Course 03: Cardiovascular, Vascular and Hematology
Lesson 12 of 12. Read the diagnostic framework and case, then complete the 10-question practice set. All material is original educational content; high-risk presentations require emergency referral.
Multimorbidity and treatment prioritization
- In a patient with CAD, CKD, diabetes and AF, prioritize the current threat to life, then assess long-term preventive treatment interactions and competing harms.
- Separate symptom control from disease-modifying care and distinguish anticoagulation from antiplatelet indications.
- Check pregnancy status, allergies, renal function, electrolyte risk, drug-drug interactions and access barriers before recommending prescriptions.
- Use a medication reconciliation method that includes OTC medicines, supplements, patches, topical agents and recent changes.
Focused case synthesis
- State the main problem representation in one sentence: age/risk, onset, defining features and key test findings.
- Rank must-not-miss diagnoses before common benign diagnoses; justify what argues for and against each.
- Select investigations by urgency and probability, not by how many tests are available.
- Define immediate disposition and a safety-net plan, then long-term prevention.
Medication classes and cautions
- Antiplatelets, anticoagulants, statins, antianginals, BP agents and HF medications have overlapping effects but distinct evidence-based indications.
- ACEi/ARBs and MRAs require attention to potassium and kidney function; diuretic adjustments require volume and electrolyte review.
- QT-prolonging agents and stimulants may aggravate arrhythmia risk; NSAIDs can worsen fluid retention and bleeding risk.
- Avoid treatment suggestions outside professional scope; escalate severe arrhythmias, ACS, stroke, shock and suspected major bleeding to emergency services.
Patient communication and informed consent
- Explain diagnosis, uncertainty, options, benefits, harms and alternatives using plain language and teach-back.
- When emergency transfer is recommended, state specific risks, need for ambulance and what has been arranged; document informed refusal respectfully if it occurs.
- For chronic disease use shared goals, affordable monitoring, reassessment dates and clear return precautions.
- Screen for anxiety, depression and social needs without missing physiologic causes of symptoms.
Exam capstone approach
- For each case answer in order: stability, differential, discriminating test, first safe action, referral, long-term prevention.
- Practice timing without relying on memorized single-test rules; troponin, ECG, D-dimer and BNP require context.
- Review common traps: normal ECG does not exclude ACS; transient deficits can be TIA; fast heart rate does not prove a primary tachyarrhythmia.
- Revise the course PDF checklists and repeat incorrectly answered questions as part of spaced practice.
Applied clinical case
A 72-year-old with HF, CKD and AF has progressive breathlessness, black stools and new dizziness. A medication list includes an anticoagulant and NSAID.
Show model clinical reasoning and disposition
Stabilize/assess urgently for clinically significant GI blood loss and possible HF deterioration, review anticoagulant/NSAID exposures and communicate an emergency handover.
Clinical self-check
- Which problem takes priority?
- Why are medicine reconciliation and bleeding history critical?
- What needs to be documented at handover?
Guidelines and further learning
- Canadian Cardiovascular Society — Guidelines Library (external)
- AHA/ACC — Atrial Fibrillation Clinical Practice Guideline (external)
- Canadian Cardiovascular Society — 2025 Heart Failure Guideline (external)
- AHA — 2025 Adult Advanced Life Support (external)