Kardiovaskular
Core concepts
Master the acute coronary syndrome pathway: ischaemic chest pain, ECG territory mapping (anterior V1–V4, inferior II/III/aVF, lateral I/aVL/V5–V6), and the distinction between STEMI (reperfusion now) and NSTEMI/unstable angina (risk-stratify, anticoagulate, early invasive). Know heart failure phenotypes by ejection fraction and the drugs that change mortality (ACE inhibitors/ARBs, beta-blockers, mineralocorticoid antagonists, SGLT2 inhibitors). Understand valvular disease by murmur timing and manoeuvres, hypertension staging and target-organ damage, and arrhythmias: atrial fibrillation anticoagulation by CHA2DS2-VASc, and wide-complex tachycardia as VT until proven otherwise.
Traps
Questions reward the next step, not the definitive diagnosis. A patient with STEMI and cardiogenic shock needs reperfusion, not just inotropes. Do not give a beta-blocker in acute decompensated heart failure or suspected cocaine-related ischaemia. Remember that a normal ECG does not exclude ACS, and that troponin rises in pulmonary embolism and renal failure. Distinguish pericarditis (diffuse ST elevation, PR depression, pleuritic pain worse supine) from STEMI (reciprocal changes).
Worked example
A 58-year-old smoker has 40 minutes of crushing retrosternal pain, diaphoresis, and ST elevation in II, III, aVF with reciprocal depression in I and aVL. Diagnosis: inferior STEMI. Rule of thumb: give aspirin and arrange primary PCI; avoid nitrates if right ventricular infarction is suspected (hypotension after nitrates). Inferior leads look at the heart's underside, supplied by the RCA in most people.