Cardiology
Ischaemic heart disease
Distinguish STEMI (ST elevation in contiguous leads, or posterior MI shown by V1–V3 depression) from NSTEMI/unstable angina, where troponin and risk scores drive the timing of angiography. Learn territory-to-artery mapping: II/III/aVF inferior (RCA), V1–V4 anterior (LAD), I/aVL/V5–V6 lateral (circumflex). A new left bundle branch block is no longer automatically treated as a STEMI equivalent - treat the patient, not the trace.
Heart failure and valves
Know HFrEF (EF ≤40%) versus HFpEF, and the four prognostic drug classes in HFrEF: ACE inhibitor/ARB or ARNI, beta-blocker, mineralocorticoid receptor antagonist and SGLT2 inhibitor. Diuretics relieve symptoms but do not alter prognosis. Aortic stenosis gives a slow-rising pulse with an ejection systolic murmur radiating to the carotids; mitral regurgitation gives a pansystolic murmur radiating to the axilla.
Arrhythmias
Regular narrow-complex tachycardia is usually AVNRT - vagal manoeuvres then adenosine. Irregular narrow-complex is atrial fibrillation: decide rate versus rhythm control, and anticoagulate according to CHA2DS2-VASc. Broad-complex tachycardia is ventricular tachycardia until proven otherwise, especially with structural heart disease; use synchronised cardioversion if unstable.
Pericardium and endocarditis
Pericarditis causes positional pleuritic pain with saddle-shaped ST elevation and PR depression - avoid anticoagulation. For endocarditis, take three sets of blood cultures before antibiotics and image with echocardiography.
Trap: attributing all chest pain with a normal ECG to anxiety; serial ECGs and troponin are mandatory. Rule of thumb: a patient with AF and a CHA2DS2-VASc of 2 or more (male) should be offered anticoagulation unless bleeding risk genuinely outweighs stroke risk - HAS-BLED does not veto treatment, it flags modifiable factors.