Cardiology — USMLE Step 3 Practice
Cardiovascular disease is one of the highest-yield areas on USMLE Step 3, spanning acute coronary syndromes, heart failure, arrhythmias, and valvular disease. Mastery of ECG interpretation and evidence-based management is essential for passing.
Frequently Asked Questions
What is the first-line treatment for acute STEMI on USMLE Step 3?
Primary percutaneous coronary intervention (PCI) within 90 minutes of first medical contact is the first-line treatment for STEMI. If PCI is not available within 120 minutes, fibrinolytic therapy (e.g., alteplase) should be given within 30 minutes of hospital arrival, provided there are no contraindications.
Which medications are contraindicated in systolic heart failure on Step 3?
Non-dihydropyridine calcium channel blockers (verapamil, diltiazem) are contraindicated in systolic (reduced EF) heart failure because they depress myocardial contractility. NSAIDs are also avoided due to fluid retention and reduced diuretic efficacy.
How do you manage atrial fibrillation with rapid ventricular response in an unstable patient?
Hemodynamically unstable AF with rapid ventricular response requires immediate synchronized cardioversion. Stable patients can be rate-controlled first with IV metoprolol or diltiazem, followed by rhythm control or anticoagulation decisions based on duration and CHADS2-VASc score.
What is the Step 3 approach to suspected aortic dissection?
Suspect aortic dissection in patients with tearing or ripping chest/back pain, pulse differentials, or wide mediastinum on CXR. CT angiography of the chest is the diagnostic test of choice. Type A dissections (involving ascending aorta) require emergency surgery; Type B dissections are managed medically with IV labetalol to reduce blood pressure and heart rate.
When should you anticoagulate in atrial fibrillation?
Anticoagulation is recommended when CHADS2-VASc score is ≥2 in men or ≥3 in women. DOACs (apixaban, rivaroxaban, dabigatran) are preferred over warfarin for non-valvular AF. Anticoagulation should be avoided or used cautiously in patients with high bleeding risk or CrCl <15 mL/min.
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