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Cardiology Guidelines Hub

Two views — quick single-liner summaries for fast reference, or the full detailed guideline library with direct source links.

✦ Curated & summarized by Dr. Ali Khan, MD · Interventional & Structural Cardiologist · NYU Langone Health

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Dr. Ali Khan's single-liner summaries of the most important cardiovascular guidelines — distilled to what actually changes practice. Each entry captures the core message in one or two sentences. For full recommendations, methodology, and evidence tables, click the source link. Last reviewed May 2026.

❤️ Preventive Cardiology & Risk Reduction 6 guidelines

Cholesterol / Blood Cholesterol Guideline

Start high-intensity statin for ASCVD; if LDL ≥70 mg/dL on max statin, add ezetimibe then PCSK9 inhibitor. Risk-enhancing factors and coronary calcium score (CAC) break ties in borderline-risk patients.

AHA · ACC · AACVPR · NLA · Multi-Society

Hypertension Guideline

BP ≥130/80 mmHg now Stage 1 HTN. Target <130/80 in most adults with CVD or high risk; lifestyle first in Stage 1 without risk factors, pharmacotherapy in Stage 2 or high-risk Stage 1.

ACC · AHA · Multi-Society

Primary Prevention of Cardiovascular Disease

Aspirin no longer routinely recommended for primary prevention over age 70 or with bleeding risk. Statins, BP control, and lifestyle are the pillars; shared decision-making guides aspirin in 40–70 year age group.

Chronic Coronary Disease (CCD)

Optimal medical therapy is the cornerstone; revascularization for symptoms despite OMT or high-risk anatomy. Routine PCI for stable CCD without ischemia does not improve outcomes (ISCHEMIA confirmed).

ACC · AHA · ACS · NLA · PCNA

Peripheral Artery Disease (PAD)

All PAD patients: statin + antiplatelet + smoking cessation. Supervised exercise therapy before revascularization for claudication; endovascular preferred over surgery for most limb-threatening ischemia with favorable anatomy.

ACC · AHA · SCAI · SVS · Multi-Society

Repair ascending aortic aneurysm ≥5.5cm (≥5.0cm in bicuspid/connective tissue disease). TEVAR for descending dissection with malperfusion; surveillance intervals based on aortic diameter and growth rate.

ACC · AHA · AATS · ACR · STS

⚡ Coronary Artery Disease & Acute Coronary Syndromes 5 guidelines

Acute Coronary Syndromes (ACS) — Unified STEMI + NSTEMI Guideline

Do NOT routinely pre-load P2Y12 in NSTEMI before knowing anatomy — 40% go to CABG. Primary PCI within 120 min for STEMI; complete revascularization preferred over culprit-only in hemodynamically stable multivessel STEMI.

ACC · AHA · ACEP · NAEMSP · SCAI — Replaces 2013 STEMI + 2014 NSTEMI

Coronary Artery Revascularization

CABG preferred for left main + multivessel CAD with high SYNTAX score or diabetes. FFR/iFR-guided PCI reduces unnecessary stenting and is Class I in stable lesions. IVUS/OCT guidance improves outcomes in complex PCI.

ACC · AHA · SCAI

Chest Pain Evaluation

0/1-hour hs-troponin algorithm safely rules in/out NSTEMI in most ED patients. HEART score guides disposition. CCTA preferred over functional testing in low-to-intermediate pretest probability chest pain without known CAD.

ACC · AHA · Multi-Society

Dual Antiplatelet Therapy (DAPT) Duration

After DES: minimum 6 months DAPT for stable CAD, 12 months post-ACS. Prolonged DAPT reduces MI but increases bleeding — individualize based on ischemic vs. bleeding risk. DAPT score helps guide duration.

ACC · AHA — Note: partially superseded by 2025 ACS guideline

High-Risk PCI — Operator & Institutional Requirements

Unprotected LM, last remaining vessel, and severely reduced EF PCI require on-site cardiac surgery capability, MCS availability, and experienced heart team. Prophylactic MCS should be planned pre-procedure, not inserted in crisis.

♥ Heart Failure & Cardiogenic Shock 4 guidelines

Heart Failure Guideline (HFrEF, HFmrEF, HFpEF)

The "Fantastic Four" for HFrEF: ACEi/ARB/ARNI + beta-blocker + MRA + SGLT2i — all Class I, start and uptitrate together. SGLT2i now Class I for HFmrEF and Class IIa for HFpEF. ICD for EF ≤35% despite ≥3 months GDMT.

AHA · ACC · HFSA

Cardiogenic Shock — SCAI Classification & Management

SCAI stages A–E define shock severity. Stage C+ requires immediate invasive hemodynamics (RHC) and consideration of MCS escalation. Impella supported by DanGer Shock for AMI-CS. VA-ECMO neutral in RCTs but used for biventricular failure.

SCAI · ACC 2025 Consensus

Hypertrophic Cardiomyopathy (HCM)

SCD risk calculation annually; ICD for prior cardiac arrest, sustained VT, or ≥2 risk factors. Mavacamten (myosin inhibitor) now approved for obstructive HCM symptomatic on beta-blocker. Septal reduction therapy for drug-refractory LVOTO.

Cardiac Amyloidosis (ATTR & AL)

Tc-PYP scan grade 2–3 + negative blood/urine immunofixation = ATTR-CM (no biopsy needed). Tafamidis (TTR stabilizer) reduces mortality in ATTR-CM; acoramidis approved 2024. Diagnose early — treatment is most effective before advanced remodeling.

ACC Expert Consensus

〜 Arrhythmias & Electrophysiology 4 guidelines

Atrial Fibrillation

Early rhythm control reduces CV outcomes (EAST-AFNET 4). Catheter ablation now Class IIa for first-line in paroxysmal/early persistent AF. Anticoagulate all CHA₂DS₂-VASc ≥2 (men) or ≥3 (women) — DOACs preferred over warfarin in non-valvular AF.

ACC · AHA · ACCP · HRS

Ventricular Arrhythmias & SCD Prevention

ICD for EF ≤35% with NYHA Class II–III on GDMT (primary prevention). Catheter ablation preferred over escalating AADs for recurrent VT in ischemic cardiomyopathy (VANISH2 2024 confirms). Avoid antiarrhythmics without ICD in high-risk structural heart disease.

AHA · ACC · HRS

Bradycardia & Cardiac Conduction Delay

PPM indicated for symptomatic SND or AV block (Class I). His bundle or left bundle branch pacing preferred over RV apical pacing in patients requiring frequent pacing — reduces pacing-induced cardiomyopathy. Consider upgrade in established RV-paced patients with new EF decline.

ACC · AHA · HRS

High-risk features (structural heart disease, abnormal ECG, exertional, family SCD history) mandate urgent evaluation. Implantable loop recorder is the diagnostic tool of choice for unexplained recurrent syncope after standard workup. Most syncope is vasovagal — no treatment needed beyond reassurance.

ACC · AHA · HRS

◆ Valvular Heart Disease & Structural Cardiology 5 guidelines

Valvular Heart Disease

TAVR preferred for aortic stenosis age >80 or high/intermediate surgical risk; SAVR or TAVR shared decision for low-risk. MitraClip (TEER) for severe primary MR with high surgical risk or anatomy suitable for repair. Heart team mandatory for all structural decisions.

Valvular Disease Focused Update — TEER, TTVR, TAVR Updates

TTVR (Evoque/TriClip) now incorporated for severe symptomatic TR with high surgical risk. Expanded TAVR indications in younger/low-risk patients. Transcatheter mitral VIV for bioprosthetic failure — SURVIV trial pending.

ACC · AHA 2024 Focused Update

Left Atrial Appendage Occlusion (Watchman)

LAA closure is a reasonable alternative to OAC in AF patients with high bleeding risk or OAC intolerance (Class IIb). CHAMPION-AF 2026 results will likely upgrade this recommendation. Post-procedure: DAPT 45 days then aspirin long-term.

SCAI · HRS · ACC · AHA

Adults with Congenital Heart Disease — PFO & ASD

PFO closure Class IIa for cryptogenic stroke age <60 with high-risk PFO features (large shunt, ASA). ASD device closure for ostium secundum ASD with significant left-to-right shunt (Qp:Qs >1.5) or RV volume overload.

ACC · AHA · HRS · ISACHD · SCAI

Infective Endocarditis

Modified Duke criteria; blood cultures x3 before antibiotics if hemodynamically stable. Surgery within 7 days for heart failure, uncontrolled infection, or high embolic risk (vegetation >10mm). TTE first; TEE for prosthetic valve or TTE non-diagnostic.

⇄ Pulmonary Embolism, VTE & Vascular Disease 3 guidelines

Venous Thromboembolism (VTE) — PE & DVT

DOACs (apixaban, rivaroxaban) preferred over warfarin for most PE/DVT. Intermediate-high-risk PE: anticoagulation alone is standard; consider catheter-directed thrombolysis for hemodynamic deterioration. HI-PEITHO trial (2026) will define CDT role in submassive PE.

ASH · ISTH · ESC

Pulmonary Hypertension

Diagnose PH: mPAP >20 mmHg on RHC (updated threshold from 25 mmHg). Group 1 PAH: upfront combination therapy (PDE5i + ERA) or oral triple therapy in high-risk patients. Always rule out Group 2 (left heart) and Group 3 (lung) before PAH-specific therapy.

AHA · ACC · CHEST · PCNA

Repair ascending aorta ≥5.5cm; ≥5.0cm in bicuspid AV or connective tissue disease. Type A dissection = surgical emergency; Type B uncomplicated = medical management; Type B with malperfusion = TEVAR. Beta-blockers to target SBP <120 mmHg in all aortic disease.

ACC · AHA · Multi-Society

📡 Echocardiography, Nuclear & Cardiac Imaging 5 guidelines

Diastolic Function Evaluation

Grade II/III diastolic dysfunction if ≥3 of 4 abnormal: e/e' >14, septal e' <7 cm/s, TR Vmax >2.8 m/s, LA Vol index >34 mL/m². Indeterminate if 2 of 4 — add exercise stress echo. HFpEF requires positive LVEDP or PCWP elevation for diagnosis.

Valvular Regurgitation Grading

Severe MR: EROA ≥0.40 cm², RVol ≥60 mL. Severe TR: vena contracta >7mm, EROA ≥0.40 cm². 3D echo and PISA alone insufficient for torrential TR (Grade 5) — integrate hepatic vein reversal, RV size, and quantitative parameters. Cardiac MRI for indeterminate cases.

Cardiac Amyloid Nuclear Imaging (Tc-PYP)

Tc-PYP grade 2–3 + negative serum/urine immunofixation = ATTR-CM diagnosis without biopsy. H/CL ratio >1.5 at 1 hour confirms uptake. Any monoclonal protein = AL possible; proceed to biopsy. PYP negative does not rule out AL amyloid.

Noninvasive Testing AUC — Chest Pain & Stable CAD

CCTA is preferred for low-intermediate pretest probability stable chest pain without known CAD. Functional testing (stress echo, nuclear) preferred when known CAD or high pretest probability. Calcium score useful in borderline 10-year risk to guide statin initiation.

ACC · AHA · ASE · ASNC · SCCT · SCMR — Multi-Society AUC

CT Planning for Structural Heart Interventions

Pre-TAVR CT is mandatory: annular area sizing, coronary heights (critical <10–12mm), calcium distribution (LVOT calcium predicts AR), and ilio-femoral access assessment. Pre-TEER/TTVR: leaflet morphology, coaptation gap, annular dimensions for device sizing.

Summaries curated by Dr. Ali Khan, MD — Interventional & Structural Cardiologist, NYU Langone Health. These are single-liner distillations for quick clinical reference — not a substitute for the full guideline text. Each summary captures the primary practice-changing recommendation. Always consult the full guideline for complete recommendations, evidence grading, and clinical context. Last reviewed May 2026.

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