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  <head>
    <title>012-01 Foundations</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Cardiovascular history, examination and core tests">
      <outline text="What the assessment must deliver">
        <outline text="Instability, symptoms, haemodynamics, localisation"/>
        <outline text="Same finding, several mechanisms"/>
        <outline text="Function and trajectory, not a label"/>
      </outline>
      <outline text="Presenting symptoms">
        <outline text="Chest discomfort">
          <outline text="Exertional pressure suggests ischaemia"/>
          <outline text="Equivalents: burning, indigestion, dyspnoea, nausea"/>
          <outline text="Tearing pain to the back: acute aortic disease"/>
          <outline text="Pleuritic pain: pericardium, lung, chest wall"/>
          <outline text="Palpable reproduction does not exclude disease"/>
        </outline>
        <outline text="Dyspnoea">
          <outline text="Orthopnoea: supine venous return and redistribution"/>
          <outline text="Nocturnal dyspnoea more specific for congestion"/>
        </outline>
        <outline text="Palpitations">
          <outline text="Capture the rhythm during symptoms"/>
        </outline>
        <outline text="Syncope">
          <outline text="Global cerebral hypoperfusion, rapid recovery"/>
          <outline text="High risk: exertional, structural, family sudden death"/>
        </outline>
        <outline text="Vascular symptoms: rest pain, cold limb, stroke"/>
      </outline>
      <outline text="Risk and background">
        <outline text="Vascular risk factors and kidney disease"/>
        <outline text="Family history of premature disease or sudden death"/>
        <outline text="Medication review">
          <outline text="Antithrombotic, anti-inflammatory, stimulant drugs"/>
          <outline text="Agents affecting electrolytes or Q T interval"/>
        </outline>
        <outline text="Functional status: baseline and rate of change"/>
      </outline>
      <outline text="General examination and vital signs">
        <outline text="Distress, work of breathing, colour, mental state"/>
        <outline text="Accurate pulse, pressure, saturation, temperature"/>
        <outline text="Compare arms, measure standing pressure"/>
        <outline text="Peripheral stigmata have limited specificity"/>
      </outline>
      <outline text="Pulse and venous pressure">
        <outline text="Slow-rising low-volume pulse: outflow obstruction"/>
        <outline text="Collapsing pulse: high stroke volume, rapid runoff"/>
        <outline text="Radiofemoral delay or unequal pulses"/>
        <outline text="Pulse deficit: beats not reaching the periphery"/>
        <outline text="Jugular venous pressure estimates right-atrial pressure">
          <outline text="Vertical height above the sternal angle"/>
          <outline text="Raised: overload, right failure, tamponade, constriction"/>
          <outline text="Inspiratory rise: impaired right-sided filling"/>
          <outline text="Technique and body habitus limit accuracy"/>
        </outline>
      </outline>
      <outline text="Precordium and periphery">
        <outline text="Parasternal heave: right-ventricular pressure load"/>
        <outline text="Added sounds">
          <outline text="Third sound from rapid filling"/>
          <outline text="Fourth from atrial contraction into a stiff ventricle"/>
        </outline>
        <outline text="Murmurs">
          <outline text="Timing, site, radiation, intensity, shape"/>
          <outline text="Diastolic murmurs are generally pathological"/>
          <outline text="Intensity does not equal severity at low flow"/>
          <outline text="Manoeuvres alter return, afterload, chamber size"/>
        </outline>
        <outline text="Oedema is not specific to heart failure"/>
      </outline>
      <outline text="Electrocardiography and monitoring">
        <outline text="Rhythm, conduction, axis, ischaemia, drug effect"/>
        <outline text="Record promptly during pain, syncope, instability"/>
        <outline text="Serial tracings reveal dynamic change"/>
        <outline text="A normal tracing excludes little"/>
        <outline text="Monitoring duration matched to symptom frequency"/>
        <outline text="Symptom-rhythm correlation is the aim"/>
      </outline>
      <outline text="Biomarkers and imaging">
        <outline text="Troponin: assay-specific timing and change"/>
        <outline text="Natriuretic peptides vary with age, kidney, rhythm"/>
        <outline text="Chest radiograph can be normal in serious disease"/>
        <outline text="Echocardiography: chambers, valves, pericardium, pressures"/>
        <outline text="Coronary computed tomography defines anatomy"/>
        <outline text="Stress testing provokes demand"/>
        <outline text="Magnetic resonance characterises tissue and scar"/>
        <outline text="Best test follows probability and the pending decision"/>
      </outline>
      <outline text="Bedside synthesis">
        <outline text="Stable or unstable"/>
        <outline text="Congested or dry, warm or poorly perfused"/>
        <outline text="Coronary, pump, valve, pericardial, vascular, non-cardiac"/>
        <outline text="Time-critical alternatives and the next decision"/>
      </outline>
      <outline text="Vascular investigations">
        <outline text="Ankle-brachial index compares ankle with arm">
          <outline text="Calcified vessels give falsely high values"/>
          <outline text="Toe pressure or waveform may help"/>
        </outline>
        <outline text="Duplex ultrasound: anatomy plus flow velocity"/>
        <outline text="Computed-tomography angiography: radiation and contrast"/>
        <outline text="Deep-vein thrombosis: probability, D-dimer, compression ultrasound"/>
        <outline text="Pulmonary embolism: probability, oxygenation, selected imaging"/>
        <outline text="Testing must not delay a limb or aortic emergency"/>
        <outline text="Recheck after intervention: bleeding, embolism, contrast injury"/>
      </outline>
    </outline>
  </body>
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