Cardiology Hot Topics

Here is a list of topics to make sure you have covered from cardiology. You can print this list and ensure you have practiced cases from each and that you are familiar with the NICE CKS guidelines for each of them.

Angina

Understand the differentiation between stable angina and acute coronary syndromes. Key knowledge areas include typical and atypical presentations, when to refer and the diagnostic tests available so you can explain to your patient. Management, depending on the urgency includes lifestyle factors and pharmacological treatments such as beta-blockers and calcium channel blockers. Emphasize health promotion strategies like smoking cessation, regular exercise, and a balanced diet.

Atrial Fibrillation: New Onset and Annual Medication Review

Focus on identifying new-onset atrial fibrillation and the importance of annual reviews. Know the CHA2DS2-VASc score for stroke risk assessment and appropriate anticoagulation choices, though in the exam you are likely for this to already be calculated for you. Nonetheless, you should be familiar with when to initiate anticoagulation and the different options. Also be familiar with the ORBIT score, which is a predictor of bleeding in patients taking anticoagulation for AF.

Discuss rate versus rhythm control strategies and the impact of lifestyle factors such as alcohol moderation on symptom management and disease progression.

Blackouts and Syncope

Recognize the common causes of syncope, including vasovagal syncope and orthostatic hypotension. Be aware of the red flags indicating cardiac syncope, which require urgent attention. Emphasize the importance of detailed patient history and physical examination in differentiating benign causes from serious ones. Family history is important here.

Chest Pain/ MI

Understand the clinical assessment of chest pain to distinguish between myocardial infarction and other causes. Although MSK chest pain is the most common type of chest pain in primary care, this may not be the case in the exam.

Key points include the use of the immediate management protocols, ECG interpretation, and the role of blood tests in diagnosis.

Discuss primary and secondary prevention strategies, including lifestyle and pharmacological interventions, depending on the scenario.

CVD Risk Assessment, Management and Prevention

This should include a holistic approach focusing on lifestyle factors, health promotion (including alcohol and smoking cessation), and medication when necessary. You should also be familiar with using evidence based scores such as QRISK2 and CHA2DVASC2.

Here you should also focus on lipid modification therapy, primary and secondary prevention of MI and stroke.

Deep Vein Thrombosis: Prevention, Management and Complications

Cover the risk factors, signs, and symptoms of DVT, along with prevention strategies, particularly in high-risk patients. Discuss the use of anticoagulants in management and the recognition of complications such as pulmonary embolism and post-thrombotic syndrome.

Erectile Dysfunction

Understand the causes, which can include vascular, neurological, hormonal, or psychological factors. Discuss the importance of assessing cardiovascular risk factors and other underlying conditions. Be aware of red flags such as loss of morning erections and gradual onset of dysfunction.

Be familiar with red flags such as gradual onset and loss of morning erections.

Giant Cell Arteritis

Focus on early symptoms like headache, scalp tenderness, and jaw claudication. Discuss the urgency of treatment and liaise with specialists at the hospital to prevent complications such as blindness. Most Ambulatory Care departments now accept referrals for possible GCA/ Temporal Arteritis.

Highlight the role of temporal artery biopsy in diagnosis as this is something they may want to do after you refer them. ESR can be useful in diagnosis as well, but this should not delay referral if vision is affected in any way.

Heart Failure: New Diagnosis and worsening chronic heart failure

Understand the diagnostic criteria, including clinical signs and the use of BNP/NT-proBNP levels. Management focuses on lifestyle factors, medication adherence, and monitoring for signs of decompensation.

You might also need to check they are on the correct dose of medication and if any of it needs titration up or down.

Beta blockers and ACE inhibitors are key medication that have been shown to improve prognosis in heart failure patients. All the heart failure patient should be on these unless contraindicated. If ACE inhibitors not tolerated, consider an ARB such as Candesartan, Losartan or Valsartan.

If symptoms persist, start either Spironolactone or Eplerenone as add on therapy unless contraindicated in high K+ or renal impairment.

Furosemide/ Bumetanide does not improve prognosis but can improve symptoms.

Dapagliflozin/ Empaglifozin and Entresto for heart failure are medications started by specialists but we should still be familiar with them, especially the SGLT-2s as they may be initiated by us if the patient also has diabetes.

Discuss the importance of multidisciplinary team involvement for optimal patient outcomes. This includes cardiac rehab, community heart failure nurses, etc.

Hypertension

Cover diagnosis, management, and when to consider secondary causes. Discuss the role of lifestyle interventions and the various classes of antihypertensives. Highlight considerations for special populations, such as those with renal impairment.

Hypertension in pregnancy including pre-eclampsia

Discuss the management strategies for hypertension in pregnancy, signs of pre-eclampsia, and its management. Emphasize the importance of regular monitoring and timely intervention to prevent adverse maternal and fetal outcomes.

Hypercholesterolaemia: Familial and acquired

Explain the differences between primary and secondary hypercholesterolaemia, focusing on genetic predispositions and lifestyle factors. Discuss management strategies including dietary advice, physical activity, and statin therapy.

Peripheral arterial disease

Cover the typical symptoms such as intermittent claudication and critical limb ischemia. Discuss risk factor management, exercise therapy, and when to refer to vascular for formal diagnosis and what the treatment options are, as the patient may ask. The majority of patients with PAD will either be current or ex-smoker. If still smoking, then smoking cessation is important to mention.

Polymyalgia rheumatica

Explain the typical presentation with bilateral shoulder and pelvic girdle pain and morning stiffness. Discuss diagnostic criteria and the rapid response to low-dose corticosteroids as a hallmark feature.

Pulmonary Embolism

Understand the risk factors, signs, and symptoms, and the use of diagnostic tools such as the Wells score and D-dimer testing. Always ask about leg pain (?DVT) as well and long haul travel/ long distance drives.

This could also be the first presentation of a malignancy, so enquire about constitutional symptoms and other red flags as you would normally.

Discuss immediate management protocols and long-term treatment strategies.

Stroke and TIA: Identification, Risk Assessment and Management + Prognosis

Know how to quickly identify symptoms of stroke and TIA for urgent management. Discuss the use of the ABCD2 score to assess the risk of subsequent stroke and the importance of secondary prevention measures.

Varicose veins

Discuss the common symptoms and complications like venous ulcers. Cover conservative management, such as compression stockings, and when to consider procedural interventions.