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GEM - cardiovascular symptomatology

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Cardiovascular symptomatology GEM

Cardiovascular Problems are important because they are common, causing high levels of morbidity & mortality, resulting in considerable costs to society (1):

  • coronary Heart Disease Greatest Burden in terms of Mortality Worldwide
  • 50% of 45 year olds will die subsequently from coronary heart disease in UK
  • stroke commonest form of acquired disability
  • estimated direct health costs of cardiovascular problems are huge £1.75 billion on CHD and £1.65 stroke (1999 costs)
  • primary and Secondary Prevention aimed at reducing risk factors (blood pressure, cholesterol, smoking, aspirin, better diabetic control) leads to clinically and statistically significant reductions in morbidity and mortality
  • consulting rates for cardiovascular disease are increasing with an aging population and account for at least 931 per 10,000 person years at risk
  • current evidence is that management of cardiovascular disease and its risk factors is often sub optimal

This GEM cannot cover the whole 'knowledge base' of the nMRCGP exam. However this GEM seeks to highlight important areas of knowledge for the primary care clinician (GP or GP registrar).

With respect to chest pain:

  • Important causes of chest pain to consider include myocardial infarction; acute coronary syndrome; pulmonary embolism; oesophageal rupture

With respect to breathlessness

  • what is paroxysmal nocturnal dyspnoea?
  • what are some suggested causes of patient presenting with a history of chest pain and breathlessness?

With respect to ankle swelling

  • what are the causes of ankle swelling/lower limb swelling
  • what features are important in the history of ankle swelling when assessing a patient?

With respect to clinical features of peripheral arterial disease

  • calf claudication is a classic symptom of peripheral arterial disease. What other conditions should be considered in the differential diagnosis?

With respect to palpitations

  • when assessing the a patient presenting with a history of palpiations it is important to assess:

With respect to symptoms of cerbrovascular disease

  • what is amaurosis fugax?
  • clinical features of cerebrovascular disease vary with respect to arterial circulation involved, for example:

With respect to the patient with a history of syncope:


  1. Royal College of General Practitioners. Curriculum Statement 15.1 Cardiovascular Problems.

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