PULSE

"Please read more" - Yet in this day and age, very few do.

Clinicians don't pull up textbooks on the wards - we pull up OpenEvidence and UpToDate. Clinical decision-making tools have evolved and so should medical education.

Textbooks have traditionally provided a foundational source of "ground truth". However, in todays world with board exams and limited time, question banks such as Uworld or MKSAP have became the go-to for studying concepts. Question banks are fantastic but have certain limitations including:

1. exorbitant cost
2. lack of mobile friendly options
3. lack of community feedback
4. lack of customizability
5. (most importantly) lack of ability to retain information with spaced repetition

While many residency and fellowship programs are able to cover costs, some do not and the cost is easily hundreds of dollars, almost in the thousands. Sometimes there are easy-to-use mobile apps with the questions banks, while for others they simply don't exist. This makes it difficult to study on the go. Cards are not perfect, and the way we practice medicine changes. There should be some involvement by the community to reflect possible discrepancies in established practice patterns. The cards themselves should be able to be customized, so that for example you can add your own personal notes, or even create your own deck. And finally, spaced repetition is arguably the best way to retain information for the long term. Many times people will go through a question bank only to place their thoughts into an Anki deck. While there are several spaced repetition programs on the market, Anki is open source and the OG in this arena.

While theres an incredible and expanding breadth within the field of cardiology, this makes it difficult to know what exactly someone needs to know to be a practicing cardiologist. There are established resources for certain topics, e.g. Klein and Mayo videos for learning echocardiography. However, there is a lack of structure with learning core cardiology concepts. If you love opening the pdfs of the guidelines and can assimiliate its contexts with ease, you do not need this deck. For the rest of us, these series of decks should provide the core set of concepts that one needs to know to call him/herself a (good) cardiologist.

The PULSE series of decks is a small attempt to provide more structured teaching within residency and fellowship by:

1. providing a comprehensive set of the "what exactly am I supposed to know?" facts in a particular field
2. using the power of spaced repetition
3. being as accessible as possible
4. iterating on community suggestions in subsequent versions

This deck is primarily intended for the busy clinical cardiology fellow who values their time. As such, the questions are short, to the point, and exactly how you will see it relavent in a clinical practice. We dred the long, drawn-out vignettes that are common in standard practice banks - this is often a deterrant when studying on the go.

Make use of downtime during a shift, and you will considerably cut down studying outside the hospital. If it's 5 o'clock and your shift ends at 7, start going through cards. If you are in between cath lab cases, start going through cards. If you have a mandatory pointless lecture, start going through cards. And I dare not say it, but some of you may be brazen enough to take this out during rounds, but do this at your own risk.

The deck is named "PULSE" or "Practice Until Life-Threatening Symptoms Emerge" as a satirical reminder that there's much more to life than studying. The only true philosophy of this deck is that life is short - make the most of your time in fellowship and in life.

"Space we can recover, lost time never."

A big thank you to all the contributors of the ROMA CAT (Review Of Milestones And Cardiology Advancement Trials) deck whose work on cardiology trials made it clear that there was a significant need for a more structured approach to learning.

And to David Wang, who was shocked (and disappointed) that I came this far in training without using Anki. Sadly, you'll never see this deck but it wouldn't have been possible without you. Rest in peace.

David Wang, MD
Massachusetts General Hospital, Anesthesia, Class of 2024
Baylor College of Medicine, Class of 2020

Since we all love lawyers and lawyers love the name of this deck, a few points to be made. The name of this deck is satire, and we do not encourage anyone to actually study until life threatening symptoms emerge (not sure exactly how that would happen tbh).

This deck is NOT an official product of the American College of Cardiology (ACC), the American Heart Association (AHA), European Society of Cardiology (ESC), or any other professional society. While this resource references publicly available clinical guidelines, it has not been reviewed or certified by these organizations. All trademarks, service marks, and logos referenced belong to their respective owners.

This deck is for educational and informational purposes only. It is designed to assist in general knowledge and exam preperation. It does not constitute medical advice, diagnosis, or treatment. Clinical guidelines are subject to change. While every effort is made to ensure accuracy, the creator is not responsible for errors, omissions, or clinical outcomes.

This project is the personal intellectual property of the creator. It is not affiliated with, sponsored by, or endorsed by any hospital, university, or academic medical center. The views and content expressed herein do not reflect the official policies or positions of the creator's employer.

©2026 PULSE. This lite version is licensed under Creative Commons Attribution-Non Commercial-Share-Alike 4.0 International (CC BY-NC-SA 4.0).

What this means for you:

1. Share: You may copy and redistribute this deck in any format.
2. Adapt: You may remix, transform, and build upon these cards.
3. Non-Commercial: You may NOT use this lite version for commercial purposes or resale.
4. Share-Alike: If you modify this deck, you must distribute your version under this same license.

By suggesting edits, fixing typos, or sharing modified versions of these cards with the community, you allow PULSE to adapt and incorporate those improvements into any future versions of this project.