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Welcome to the Cardiovascular Medicine Sestion of MKSAP 191 In these pages, you will find updated information on risk factors for cardiovascular disease, diagnostic testing. coronary artery disease, heart failure, arrhythmias, valvular heart disease, myocardial disease, pericardial disease. diseases ofthe aorta. peripheral artery disease, and other clinical challenges. All of these topics are uniquely focused on the needs of generalists and subspecialists outside of cardiologr. MKSAP 19 strives to provide the clinical knowledge its learners need to navigate their longitudinal learning paths. MKSAP 19's core content contains essential, newly researched inlormation in 11 subspecialty areas of internal medicine created by dozens ol expert generalists and subspecialists. Development of MKSAP 19's syllabus and its 1200 all ne\ r, peer reviewed. psychometrically validated multiple choice questions (MCQs) has been informed by ABIM Certification and Maintenance of Certification (MOC) requirements, emerging internal medicine knowledge, and our learners' feedback. MKSAP 19 contin ues to include High Value Core (HVC) recommendations and MCQs, based on the concept of balancing clinical benefit with costs and harms. Hospital based internists can continue to trust that MKSAP's comprehensive hospitalist content, integrated throughout the syllabus, and hospitalist focused MCQs, specially designated with the blue hospitalist icon (E). continue to align with the ABIM's Focused Practice in Hospital Medicine MOC exam blueprint and enhance Iearning for hospital-based practitioners.

MKSAP 19 strives to provide the clinical knowledge its learners need to navigate their longitudinal learning paths. MKSAP 19's core content contains essential, newly researched inlormation in 11 subspecialty areas of internal medicine created by dozens ol expert generalists and subspecialists. Development of MKSAP 19's syllabus and its 1200 all ne\ r, peer reviewed. psychometrically validated multiple choice questions (MCQs) has been informed by ABIM Certification and Maintenance of Certification (MOC) requirements, emerging internal medicine knowledge, and our learners' feedback. MKSAP 19 contin ues to include High Value Core (HVC) recommendations and MCQs, based on the concept of balancing clinical benefit with costs and harms. Hospital based internists can continue to trust that MKSAP's comprehensive hospitalist content, integrated throughout the syllabus, and hospitalist focused MCQs, specially designated with the blue hospitalist icon (E). continue to align with the ABIM's Focused Practice in Hospital Medicine MOC exam blueprint and enhance Iearning for hospital-based practitioners. More than ever before, MKSAP 19 Digital focuses on individualized learning and convenience. In addition to custom quizzes and interlinked questions and syllabus sections, MKSAP 19 Digital's new learning dashboard enables users to create a self directed learning plan, with topic specific links to resources within MKSAP and ACP Online. Multimedia formats, including whiteboard animations and clinical videos, will benefit our audiovisual learners, while MKSAP's Earn-as-You Go CME/MOC feature now allows subscribers to earn CME/MOC as they answer individual questions. In addition to Extension Questions and New Info Updates, MKSAP 19 Complete and Complete Green continue to offer Virtual Dx and Flashcards and now oiler brand new enhancements: MKSAP Quick Qs, a set of concise questions mapped to high-frequency/high importance areas of the ABIM blueprint mirroring boards-style MCQs, and an embedded digital version of Board Basics lor easy access exam prep.

More than ever before, MKSAP 19 Digital focuses on individualized learning and convenience. In addition to custom quizzes and interlinked questions and syllabus sections, MKSAP 19 Digital's new learning dashboard enables users to create a self directed learning plan, with topic specific links to resources within MKSAP and ACP Online. Multimedia formats, including whiteboard animations and clinical videos, will benefit our audiovisual learners, while MKSAP's Earn-as-You Go CME/MOC feature now allows subscribers to earn CME/MOC as they answer individual questions. In addition to Extension Questions and New Info Updates, MKSAP 19 Complete and Complete Green continue to offer Virtual Dx and Flashcards and now oiler brand new enhancements: MKSAP Quick Qs, a set of concise questions mapped to high-frequency/high importance areas of the ABIM blueprint mirroring boards-style MCQs, and an embedded digital version of Board Basics lor easy access exam prep. Language can be imprecise and imperfect, but MKSAP 19's Editors and contributors commit to using language and images that support ACP's commitment to being an anti-racist organization that supports diversity, equity, and inclusion throughout health care and health education. ACP also continues to ensure diversity among MKSAP's physician contributors. When appropriate, the MKSAP Editors also rely on MKSAP 19 Digital's expanded use of multimedia enhancements, including video and audio. to explore and more fully explain issues surrounding the presentation of MKSAP 19 clinical content as it relates to race and ethnicity. MKSAP 19 users are encouraged to contact the Editors at mksap-editorspacponline.org to help us identify opportunities for improvement in this area. On behall ol the many internists and editorial staff who have helped us create our new edition, we are honored that you have chosen to use MKSAP 19 to meet your lifelong learning needs. Sincerely, Davoren Chick, MD, FACP Editor-in-Chief Senior Vice President Medical Education Division American College of Physicians il

Cardiovascu lar Medicine Committee Sreekanth Vemulapalli, MD Director, Cardiac Diagnostic Unit and Echocardiography Andrew Wang, MD, Section Editor Laboratories Professor of Medicine Associate Director for Healthcare Delivery Transformation Vice Chief for Clinical Affairs l Division of Cardiologz Division of Cardiologz i Duke University Medical Center ; Duke University Medical Center Durham. North Carolina i Durham. North Carolina b GregoryW Barsness, MD i

Committee Sreekanth Vemulapalli, MD Director, Cardiac Diagnostic Unit and Echocardiography Andrew Wang, MD, Section Editor Laboratories Professor of Medicine Associate Director for Healthcare Delivery Transformation Vice Chief for Clinical Affairs l Division of Cardiologz Division of Cardiologz i Duke University Medical Center ; Duke University Medical Center Durham. North Carolina i Durham. North Carolina b GregoryW Barsness, MD i b Assistant Professor of Medicine Editor-in-Chief Consultant, Departments of Cardiovascular Diseases Davoren Chick, MD, FACP t i. and Radiologr Senior Vice President, Medical Education : I Mayo Clinic College of Medicine and Sciences American College ol Physicians Rochester, Minnesota Philadelphia. Pennsylvania i. : R. Michael Benitez, MD i Professor of Medicine Senior Deputy Editor Associate Chief (Clinical) F I Patrick C. Alguire, MD, FACP I Division of Cardiovascular Medicine American College of Physicians l' University of Maryland School of Medicine Philadelphia, Pennsylvania t tI Baltimore, Maryland i Gerald S. Bloomfield, MD, MPH I Deputy Editor Associate Professor of Medicine and Global Health i Richard S. Eisenstaedt, MD, MACP I Division of Cardiologz Duke University Chair, Department of Medicine F Durham, North Carolina Abington Hospital, Jefferson Health t Abington, Pennsylvania b HeidiM. Connolly, MD Clinical Professor of Medicine I Professor of Medicine Sidney Kimmel Medical College at Thomas Jefferson i Department of Cardiovascular Diseases University I I Mayo Clinic College of Medicine and Sciences Philadelph ia. Pen nsylvan ia i Rochester, Minnesota t' W. Schuyler Jones, MD Cardiovascular Medicine Reviewers i Associate Professor of Medicine Ahmed Sami Abuzaid, MD, FACP, RPVI L Division of Cardiologr Yousaf Ali, MD, MS Duke University and Duke Clinical Research lnstitute [" Floyd W. Burke, MD, FACP I Durham, North Carolina i Joseph P. Carrozza, ir., It4D, FACP b Stuart D. Russell, MD, EACP Benjamin S. Citrin, MD, FACP t I Professor of Medicine Islam Y. Elgendy, MD, FACP t' Regional Director of Heart Failure David L. Fischman, MD, FACP It_. Division of Cardiologr D. R. Shanti Gunawardena, MD, PhD, FACP L" Duke University School of Medicine Richard Hahn, MD, FACP Ir Durham, North Carolina James Marsh, MD, FACP I Patrick G. o'Malley, MD, MPH, FACP BenjaminA. Steinberg, MD, MHS Kashif J. Piracha, MD, FACP Assistant Professor of Medicine Harish Raj Seetha Rammohan, MD, MRCP, FACP Cardiovascular Medicine Division \ l University of Utah Rahul Sharma, MD, FACP t Saurabh Sharma, MD, FACP h Salt Lake City, Utah

b Assistant Professor of Medicine Editor-in-Chief Consultant, Departments of Cardiovascular Diseases Davoren Chick, MD, FACP t i. and Radiologr Senior Vice President, Medical Education : I Mayo Clinic College of Medicine and Sciences American College ol Physicians Rochester, Minnesota Philadelphia. Pennsylvania i. : R. Michael Benitez, MD i Professor of Medicine Senior Deputy Editor Associate Chief (Clinical) F I Patrick C. Alguire, MD, FACP I Division of Cardiovascular Medicine American College of Physicians l' University of Maryland School of Medicine Philadelphia, Pennsylvania t tI Baltimore, Maryland i Gerald S. Bloomfield, MD, MPH I Deputy Editor Associate Professor of Medicine and Global Health i Richard S. Eisenstaedt, MD, MACP I Division of Cardiologz Duke University Chair, Department of Medicine F Durham, North Carolina Abington Hospital, Jefferson Health t Abington, Pennsylvania b HeidiM. Connolly, MD Clinical Professor of Medicine I Professor of Medicine Sidney Kimmel Medical College at Thomas Jefferson i Department of Cardiovascular Diseases University I I Mayo Clinic College of Medicine and Sciences Philadelph ia. Pen nsylvan ia i Rochester, Minnesota t' W. Schuyler Jones, MD Cardiovascular Medicine Reviewers i Associate Professor of Medicine Ahmed Sami Abuzaid, MD, FACP, RPVI L Division of Cardiologr Yousaf Ali, MD, MS Duke University and Duke Clinical Research lnstitute [" Floyd W. Burke, MD, FACP I Durham, North Carolina i Joseph P. Carrozza, ir., It4D, FACP b Stuart D. Russell, MD, EACP Benjamin S. Citrin, MD, FACP t I Professor of Medicine Islam Y. Elgendy, MD, FACP t' Regional Director of Heart Failure David L. Fischman, MD, FACP It_. Division of Cardiologr D. R. Shanti Gunawardena, MD, PhD, FACP L" Duke University School of Medicine Richard Hahn, MD, FACP Ir Durham, North Carolina James Marsh, MD, FACP I Patrick G. o'Malley, MD, MPH, FACP BenjaminA. Steinberg, MD, MHS Kashif J. Piracha, MD, FACP Assistant Professor of Medicine Harish Raj Seetha Rammohan, MD, MRCP, FACP Cardiovascular Medicine Division \ l University of Utah Rahul Sharma, MD, FACP t Saurabh Sharma, MD, FACP h Salt Lake City, Utah tt-

b Assistant Professor of Medicine Editor-in-Chief Consultant, Departments of Cardiovascular Diseases Davoren Chick, MD, FACP t i. and Radiologr Senior Vice President, Medical Education : I Mayo Clinic College of Medicine and Sciences American College ol Physicians Rochester, Minnesota Philadelphia. Pennsylvania i. : R. Michael Benitez, MD i Professor of Medicine Senior Deputy Editor Associate Chief (Clinical) F I Patrick C. Alguire, MD, FACP I Division of Cardiovascular Medicine American College of Physicians l' University of Maryland School of Medicine Philadelphia, Pennsylvania t tI Baltimore, Maryland i Gerald S. Bloomfield, MD, MPH I Deputy Editor Associate Professor of Medicine and Global Health i Richard S. Eisenstaedt, MD, MACP I Division of Cardiologz Duke University Chair, Department of Medicine F Durham, North Carolina Abington Hospital, Jefferson Health t Abington, Pennsylvania b HeidiM. Connolly, MD Clinical Professor of Medicine I Professor of Medicine Sidney Kimmel Medical College at Thomas Jefferson i Department of Cardiovascular Diseases University I I Mayo Clinic College of Medicine and Sciences Philadelph ia. Pen nsylvan ia i Rochester, Minnesota t' W. Schuyler Jones, MD Cardiovascular Medicine Reviewers i Associate Professor of Medicine Ahmed Sami Abuzaid, MD, FACP, RPVI L Division of Cardiologr Yousaf Ali, MD, MS Duke University and Duke Clinical Research lnstitute [" Floyd W. Burke, MD, FACP I Durham, North Carolina i Joseph P. Carrozza, ir., It4D, FACP b Stuart D. Russell, MD, EACP Benjamin S. Citrin, MD, FACP t I Professor of Medicine Islam Y. Elgendy, MD, FACP t' Regional Director of Heart Failure David L. Fischman, MD, FACP It_. Division of Cardiologr D. R. Shanti Gunawardena, MD, PhD, FACP L" Duke University School of Medicine Richard Hahn, MD, FACP Ir Durham, North Carolina James Marsh, MD, FACP I Patrick G. o'Malley, MD, MPH, FACP BenjaminA. Steinberg, MD, MHS Kashif J. Piracha, MD, FACP Assistant Professor of Medicine Harish Raj Seetha Rammohan, MD, MRCP, FACP Cardiovascular Medicine Division \ l University of Utah Rahul Sharma, MD, FACP t Saurabh Sharma, MD, FACP h Salt Lake City, Utah tt- i

Each single MKSAP 19 self assessment question qualifies for rigor in all ofits educational activities. To this end, and one quarter of a CME credit hour or ABIM MOC point. consistent with the policies of the ACP and the Accreditation Council for Continuing Medical Education (ACCME), con MKSAP 19 Subscribers can enter their self assessment question answers and submit for CME/MOC in two ways: tributors to all ACP continuing medical education activities are required to disclose all relevant financial relationships 1. Users of MKSAP 19 Complete who prefer to use their with any entily producing, marketing, re selling, or dis- print books and a paper answer sheet to study and tributing health care goods or services consumed by, or record their answers can use the printed answer sheet used on, patients. Contributors are required to use generic at the back ofthis book to record their answers. The names in the discussion of therapeutic options and are corresponding online answer sheets, which are avail required to identify any unapproved, off label. or inves able on the MKSAP 19 Resource Page, may be used to tigative use of commercial products or devices. Where a transcribe answers onto the online answer sheets. Users trade name is used, all available trade names for the same may then submit their answers to qualify for CME cred- product B?e are also included. If trade-name products man- its or MOC points (see below for information on Opting ufactured by companies with whom contributors have rela in for MOC). Users who prefer to record their answers tionships are discussed, contributors are asked to provide on a paper answer sheet should save their answer sheet evidence based citations in support ofthe discussion. The for future use. Users who study with MKSAP 19 print information is reviewed by the committee responsible for can also submit their answers directly within MKSAP 19 producing this content. lf necessary adjustments to topics Digital by accessing the self assessment questions dash or contributors' roles in content development are made to board and selecting the preferred subspecialty section balance the discussion. All relevant relationships are miti- to begin answering questions. gated. Readers ofthis content are asked to evaluate it for evi dence of commercial bias and send any relevant comments 2. Users of MKSAP 19 Digital can enter their answers within to mksap _editors 6r acponline. org so that future decisions the digital program by accessing the self assessment about content and contributors can be made in light of this questions dashboard and selecting the preferred subspe information. cialty section to begin answering questions and clicking the Submit CME button once they qualify for CME and are ready to submit. Learners should keep in mind their Mitigation of Conflicts yearly CME and MOC deadlines when determining the To mitigate all conflicts of interest and influences of vested appropriate time to submit. interests, ACP's content planners used best evidence and Learners' CME/MOC submission progress will be shown updated clinical care guidelines in developing content. on the MKSAP 19 Digital CME/MOC/CPD page. when such evidence and guidelines were available. A11 content underwent review by external peer reviewers not on the committee to ensure that the material was bal Opting in for MOC anced and unbiased. Contributors' disclosure information MKSAP 19 users can opt in for simultaneous submission of can be found with the list of contributors' names and CME and MOC points as they answer self-assessment ques those of ACP principal staff listed in the beginning of tions. To opt in, users will be required to complete a form this book. requesting their name, date of birth, and ABIM number. The MOC Opt-in Form will be presented during a user's first CME submission and needs to be completed only once. Language Reflecting Diversity, Equity, and lnclusion within MKSAP 19 MKSAP 19's Editors and contributors commit to using ABIM Maintenance of Certification Ianguage and images that support ACP's commitment to Successful completion of the CME activity, which includes being an anti racist organization that suppofts diversity. participation in the evaluation component, enables the par equig, and inclusion throughout health care and health ticipant to earn up to 300 medical knowledge MOC points education. ACP also continues to ensure diversity among in the ABIM's MOC program. It is the CME activity provider's MKSAP's physician-contributors. When appropriate. the responsibility to submit participant completion information MKSAP Editors will also rely on MKSAP 19 Digital's erpanded to ACCME for the purpose of granting MOC credit. use of multimedia enhancements, including video and audio, to explore and more fully explain issues surounding the pre- sentation of MKSAP 19 clinical content as it relates to race Disclosure Policy and ethnicity. MKSAP 19 users are encouraged to contact It is the policy of the American College of Physicians (ACP) the Editors at mksap editors4aacponline.org to help us iden- to ensure balance, independence, objectivity, and scientific tiff opportunities for improvement in this area.

Each single MKSAP 19 self assessment question qualifies for rigor in all ofits educational activities. To this end, and one quarter of a CME credit hour or ABIM MOC point. consistent with the policies of the ACP and the Accreditation Council for Continuing Medical Education (ACCME), con MKSAP 19 Subscribers can enter their self assessment question answers and submit for CME/MOC in two ways: tributors to all ACP continuing medical education activities are required to disclose all relevant financial relationships 1. Users of MKSAP 19 Complete who prefer to use their with any entily producing, marketing, re selling, or dis- print books and a paper answer sheet to study and tributing health care goods or services consumed by, or record their answers can use the printed answer sheet used on, patients. Contributors are required to use generic at the back ofthis book to record their answers. The names in the discussion of therapeutic options and are corresponding online answer sheets, which are avail required to identify any unapproved, off label. or inves able on the MKSAP 19 Resource Page, may be used to tigative use of commercial products or devices. Where a transcribe answers onto the online answer sheets. Users trade name is used, all available trade names for the same may then submit their answers to qualify for CME cred- product B?e are also included. If trade-name products man- its or MOC points (see below for information on Opting ufactured by companies with whom contributors have rela in for MOC). Users who prefer to record their answers tionships are discussed, contributors are asked to provide on a paper answer sheet should save their answer sheet evidence based citations in support ofthe discussion. The for future use. Users who study with MKSAP 19 print information is reviewed by the committee responsible for can also submit their answers directly within MKSAP 19 producing this content. lf necessary adjustments to topics Digital by accessing the self assessment questions dash or contributors' roles in content development are made to board and selecting the preferred subspecialty section balance the discussion. All relevant relationships are miti- to begin answering questions. gated. Readers ofthis content are asked to evaluate it for evi dence of commercial bias and send any relevant comments 2. Users of MKSAP 19 Digital can enter their answers within to mksap _editors 6r acponline. org so that future decisions the digital program by accessing the self assessment about content and contributors can be made in light of this questions dashboard and selecting the preferred subspe information. cialty section to begin answering questions and clicking the Submit CME button once they qualify for CME and are ready to submit. Learners should keep in mind their Mitigation of Conflicts yearly CME and MOC deadlines when determining the To mitigate all conflicts of interest and influences of vested appropriate time to submit. interests, ACP's content planners used best evidence and Learners' CME/MOC submission progress will be shown updated clinical care guidelines in developing content. on the MKSAP 19 Digital CME/MOC/CPD page. when such evidence and guidelines were available. A11 content underwent review by external peer reviewers not on the committee to ensure that the material was bal Opting in for MOC anced and unbiased. Contributors' disclosure information MKSAP 19 users can opt in for simultaneous submission of can be found with the list of contributors' names and CME and MOC points as they answer self-assessment ques those of ACP principal staff listed in the beginning of tions. To opt in, users will be required to complete a form this book. requesting their name, date of birth, and ABIM number. The MOC Opt-in Form will be presented during a user's first CME submission and needs to be completed only once. Language Reflecting Diversity, Equity, and lnclusion within MKSAP 19 MKSAP 19's Editors and contributors commit to using ABIM Maintenance of Certification Ianguage and images that support ACP's commitment to Successful completion of the CME activity, which includes being an anti racist organization that suppofts diversity. participation in the evaluation component, enables the par equig, and inclusion throughout health care and health ticipant to earn up to 300 medical knowledge MOC points education. ACP also continues to ensure diversity among in the ABIM's MOC program. It is the CME activity provider's MKSAP's physician-contributors. When appropriate. the responsibility to submit participant completion information MKSAP Editors will also rely on MKSAP 19 Digital's erpanded to ACCME for the purpose of granting MOC credit. use of multimedia enhancements, including video and audio, to explore and more fully explain issues surounding the pre- sentation of MKSAP 19 clinical content as it relates to race Disclosure Policy and ethnicity. MKSAP 19 users are encouraged to contact It is the policy of the American College of Physicians (ACP) the Editors at mksap editors4aacponline.org to help us iden- to ensure balance, independence, objectivity, and scientific tiff opportunities for improvement in this area. vl