelf with clinical-topic labels for now; whether and how to split any subtopic into its own browsable grouping is an open design question, worth real weight now that the list is finished rather than still growing. A few subtopics (cardiac amyloidosis specifically, certain aortopathy/aneurysm-surveillance pivots, peripheral arterial disease/claudication, and venous disease) have no dedicated chapter yet on the mothership reference site — cases in these areas link out only where a genuinely accurate match exists elsewhere in the curriculum. Case order (and the case-pager Next/Previous wiring on each page) follows build sequence, not clinical grouping; Case-0191 is the final case in build order and has no Next link.