Part I:The Patient Presents With 1
1.Chest Pain 3
Differential diagnosis of chest pain 3
History to focus on the differential diagnosis of chest pain 3
Examination of patients who have chest pain 4
Investigation of patients who have chest pain 5
Preface 5
Central chest pain at rest of recent onset in an ill patient 7
Differential diagnosis of dyspnoea 11
History to focus on the differential diagnosis of dyspnoea 11
2.Dyspnoea 11
Examination of dyspnoeic patients 12
Investigation of dyspnoeic patients 13
Dyspnoea at rest of recent onset in an ill patient 15
3.Syncope 19
Differential diagnosis of syncope 19
History to focus on the differential diagnosis of syncope 19
Examination of patients who present with syncope 20
Investigation of patients who present with syncope 21
Syncope of recent onset in an ill patient 22
Differential diagnosis of palpitations 25
History to focus on the differential diagnosis of palpitations 25
4.Palpitations 25
Examination of patients who have palpitations 26
Investigation of patients who have palpitations 27
5.Ankle Swelling 31
Differential diagnosis of oedema 31
History to focus on the differential diagnosis of ankle swelling 32
Examination of patients who have oedema 32
Investigation of patients who have oedema 34
Important aspects 34
Differential diagnosis of a heart murmur 37
History to focus on the differential diagnosis of a heart murmur 37
6.Heart Murmur 37
Examination of patients who have a heart murmur 39
Investigation of patients who have a heart murmur 42
7.High Blood Pressure 43
Differential diagnosis 43
History to focus on the differential diagnosis of high blood pressure 43
Examination of patients who have high blood pressure 44
Investigation of patients who have high blood pressure 46
8.Fever Associated With A Cardiac Symptom or Sign 49
Differential diagnosis 49
History to focus on the differential diagnosis of fever 49
Examination of patients who have a fever associated with a cardiac symptom or sign 50
Investigation of patients who have a fever associated with a cardiac symptom or sign 52
Part II:History, Examination, and Common Investigations 55
9.History 57
Aim of history taking 57
Presenting complaint 57
Systems review 60
Allergies 62
Family History 62
Social history 62
How to begin the examination 65
Observation 65
10.Examination 65
Examination of the hands 66
Examination of the pulse 66
Take the blood pressure 66
Examination of the face 67
Examination of the jugular venous pressuer 67
Examination of the praecordium 68
Finishing off the examination 70
11.How to Write a Medical Clerking 71
Documentation of the history 71
At the end of the clerking 73
Sample medical clerking 73
Documentation of the examination findings 73
12.Common investigations 77
Electrocardiography 77
Echocardiography 84
Myocardial perfusion imaging 86
Magnetic resonance imaging 87
Positron emission tomography 87
Cardiac catheterization 87
Part III:Diseases and Disorders 91
Clinical features of angina pectoris 93
Risk factors for coronary artery disease 93
Pathophysiology of angina pectoris 93
Definition of angina pectoris 93
13.Angina Pectoris 93
Investigation of angina pectoris 95
Management of angina pectoris 96
Unstable angina 100
Low molecular weight heparins 101
14.Acute Myocardial Infarction 103
Definition of acute myocardial infarction 104
Clinical features of acute myocardial infarction 104
Investigation of acute myocardial infarction 106
Management of acute myocardial infarction 107
Summary of management of ischaemic chest pain 111
Heart block after myocardial infarction 112
15.Supraventricular Tachyarrythmias 113
Definition of supraventricular tachyarrhythmias 113
Sinus tachycardia 113
Premature atrial ectopics 113
Nodal and junctional ectopics 113
Atrial tachycardia 114
Atrioventricular junctional tachycardia 115
Atrioventricular nodal re-entrant tachycardia 115
Wolff-Parkinson-White syndrome 116
Atrial fibrillation 117
Afrial flutter 117
Investigation of patients who have supraventricular tachyarrhythmisas 119
Drugs used to treat tachyarrhythmias 121
16.Ventricular Tachyarrhythmias 123
Definition of ventricular tachyarrhythmias 123
Ventricular ectopic beats 123
Ventricular tachycardia 124
Ventricular fibrillation 125
Torsades de pointes 126
Drugs used to treat ventricular tachycardia and fibrillation 127
Non-pharmacological treatments of ventricular tachyarrhythmias 128
Basic life support 131
17.Cardiac Arrest and Resuscitation 131
Advanced life support 134
18.Bradyarrhythmias 137
Definition of bradyarrhythmias 137
Sinus bradycardia 137
Sinus node disease 137
Atrioventricular block 138
Bundle branch block 141
Investigation of bradyarrhythmias 142
Pacemakers 143
Pathophysiology of cardiac failure 145
Definition of cardiac failure 145
19.Cardiac Failure 145
Causes of cardiac failure 147
Clinical features of cardiac failure 148
Examination of patients who have cardiac failure 149
Investigation of cardiac failure 150
Management of cardiac failure 151
20.Cardiomyopathy 157
Definition of cardiomyopathy 157
Dilated cardiomyopathy 157
Hypertrophic obstructive cardiomyopathy 158
Restrictive cardiomyopathy 160
Acute pericarditis 161
21.Pericarditis and Pericardial Effusion 161
Dressler s syndrome 163
Chronic constrictive pericarditis 163
Pericardial effusion 163
22.Valvular Heart Disease 165
Rheumatic fever 165
Mitral stenosis 166
Mitral regurgitation 168
Aortic stenosis 171
Aortic regurgitation 173
Tricuspid regurgitation 174
Assessing the severity of a valve lesion 174
Other valve lesions 176
Prosthetic heart valves 176
23.Infective Endocardifis 177
Definition of infective endocarditis 177
Epidemiology of infective endocarditis 177
Pathophysiology of infective endocarditis 178
Clinical features of infective endocarditis 179
Investigation of a patient who has infective endocarditis 180
Management of infective endocarditis 181
Complication of infective endocarditis 182
Monitoring of patients who have infective endocarditis 182
Causes of hypertension 183
24.Hypertension 183
Definition of hypertension 183
Clinical features of hypertension 184
Investigation of a patient who has hypertension 184
Management of hypertension 186
Phaeochromocytoma 187
25.Congenital Heart Disease 189
Definition of congenital heart disease 189
Causes of congenital heart disease 189
Complication of congenital heart disease 189
Atrial septal defect 190
Ventricular septal defect 192
Patent ductus arteriosus 193
Coarctation of the aorta 193
Other causes of congenital heart disease 195
Notes on pulmonary hypertension and Eisenmenger s syndrome 195
Part IV:Self-assessment 197
Multiple-choice questions 199
Short-answer questions 203
Patient management problems 206
MCQ answers 207
SAQ answers 208
Index 211