Cardiovascular Disorders
Core knowledge
Master hypertension (diagnosis, ABPM, target organ damage, first-line agents), ischaemic heart disease (stable angina vs ACS, TIMI/GRACE, dual antiplatelet therapy, reperfusion), heart failure (HFrEF vs HFpEF, ejection fraction, quadruple therapy), atrial fibrillation (CHA₂DS₂-VASc, HAS-BLED, anticoagulation), and dyslipidaemia (ASCVD risk, statin intensity).
Risk stratification
Use SCORE2/ASCVD calculators for primary prevention. Know that diabetes and CKD are risk enhancers. In secondary prevention, high-intensity statins and antiplatelet therapy are standard.
Clinical reasoning
- Chest pain: classify typical vs atypical; ECG within 10 minutes for suspected ACS; troponin at 0 and 1–3 hours (hs-cTn algorithms).
- Syncope: red flags - exertional, structural heart disease, family history of sudden death, abnormal ECG.
- Peripheral oedema/dyspnoea: differentiate HF, COPD, anaemia, venous insufficiency.
Traps
- Using CHA₂DS₂-VASc to decide whether to anticoagulate and HAS-BLED to identify modifiable bleeding risks - not to withhold anticoagulation.
- Prescribing beta-blockers in acute decompensated HF or ACE inhibitors in bilateral renal artery stenosis.
- Missing aortic dissection (tearing pain, pulse deficit, widened mediastinum) in a hypertensive patient.
- Confusing HFrEF (reduced EF, prognostic benefit from quadruple therapy) with HFpEF (diuretics, SGLT2 inhibitors).
Worked rule
A 68-year-old with AF and CHA₂DS₂-VASc = 3: anticoagulate (DOAC preferred in most), regardless of HAS-BLED, while correcting modifiable bleeding factors.