GEM - Curriculum Statement 15.1 Cardiovascular Problems

Knowledge Base for the nMRCGP

Curriculum Statement 15.1 Cardiovascular Problems

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Symptoms

Key issues in the diagnosis of cardiovascular problems will be eliciting of the appropriate signs and symptoms and subsequent investigation and / or referral of people presenting with:

• chest pain (Cardiac causes e.g.ischaemic heart disease, pericarditis and aortic dissection versus non-cardiac causes e.g. chest wall/musculoskeletal, psychological, respiratory, gastrointestinal)
• breathlessness (heart failure, respiratory problems, thromboembolism, anaemia, obesity, malignancy)
• ankle swelling (heart failure,thromboembolism, venous stasis, varicose veins, DVT, leg ulcers, lymphoedema,anaemia, obesity, malignancy, hypoproteinamia)
• symptoms or signs thought to be due to peripheral vascular disease (arterial and venous)
  • clinical features of large vessel peripheral arterial disease
  • clinical features of small vessel peripheral arterial disease
  • different forms of peripheral venous disease
• palpitations and silent arrhythmias
• signs and symptoms of cerebrovascular disease
• collapse

Common and/or important conditions

• Coronary heart disease (angina, acute coronary syndromes, myocardial infarction, cardiac arrest)
• heart failure
• Arrhythmias (Ectopic beats, missed beats, atrial fibrillation & flutter, narrow & broad complex tachycardias, brady-arrythmias)
• Other heart disease (valve disease, cardiomyopathy, congenital)
• Peripheral vascular disease (arterial and venous)
• Cerebrovascular disease (stroke and TIA)
• Thromboembolic disease

Investigations

• Blood pressure measurement
• Electrocardiogram (12 lead ECG)
• 24 hour ambulatory blood pressure measurement
• Venous Dopplers and ABPI measurement
• Knowledge of secondary care investigations and treatment including echocardiography, 24 hour arrthymia monitoring, venography, invasive procedures such as angioplasty, coronary artery bypass grafting.

Treatment

• Treatment of people at risk from cardiovascular problems including specific management ofraised blood pressureand lipids
• Chronic disease management including specific disease management, systems of care, multidisciplinary team work for people with established cardiovascular problems, rehabilitation and also palliative care for those with end stage cardiac failure
• Communication with patients and their families and inter professional communication both within the PHCT and between primary and secondary care Emergency care
• Acute treatment of people presenting with cardiovascular problems or symptoms thought to be due to cardiovascular problems

Prevention

• This will involve the following risk factors
  • Blood Pressure
  • Lipids
  • Smoking
  • Other modifiable risk factors (including alcohol, exercise, obesityand diet)
  • Fixed factors: age ethnicity, sex and family history
  • Co-morbidities especially diabetes
  • Combining Risk Factors risk calculation and communicating risk