Series editor’s foreword v
Prefaces vi
Acknowledgement vii
Series editor’s acknowledgement viii
Rapid UKMLA Index ix

Section 1 The basics 1
1 Cardiac anatomy, physiology and development 3

Why do we need a cardiovascular system? 3
Anatomy of the heart and great vessels 3
Development of the heart and great vessels 11

2 The cardiac cycle, control of cardiac output and
haemodynamic regulation 15
Cardiac electrophysiology 15
The cardiac cycle 19
Control of cardiac output 22
Haemodynamics and vascular function 24
Integrated control of the cardiovascular system
and cardiovascular reflexes 27

3 ECG interpretation 35
The electrocardiogram 35
Presenting an ECG 39

4 Other cardiac investigations 41
Common cardiac blood tests 41
Exercise ECG 41
Echocardiography 43
Computed tomography coronary angiography 45
Cardiac magnetic resonance 46
Cardiac catheterization 46
Radionuclide imaging 47

Section 2 Presenting complaints 49

5 History and examination of the cardiovascular system 51
History 51
Clinical examination 51
Cardiovascular examination summary 57

6 Chest pain 59
Differential diagnosis 59
History 59
Examination 61
Investigations 62
New onset central chest pain at rest in an ill patient 64

7 Breathlessness and peripheral oedema 67
Differential diagnosis 67
History 67
Examination 69
Investigation 70
Recent onset dyspnoea at rest in an ill patient 72

8 Palpitations 75
Differential diagnosis 75
History 75
Examination 76
Investigations 78
Palpitations in the unwell patient 80

9 Syncope 83
Differential diagnosis of syncope 83
History 83
Examination 85
Investigations 86
Reflex (neurally mediated) syncope 87
Syncope of recent onset in the unwell patient 87
Driving regulations in syncopal patients 89

10 Heart murmurs 91
Differential diagnosis 91
History 91
Examination 93
Investigations 95
Presenting your findings 98

Section 3 Clinical conditions 101

11 Atherosclerosis and its risk factors 103
Pathogenesis of atherosclerosis 103
Classification of ischaemic heart disease 104
Risk factors for atherosclerosis 107
Risk prediction and primary prevention of ischaemic
heart disease 107
Lipids and the cardiovascular system 108
Hypertension 111

12 Stable angina and acute coronary syndromes 123
Stable angina 123
Acute coronary syndromes 129
13 Heart failure 139
Pathophysiology of heart failure 139
Clinical features 141
Investigations 143
Management 145

14 Arrhythmias 151
Bradyarrhythmias 151
Supraventricular tachyarrhythmias 156
Ventricular arrhythmias 164
Antiarrhythmic drugs 169
Algorithms for management of arrhythmias 170
Cardiac arrest and resuscitation 171

15 Valvular disease 179
Rheumatic heart disease 179
Aortic stenosis 180
Aortic regurgitation 183
Mitral stenosis 185
Mitral regurgitation 188
Tricuspid disease 190
Pulmonary disease 192
Assessing the severity of a valve lesion 192
Prosthetic heart valves 192
Infective endocarditis 194

16 Diseases of the myocardium and pericardium 203
Diseases of the myocardium 203
Diseases of the pericardium 208

17 Congenital heart disease 213
Causes of congenital heart disease 213
Complications of congenital heart disease 214
Pregnancy risk assessment 215
Congenital defects with left-to-right shunts 215
Congenital defects with right-to-left shunts 219
Obstructive congenital defects 221
Other lesions in congenital heart disease 222

18 Vascular disease 225
Arterial disease 225
Venous disease 237

Self-Assessment 241
UKMLA High Yield Association Table 243
UKMLA Single Best Answer (SBA) Questions 249
UKMLA SBA Answers 263
OSCEs and Short Clinical Cases 277
Glossary 301
Index