Cardiovascular Medicine
What this domain tests
Everyday management of hypertension, atrial fibrillation, heart failure and lipid disorders, plus recognition of the acutely unwell cardiac patient and safe referral from a community setting.
Core rules
- Confirm hypertension before treating. Clinic readings of 140/90 or above need out-of-office confirmation (ABPM or home series). Targets are generally below 140/85 clinic and below 135/85 at home, individualised in frailty.
- AF: stroke risk drives the decision. Use CHA₂DS₂-VASc; a DOAC is first-line for most, with dose reduction only for licensed criteria (age, weight, renal function) - under-dosing is a recognised error. Rate control with a beta-blocker or rate-limiting calcium channel blocker; consider rhythm control referral for symptomatic or young patients.
- Heart failure. Suspect on exertional breathlessness, orthopnoea and ankle swelling; check NT-proBNP before echo. Review ACE inhibitor/ARNI, beta-blocker, MRA and SGLT2 inhibitor, plus daily weights and NSAID avoidance.
- Lipids. Statin for established vascular disease regardless of cholesterol; use a risk calculator for primary prevention and discuss absolute benefit.
- Red flags. Crushing chest pain, pain with syncope or breathlessness, new murmur with fever, a cold pulseless limb - same-day emergency transfer, not a clinic appointment.
Worked example
A 68-year-old with a BP of 158/94 on three separate visits has an ABPM mean of 149/91. You start an ACE inhibitor, arrange bloods and a repeat in four weeks, add a calcium channel blocker if not at target, and calculate cardiovascular risk to decide on a statin. The ABPM step is what justifies the diagnosis and the lifelong medication.
Traps
- Diagnosing hypertension on a single clinic reading.
- Prescribing an anticoagulant without checking renal function and weight for DOAC dosing.
- Missing heart failure because the chest is clear and the patient is not obviously fluid overloaded.
- Attributing exertional symptoms to age without an ECG.