Coronary syndromes, arrhythmias, valvular disease, heart failure, congenital defects, and vascular conditions — core content for MRCP, PLAB, and UKMLA.
Permanent dilatation of the abdominal aorta to ≥3 cm, most commonly infrarenal. Usually asymptomatic until rupture, which carries ~80% overall mortality. UK NHS screening programme for men at age 65.
Spectrum of acute myocardial ischaemia encompassing unstable angina, NSTEMI, and STEMI. Caused by atherosclerotic plaque rupture with thrombus formation.
Rapid onset or worsening of heart failure symptoms requiring urgent medical intervention. May present as de novo acute HF or acute decompensation of chronic HF.
Sudden decrease in limb perfusion threatening tissue viability, requiring emergency revascularisation within 6 hours to prevent irreversible damage and limb loss. Causes include embolism and thrombosis in situ.
Inflammation of the pericardium causing characteristic sharp chest pain relieved by sitting forward, with widespread saddle-shaped ST elevation on ECG. Most cases are idiopathic/viral and self-limiting.
Pharmacological prevention and treatment of thromboembolic disease using parenteral (heparin) and oral (warfarin, DOACs) agents. Underpins management of AF, VTE, and mechanical heart valves.
Life-threatening emergency caused by a tear in the aortic intima allowing blood to enter the media, creating a false lumen. Type A involves ascending aorta requiring emergency surgery; Type B involves descending aorta managed medically.
Retrograde blood flow from the aorta into the left ventricle during diastole due to incompetent aortic valve closure. Causes include bicuspid valve, aortic root dilatation, and infective endocarditis.
Progressive narrowing of the aortic valve orifice causing left ventricular outflow obstruction. Most commonly caused by degenerative calcification in the elderly or bicuspid aortic valve in younger patients.
Inherited cardiomyopathy characterised by fibro-fatty replacement of the right ventricular myocardium, predisposing to ventricular arrhythmias and sudden cardiac death, particularly during exercise.
Commonest sustained cardiac arrhythmia, characterised by rapid, irregular atrial activation replacing normal sinus rhythm. Major risk factor for stroke requiring anticoagulation assessment.
Macro-re-entrant atrial tachycardia with regular atrial rate ~300 bpm, typically with 2:1 AV block giving ventricular rate ~150 bpm. Characterised by sawtooth flutter waves on ECG.
Congenital defect in the interatrial septum allowing left-to-right shunting. Secundum ASD is the most common type. Often presents in adulthood with dyspnoea, AF, or paradoxical embolism.
Inherited cardiac channelopathy characterised by a distinctive coved ST elevation in V1-V3 with risk of ventricular fibrillation and sudden cardiac death, typically in young men.
Conduction delay or block in one of the bundle branches causing widened QRS (≥120 ms) with characteristic morphology. LBBB may indicate structural heart disease; RBBB can be a normal variant.
Cessation of effective cardiac mechanical activity confirmed by absence of pulse and responsiveness. Managed according to Resuscitation Council UK ALS guidelines with CPR, defibrillation for shockable rhythms, and reversible cause correction.
Structured programme of exercise, education, and psychological support for patients recovering from cardiac events or procedures. Reduces cardiovascular mortality and hospital readmissions.
Life-threatening compression of the heart by fluid accumulation in the pericardial space, impairing diastolic filling and reducing cardiac output. Requires emergency pericardiocentesis.
Systematic evaluation of an individual's risk of developing atherosclerotic cardiovascular disease over 10 years. QRISK3 is the recommended tool in the UK, guiding decisions on statin therapy and lifestyle interventions.
Inherited arrhythmia syndrome characterised by exercise or emotion-triggered bidirectional or polymorphic ventricular tachycardia in the absence of structural heart disease or QT prolongation.
Congenital narrowing of the aorta, typically at the isthmus just distal to the left subclavian artery near the ligamentum arteriosum. Causes upper limb hypertension with reduced lower limb pulses.
Complete failure of conduction between atria and ventricles (third-degree AV block) with independent atrial and ventricular rhythms. Requires urgent pacing in most acquired cases.
Chronic fibrotic thickening and calcification of the pericardium leading to impaired diastolic filling and progressive right heart failure. Often presents insidiously with ascites and oedema.
Blood clot formation in the deep venous system, most commonly in the lower limbs. Major risk is pulmonary embolism. Diagnosed with D-dimer and compression ultrasonography; treated with anticoagulation.
Left ventricular dilatation and systolic dysfunction not explained by coronary artery disease or abnormal loading conditions. The most common cardiomyopathy and a leading indication for heart transplantation.
Clinical syndrome where the heart is unable to pump sufficiently to meet the body's metabolic demands, or can only do so at elevated filling pressures. Classified by ejection fraction.
Heart failure with LVEF ≥50%, characterised by diastolic dysfunction with impaired ventricular relaxation and filling. Accounts for ~50% of all heart failure cases.
Elevated blood lipid levels (cholesterol and/or triglycerides) representing a major modifiable cardiovascular risk factor. High-intensity statin therapy is the cornerstone of management per NICE CG181.
Sustained elevation of systemic arterial blood pressure (clinic BP ≥140/90 mmHg or ABPM/HBPM ≥135/85 mmHg). Affects ~30% of UK adults and is the leading modifiable risk factor for cardiovascular disease.
Severe hypertension (usually SBP >180 and/or DBP >120 mmHg) with acute end-organ damage requiring immediate but controlled BP reduction.
Inherited cardiac condition with asymmetric LV hypertrophy (≥15 mm) not explained by loading conditions. The most common cause of sudden cardiac death in young athletes.
Retrograde blood flow from the left ventricle to the left atrium during systole due to incompetent mitral valve closure. The most common valvular lesion in developed countries.
Narrowing of the mitral valve orifice obstructing blood flow from the left atrium to the left ventricle. Almost exclusively caused by rheumatic heart disease in the UK.
Displacement of one or both mitral valve leaflets into the left atrium during systole by ≥2 mm. The most common valve abnormality, usually benign but may cause significant mitral regurgitation.
Inflammation of the myocardium, most commonly viral, presenting with chest pain, heart failure, or arrhythmias. Cardiac MRI is the gold standard non-invasive investigation.
Persistence of the fetal communication between the aorta and pulmonary artery after birth. Causes continuous left-to-right shunting with a characteristic continuous 'machinery' murmur.
Atherosclerotic narrowing of the peripheral arteries, most commonly affecting the lower limbs, causing intermittent claudication and, in severe cases, critical limb ischaemia with rest pain and tissue loss.
Obstruction to right ventricular outflow at the level of the pulmonary valve, most commonly congenital. Usually well tolerated; severe cases may require balloon valvuloplasty.
Blood pressure remaining above target despite optimal doses of three antihypertensive agents including a diuretic. Affects ~10-15% of treated hypertensives.
Rare cardiomyopathy characterised by impaired ventricular filling due to increased myocardial stiffness with normal or near-normal wall thickness and systolic function. Most commonly caused by amyloidosis.
Chronic valvular heart disease resulting from acute rheumatic fever following Group A streptococcal pharyngitis. Mitral valve is most commonly affected. Declining in UK but still prevalent globally.
Intermittent failure of conduction of atrial impulses to the ventricles, classified as Mobitz type I (Wenckebach) with progressive PR prolongation or Mobitz type II with fixed PR and dropped beats.
Dysfunction of the sinoatrial node causing a combination of inappropriate sinus bradycardia, sinus pauses/arrest, and alternating tachycardia-bradycardia. Most common indication for pacemaker in elderly.
Predictable chest pain/discomfort caused by myocardial ischaemia during exertion or stress, relieved by rest or GTN. Due to fixed atherosclerotic coronary artery stenosis.
ST-elevation myocardial infarction caused by complete thrombotic occlusion of a coronary artery, resulting in transmural myocardial necrosis requiring emergency reperfusion.
Umbrella term for tachyarrhythmias originating above the ventricles, most commonly AVNRT and AVRT. Presents as regular narrow-complex tachycardia at 140-250 bpm.
Transient loss of consciousness due to transient global cerebral hypoperfusion, characterised by rapid onset, short duration, and spontaneous complete recovery. Most commonly vasovagal (neurally mediated).
Transient LV systolic dysfunction with apical ballooning, typically triggered by emotional or physical stress, mimicking acute MI but with unobstructed coronary arteries. Also known as stress cardiomyopathy.
Most common cyanotic congenital heart disease comprising four defects: VSD, overriding aorta, RVOT obstruction, and RV hypertrophy. Presents with cyanosis and 'tet spells' in infancy.
Dilatation of the thoracic aorta to ≥150% of normal diameter. Often asymptomatic, with risk of rupture and dissection. Frequently associated with connective tissue disorders and bicuspid aortic valve.
Polymorphic ventricular tachycardia occurring in the context of QT prolongation, characterised by twisting of the QRS axis around the isoelectric baseline. A life-threatening arrhythmia requiring urgent treatment.
Backward flow of blood from the right ventricle into the right atrium during systole. Most commonly secondary (functional) due to RV dilatation from pulmonary hypertension or left-sided heart disease.
Dilated, tortuous superficial veins of the lower limbs resulting from incompetent venous valves. Common and usually cosmetic, but may cause symptoms or progress to chronic venous insufficiency.
Chaotic, disorganised ventricular electrical activity producing no effective cardiac output. A shockable cardiac arrest rhythm requiring immediate defibrillation.
Congenital defect in the interventricular septum allowing left-to-right shunting. The most common congenital heart defect overall. Small VSDs often close spontaneously; large VSDs require surgical repair.
Wide-complex tachycardia (QRS ≥120ms, rate >100 bpm) originating from the ventricles. Potentially life-threatening, may degenerate into VF. Most commonly occurs in structural heart disease.