Cardiology
Core concepts
Master the acute coronary syndrome pathway: ischaemic symptoms, serial high-sensitivity troponin with a clear rise/fall, ECG territory mapping, and risk stratification (GRACE). Know heart failure phenotypes by ejection fraction, the four pillars of HFrEF therapy (ARNI/ACEi, beta-blocker, MRA, SGLT2 inhibitor), and when diuretics relieve congestion rather than change prognosis. Be fluent in valvular auscultation (timing, manoeuvres: handgrip, Valsalva, squat-to-stand) and in the ECG patterns that demand urgent action: STEMI, Wellens, Brugada, long QT, complete heart block, wide-complex tachycardia.
Traps
Questions love the normal troponin drawn too early, the pulmonary embolism mimicking inferior STEMI, and pericarditis with PR depression and diffuse ST elevation. Aortic stenosis with a soft S2 and late-peaking murmur is easily missed. In AF, the trap is rate control versus anticoagulation - CHA2DS2-VASc drives the latter independently of rhythm. Remember that a normal BNP does not exclude heart failure with preserved EF, and that hypotension plus a new murmur means mechanical complication until proven otherwise.
Rule of thumb
For suspected ACS with a non-diagnostic first troponin, repeat at 1–3 hours and apply the delta, not the absolute value alone. For any wide-complex tachycardia in a haemodynamically unstable patient, synchronised cardioversion - do not spend time distinguishing VT from SVT with aberrancy.
Worked example
A 62-year-old smoker has 40 minutes of chest pain, inferior ST elevation, and hypotension. Inferior STEMI with right ventricular involvement is likely: give fluids cautiously, avoid nitrates and morphine, and arrange primary PCI.