Course 03: Cardiovascular, Vascular and Hematology
Lesson 4 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.
Diagnosis and phenotypes
- Heart failure is a clinical syndrome of congestion and/or inadequate cardiac output due to cardiac dysfunction; assess dyspnea, orthopnea, weight gain, edema and fatigue.
- Examine JVP, pulses, edema, lung findings and perfusion; obtain ECG, labs, natriuretic peptide where appropriate and echocardiography.
- Differentiate reduced EF from mildly reduced, preserved and improved EF; management options vary with EF and phenotype.
- Consider mimics and contributors: COPD, anemia, renal failure, obesity, thyroid disease, valvular disease and medications.
HFrEF evidence-based care
- The central disease-modifying drug classes for symptomatic HFrEF are an ARNI/ACEi/ARB pathway, evidence-based beta blocker, mineralocorticoid receptor antagonist and SGLT2 inhibitor when eligible.
- Diuretics relieve volume overload but do not replace the disease-modifying foundation; monitor renal function, potassium, BP and congestion.
- Assess need for specialist involvement, device therapy and cardiac rehabilitation; medication sequencing is individualized.
- Avoid drugs that may aggravate HF and monitor for adverse effects, including nonprescribed products that alter fluid balance or BP.
HFpEF and HF with EF above 40%
- Confirm objective evidence of congestion or elevated filling pressures; dyspnea with a normal EF does not by itself prove HF.
- Treat contributory hypertension, diabetes, sleep apnea, AF, ischemia and obesity where applicable.
- SGLT2 inhibitors are important evidence-based options in appropriate symptomatic HF with non-reduced EF under current Canadian guidance.
- Recognize frequent overlap of HF with CKD, pulmonary disease and frailty.
Cardiomyopathy and myocarditis
- Dilated cardiomyopathy may follow ischemic, genetic, toxic, metabolic or inflammatory injury; family history and echocardiography inform assessment.
- Hypertrophic cardiomyopathy may present with exertional syncope, dyspnea or family history of sudden death; avoid dismissing these as benign.
- Myocarditis may occur after viral illness with chest pain, dyspnea, palpitations and troponin elevation; urgent evaluation is needed for possible ventricular dysfunction or arrhythmia.
- Peripartum cardiomyopathy should be considered with new HF late in pregnancy or postpartum.
Pericardial syndromes and decompensation
- Pericarditis may cause sharp positional pleuritic pain and diffuse ST elevation; exclude ACS and evaluate for effusion.
- Tamponade may cause hypotension, distended neck veins, tachycardia and obstructive shock; urgent emergency management is necessary.
- Acute pulmonary edema, hypoxemia, altered mentation, hypotension or cool extremities signals possible decompensated HF/shock.
- Provide clear return precautions and arrange appropriate rapid reassessment following a change in symptoms or diuretic regimen.
Applied clinical case
A 46-year-old develops dyspnea, palpitations and chest discomfort 10 days after a febrile illness. Troponin is elevated and echo shows a new depressed EF.
Show model clinical reasoning and disposition
Possible myocarditis with acute ventricular dysfunction requires urgent cardiology/emergency assessment, rhythm monitoring and evaluation of alternative causes including ACS.
Clinical self-check
- How do injury and infarction differ?
- What findings suggest decompensated HF?
- Which drugs modify HFrEF outcomes?
Guidelines and further learning
- Canadian Cardiovascular Society — 2025 Heart Failure Guideline (external)
- Canadian Cardiovascular Society — Guidelines Library (external)
- AHA/ACC — 2025 Acute Coronary Syndromes Guideline (external)