Chapter 3: Cardiovascular Medicine

The material systematically addresses shock states across their major classifications—hypovolemic, cardiogenic, obstructive, and distributive—and emphasizes recognition of shock manifestations including hypotension, altered consciousness, tachycardia, and peripheral vasoconstriction, alongside treatment strategies focused on correcting underlying etiologies and providing hemodynamic support. The chapter extensively covers hypertension, distinguishing between primary hypertension arising from multifactorial genetic and environmental contributors and secondary hypertension with identifiable causes, while addressing the management of hypertensive emergencies requiring immediate therapeutic intervention. Heart failure pathophysiology centers on fluid and electrolyte retention mechanisms producing congestion and edema, with detailed coverage of pharmacologic management using angiotensin-converting enzyme inhibitors, beta-blockers, and diuretic therapy. Atherosclerotic disease and ischemic heart disease mechanisms are explored, including plaque formation, stenosis development, and ischemic consequences, with emphasis on therapeutic approaches combining lifestyle modification, pharmacotherapy, and revascularization procedures. Acute coronary syndromes receive detailed attention across the spectrum from unstable angina through non-ST elevation and ST elevation myocardial infarction, including diagnostic utilization of electrocardiography and cardiac biomarkers alongside evidence-based acute management. The chapter encompasses congenital cardiac anomalies classified by cyanotic and non-cyanotic presentations, valvular pathology including stenotic and regurgitant lesions of major valve systems, rhythm disturbances and their pharmacologic or electrical management, and cardiomyopathy subtypes including dilated, hypertrophic, and restrictive forms with their distinct pathophysiologic characteristics. Pericardial inflammation, effusion, infectious endocarditis with diagnostic Duke criteria, and rheumatic sequelae of streptococcal infection round out the discussion of inflammatory and infectious cardiac conditions. The chapter concludes with peripheral vascular pathology including atherosclerotic arterial disease manifesting as claudication and venous thromboembolism managed through anticoagulation strategies.