Curriculum

17 Sections
1548 Lessons
100 Days

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U01.01 Biochemistry
This biochemistry review for USMLE Step 1 covers essential topics including metabolism, enzymology, and molecular biology.
126
U01.02 Immunology
Prepare for USMLE Step 1 Immunology with a comprehensive review covering foundational concepts, immune system mechanisms, and key disorders to solidify your understanding and boost exam readiness.
42
U01.03 Microbiology
Review essential microbiology topics for the USMLE Step 1, covering key pathogens, mechanisms of disease, and antimicrobial principles critical for mastering infectious disease concepts.
172
U01.04 General Pathology
Explore key concepts in general pathology essential for the USMLE Step 1. This review covers fundamental principles, disease mechanisms, and clinical correlations to help you excel in your medical exam.
35
U01.05 Pharmacology
Master key pharmacology concepts for the USMLE Step 1 with a focus on drug mechanisms, therapeutic uses, adverse effects, and interactions essential for high-yield exam performance.
43
U01.06 Public Health Sciences
Review essential Public Health Sciences topics for the USMLE Step 1, covering epidemiology, biostatistics, health policy, and ethics to strengthen your understanding of foundational public health principles.
53
U01.07 Cardiovascular system
Comprehensive review of essential cardiovascular system topics to help you excel in the USMLE Step 1 exam, covering key concepts from anatomy to pathology.
73
U01.08 Endocrine system
Master essential concepts of the endocrine system for USMLE Step 1, covering hormone regulation, feedback mechanisms, and key disorders to boost your exam readiness.
51
U01.09 Gastrointestinal system
Review key topics in the gastrointestinal system for the USMLE Step 1, covering essential concepts in anatomy, physiology, pathology, and pharmacology to reinforce your understanding and test readiness.
131
U01.10 Hematology and Oncology
This review covers essential Hematology and Oncology topics for the USMLE Step 1, including hematopoiesis, coagulation, anemias, leukemias, lymphomas, and neoplastic syndromes.
148
U01.11 Musculoskeletal, Skin, and Connective Tissue
Review essential topics for the USMLE Step 1 Musculoskeletal, Skin, and Connective Tissue systems, covering anatomy, physiology, pathology, and pharmacology fundamentals critical for exam success.
178
U01.12 Neurology and Special Senses
Master the foundational concepts of Neurology and Special Senses with our USMLE Step 1 review, covering essential topics like neuroanatomy, neurophysiology, and sensory pathways.
143
U01.13 Psychiatry
Psychiatry for the USMLE Step 1 focuses on understanding the pathophysiology, diagnosis, and treatment of psychiatric disorders, with an emphasis on key concepts like neurotransmitter imbalances, mental health disorders, and pharmacology.
83
U01.14 Renal System
The Renal System review for USMLE Step 1 covers key concepts including renal physiology, nephron function, acid-base balance, electrolyte regulation, and renal pathology, crucial for understanding both normal and abnormal kidney functions.
81
U01.15 Reproductive System
The USMLE Step 1 Reproductive System review covers key concepts in human reproduction, including anatomy, physiology, endocrinology, and common pathologies affecting both male and female reproductive health.
124
U01.16 Respiratory System
The Respiratory System review for the USMLE Step 1 covers key concepts in anatomy, physiology, pathophysiology, and pharmacology essential for understanding respiratory diseases and treatments.
61
U01.17 Rapid Review
he USMLE Step 1 Rapid Review covers essential topics across multiple disciplines, providing a concise, high-yield overview to reinforce key concepts and optimize your exam preparation.
5

U01.07.040 Ischemic heart disease manifestations

Ischemic heart disease (IHD) encompasses a range of conditions caused by a reduction in blood flow to the myocardium, primarily due to coronary artery disease (CAD). The following sections describe the key manifestations, pathophysiology, and diagnostic features of ischemic heart disease.

1. Angina

Angina refers to chest pain due to ischemic myocardium caused by coronary artery narrowing or spasm. There is no myocyte necrosis in this condition.

Types of Angina

Type	Cause	Characteristics	ECG Findings	Treatment
Stable Angina	Atherosclerosis (≥ 70% occlusion)	Exertional chest pain, resolves with rest or nitroglycerin.	ST depression	Rest, nitroglycerin, lifestyle changes
Vasospastic (Prinzmetal) Angina	Coronary artery spasm	Occurs at rest, often triggered by cocaine, alcohol, or triptans.	Transient ST elevation	Ca²⁺ channel blockers, nitrates, smoking cessation
Unstable Angina	Thrombosis with incomplete occlusion	Increased frequency/intensity of chest pain, possible pain at rest.	ST depression, T-wave inversion	Hospitalization, antiplatelet therapy

Stable Angina

Caused by coronary artery narrowing due to atherosclerosis (≥ 70% occlusion).
Symptoms: Exertional chest pain in the classic distribution (e.g., substernal).
ECG: ST depression.
Treatment: Rest, nitroglycerin.

Vasospastic (Prinzmetal or Variant) Angina

Caused by coronary artery spasm, occurring at rest.
Risk Factors: Smoking (primary), not hypertension or hypercholesterolemia.
Triggers: Cocaine, alcohol, triptans.
ECG: Transient ST elevation.
Treatment: Ca²⁺ channel blockers, nitrates, smoking cessation (if applicable).

Unstable Angina

Caused by thrombosis with incomplete coronary artery occlusion.
Symptoms: Chest pain increases in frequency or intensity, or occurs at rest.
ECG: ST depression and/or T-wave inversion, no elevation of cardiac biomarkers.
Treatment: Hospitalization, antiplatelet therapy, and monitoring.

2. Coronary Steal Syndrome

Coronary steal syndrome occurs when blood is shunted away from ischemic myocardial tissue during vasodilation, exacerbating ischemia.

Pathophysiology: Distal to a coronary stenosis, vessels are maximally dilated at baseline. Administration of vasodilators (e.g., dipyridamole, regadenoson) dilates normal vessels, redirecting blood flow away from areas perfused by stenosed vessels, leading to ischemia in the myocardium.
Significance: This phenomenon forms the basis of pharmacologic stress testing with coronary vasodilators.

3. Sudden Cardiac Death

Sudden cardiac death refers to death due to cardiac causes within one hour of the onset of symptoms, commonly caused by a lethal arrhythmia such as ventricular fibrillation (VF).

Associated Conditions: CAD (up to 70% of cases), cardiomyopathies (hypertrophic, dilated), and hereditary ion channelopathies (e.g., long QT syndrome, Brugada syndrome).
Prevention: Implantable cardioverter-defibrillator (ICD).

4. Chronic Ischemic Heart Disease

Chronic ischemic heart disease leads to progressive heart failure (HF) over many years due to sustained ischemic myocardial damage.

Pathophysiology: Long-term damage to the myocardium from ischemia results in heart failure symptoms, typically presenting in the later stages of ischemic heart disease.

5. Myocardial Infarction (MI)

MI is most commonly caused by the rupture of an atherosclerotic plaque, leading to acute thrombosis and myocardial injury. The extent and location of infarction can be assessed using cardiac biomarkers.

Types of Myocardial Infarction

Type	Cause	ECG Findings	Affected Myocardial Region
NSTEMI (Non-ST Elevation MI)	Subendocardial infarcts (inner 1/3 of myocardial wall)	ST depression	Subendocardial (inner layers of myocardium)
STEMI (ST Elevation MI)	Transmural infarcts (full-thickness myocardial wall)	ST elevation, pathologic Q waves	Transmural (full-thickness of the myocardial wall)

NSTEMI

Cause: Subendocardial infarction (inner 1/3 of the myocardial wall).
ECG: ST depression.
Markers: Elevated cardiac biomarkers (e.g., CK-MB, troponins).

STEMI

Cause: Transmural infarction (full-thickness myocardial wall).
ECG: ST elevation and pathologic Q waves.
Markers: Elevated cardiac biomarkers.

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USMLE Step 1 Review Series