There has been increasing evidence of rhythm control in AF. This is what we know in 2024 and my approach.
Read moreMy approach to heart murmurs
Murmurs could be benign, up to 10% of adults, 30% of children, and could be exacerbated by conditions such as anaemia, pregnancy, fever, hyperthyroidism. Murmurs could also pathological, including valvular lesions and structural abnormalities.
Here is my approach.
Read moreMy approach to palpitations
The two top reasons for patients seeking medical attention for palpitations are
Symptoms being bothersome
Is there something wrong? Is there a risk of sudden death?
The top priority for physician though is whether the murmur is benign or malignant.
Read moreHeart failure medications - dosages
Heart failure medications save lives.
Dosages are important though, and many patients may not be on sufficient dosages.
Here are a number of tables useful for references, adapted from ACC/AHA guidelines 2013.
Read moreHeart failure - Definitions
Terminology can sometimes be confusing in heart failure care.
Here is a summary:
NYHA Class, HF stages, HFpEF vs. HFrEF
Read moreFrailty and Cardiovascular Disease
Frailty is relevant to cardiology because the disease process predispose to physical impairments that ultimate worsen the cardiovascular illness.
The phenomenon of increased vulnerability to stressors due to decreased physiological reserves leads to poor clinical outcomes after cardiovascular insults. Equally CVD worsens frailty due to hospitalisation, debilitation, immobility, systemic illness that underpins physiological deterioration in physical frailty. In cardiology, frailty is highly prevalent in patients with heart failure, valvular heart disease, but also myocardial infarction.
Read moreGLP-1 Agonists - FAQ
GLP-1 agonist is a class of medications that are used in type 2 diabetes and obesity. This is what we need to know
Aspirin for Primary Prevention
Aspirin use in primary prevention is controversial, contrasting that of secondary prevention. It may offer benefit in some, but for most, risk-benefit analysis may argue against its use. Here is the discussion.
Read moreOur approach to CT calcium score
In primary prevention, CT calcium scoring has been suggested to help decision making surrounding statin use.
Some of the underlying concepts are somewhat complex, but the screening paradigm remains that of matching the intensity of preventive efforts with the individual’s absolute risk.
The appropriateness of CT calcium scoring in an individual patient therefore depends
patient’s pretest probability of atherosclerotic cardiovascular risk
potential benefits of preventive therapies
negative aspects and risks of preventive therapies
patient preference
QT interval
We are often asked about how best to calculate the QT interval. This is the simplest way.
Use leads II, V5
Count the number of small boxes for the QT
Note heart rate
Use this website, and put in the two numbers, to get QTc
Arrhythmia in general practice
Most Patient would be asymptomatic when presented to the GP Practice. Hence ECG performed at the time would not normally demonstrate arrhythmia
Key is to identify high risk features on ECG
Read moreChronic venous insufficiency
Venous disease affects all age groups, gender and racial groups. Interventional radiology approaches may improve patient outcome dramatically. Who are those?
Read moreC19 mRNA Vaccine Myocarditis
C19 mRNA vaccine myocarditis has been of concern for both the Pfizer and Moderna. Below, we have included some useful tables and resources that we could use in our practices.
Read moreMy approach to heart murmur
Murmur is common, but picking out the significant ones could be hard. Here is my approach.
Read morePrimary aldosteronism - the cardiologist's simplistic approach
Screening for secondary causes of hypertension is important, though often not thought of. Primary aldosteronism is the most common endocrine cause. The screening test is the aldosterone-renin ratio (ARR).
Read moreMy approach to chest pain
Chest pain presentations are common, but management can be variable and difficult to understand. Here is my approach:
Read moreWhat should I do with heart failure with preserved ejection fraction?
HFpEF stands for heart failure with preserved ejection fraction. Commonly, it is defined as those with an LV ejection fraction of more than 50%, though varying definitions do exist.
This condition is poorly understood and is difficult to diagnose, because it is largely one of excluding other potential non cardiac causes of symptoms suggestive of HF.
Read moreECG - My Approach
ECG interpretation could be difficult, but a simplified approach would serve us well 95% of the time. Here is my approach:
Read moreNTproBNP - when should I actually order one?
NTproBNP is a very useful test in heart failure. However, often it is overused, as the diagnosis of heart failure should be a clinical one.
Here are the scenarios where it may be useful:
Hypertension treatment – how should we choose?
First line agents for hypertension are one of three classes:
- ACE inhibitors or Angiotensin receptor blockers
- Thiazides
- Calcium channel blockers
Drug preference is mainly influenced by co-morbidities and contraindications, rather than a simple age cut-off.
Read more