Cardiology
Core framework
Approach every cardiac stem by fixing the syndrome first (acute coronary syndrome, acute heart failure, syncope, arrhythmia, valvular presentation) and then the haemodynamic state. Know the universal management triad for ACS: aspirin plus a P2Y12 inhibitor, anticoagulation, and reperfusion within time targets (primary PCI within 120 minutes of first medical contact where achievable). Understand heart failure by ejection fraction, the four prognostic pillars in HFrEF (ACE inhibitor/ARNI, beta-blocker, mineralocorticoid antagonist, SGLT2 inhibitor), and the distinction between HFpEF and constrictive/restrictive physiology.
Concepts examiners test
Valve lesion haemodynamics and their bedside signs; ECG pattern recognition (Wellens, Brugada, WPW pre-excitation, long QT, hyperkalaemia); pericardial tamponade physiology (pulsus paradoxus, electrical alternans); infective endocarditis Duke criteria and when to operate; anticoagulation in atrial fibrillation by CHA2DS2-VASc; and the hypertensive emergency versus urgency distinction.
Traps
- Aortic stenosis + syncope is a surgical/valve problem, not a rhythm problem - do not anchor on vasovagal.
- Normal troponin does not exclude unstable angina; serial sampling and clinical risk scores matter.
- Digoxin toxicity is worsened by hypokalaemia and renal impairment; check levels and potassium.
- Do not give nitrates in right ventricular infarction or severe aortic stenosis.
- Beta-blockers are contraindicated in acute decompensated heart failure and in cocaine-associated chest pain.
Worked rule of thumb
A patient with crushing chest pain, ST elevation in II, III, aVF and hypotension with clear lungs: infer right ventricular involvement; treat with cautious fluids, avoid nitrates and diuretics, and proceed to urgent revascularisation. Hypotension with clear lungs after inferior MI should prompt a right-sided ECG and bedside echo rather than a reflex diuretic.