Master Cardiology
for MRCP Part 1
Access 50+ high-yield questions tailored for the 2026 syllabus. Includes AI-powered explanations and performance tracking.
Core Concepts
Cardiology covers the heart and vascular system, focusing on conditions impacting cardiac function, rhythm, and structural integrity. Key concepts include the cardiac cycle (preload, afterload, contractility, stroke volume, cardiac output), basic ECG interpretation (rhythm, rate, axis, intervals, ST/T changes), and the pathophysiology of common conditions like heart failure, ischemic heart disease, valvular disorders, and arrhythmias. Understanding the distinction between systolic (HFrEF) and diastolic (HFpEF) heart failure, stable angina vs. acute coronary syndromes (ACS), and common valvular lesions is crucial.
Clinical Presentation
- Chest Pain: Ischemic (exertional, retrosternal, radiating, relieved by rest/GTN) vs. non-ischemic (pleuritic, positional, sharp).
- Dyspnoea: Exertional, orthopnoea, paroxysmal nocturnal dyspnoea (PND) suggest heart failure. Acute onset with pleuritic pain and haemoptysis suggests PE.
- Palpitations: Awareness of heart beat. Regular/irregular, fast/slow helps differentiate arrhythmias.
- Syncope/Pre-syncope: Transient loss of consciousness due to global cerebral hypoperfusion. Suspect arrhythmias, severe aortic stenosis, HOCM.
- Oedema: Bilateral pitting lower limb oedema suggests right heart failure.
- Murmurs: Systolic (AS, MR, TR, VSD, HOCM) vs. Diastolic (AR, MS). Timing, location, radiation, character are key.
- JVP: Elevated JVP with hepatojugular reflux in right heart failure, tamponade.
- Peripheral Signs: Cyanosis, clubbing, splinter haemorrhages (endocarditis), radio-femoral delay (coarctation), xanthelasma/corneal arcus (hyperlipidaemia).
Diagnosis (Gold Standard)
The gold standard for diagnosis varies by condition:
- Ischemic Heart Disease (ACS): ECG (ST elevation/depression, T wave inversion), Serial Troponins (cardiac specific, rise and fall pattern). Invasive Coronary Angiography is gold standard for CAD.
- Heart Failure: Echocardiography (assessment of LV function, valvular disease, chamber size). BNP/NT-proBNP are useful biomarkers.
- Valvular Heart Disease: Echocardiography (Doppler assessment of valve function and gradients).
- Arrhythmias: 12-lead ECG for symptomatic events. 24-hour Holter or prolonged ambulatory ECG monitoring for paroxysmal/intermittent arrhythmias.
- Hypertension: 24-hour Ambulatory Blood Pressure Monitoring (ABPM) for diagnosis confirmation and white-coat hypertension exclusion.
- Pericardial Effusion/Tamponade: Echocardiography.
- Cardiomyopathies: Echocardiography, Cardiac MRI (CMR) for detailed tissue characterisation.
Management (First Line)
- Acute Coronary Syndrome (ACS): MONA (Morphine, Oxygen if SpO2 <90%, Nitrates, Aspirin) + Clopidogrel/Ticagrelor/Prasugrel. Reperfusion via Primary PCI (STEMI) or Fibrinolysis (if PCI delayed).
- Heart Failure with Reduced Ejection Fraction (HFrEF): ACE inhibitor (or ARB), Beta-blocker, Mineralocorticoid Receptor Antagonist (MRA) (e.g., Spironolactone), SGLT2 inhibitor (e.g., Dapagliflozin). Diuretics for symptom relief.
- Hypertension: Lifestyle modification. First-line drugs depend on age/ethnicity: ACEi/ARB, Calcium Channel Blocker (CCB), Thiazide-like diuretic.
- Atrial Fibrillation (AF): Rate control (beta-blocker, rate-limiting CCB like diltiazem) vs. Rhythm control (amiodarone, flecainide). Anticoagulation based on CHA2DS2-VASc score (DOACs preferred over Warfarin).
- Valvular Heart Disease: Medical management of symptoms (e.g., diuretics for HF symptoms). Surgical valve repair/replacement or Transcatheter Aortic Valve Implantation (TAVI) for severe symptomatic disease.
- Acute Pericarditis: NSAIDs (e.g., ibuprofen) + colchicine.
Exam Red Flags
- Sudden onset severe tearing chest pain radiating to the back: Aortic Dissection.
- Hypotension, elevated JVP, muffled heart sounds (Beck's Triad): Cardiac Tamponade.
- Systolic ejection murmur radiating to carotids with syncope, angina, dyspnoea: Severe Aortic Stenosis.
- New murmur, fever, positive blood cultures, peripheral stigmata (e.g., Janeway lesions, Osler's nodes, Roth spots): Infective Endocarditis.
- Broad complex tachycardia: Assume Ventricular Tachycardia (VT) until proven otherwise – treat urgently.
- Pulseless Electrical Activity (PEA) arrest: Consider reversible causes (H's and T's: Hypoxia, Hypovolaemia, Hypo/Hyperkalaemia, Hypothermia; Toxins, Tamponade, Tension Pneumothorax, Thrombosis - coronary/pulmonary).
- Patient presenting with worsening HF symptoms post viral illness: Myocarditis.
Sample Practice Questions
A 72-year-old male with a history of recurrent syncope and exertional angina presents for evaluation. On examination, his pulse is regular, and blood pressure is 120/80 mmHg. Cardiac auscultation reveals a crescendo-decrescendo systolic murmur loudest at the right upper sternal border, radiating to the carotids. There is a diminished and delayed carotid upstroke (pulsus parvus et tardus). What is the most appropriate initial diagnostic investigation?
A 30-year-old previously healthy male collapses suddenly during a football match. Resuscitation attempts are unsuccessful. Autopsy reveals significant left ventricular hypertrophy, particularly asymmetric septal hypertrophy, with myocardial disarray on histology, and no evidence of coronary artery disease. Which of the following genetic mutations is most commonly associated with this condition?
A 72-year-old male with a history of chronic kidney disease and hypertension presents with sudden onset of severe tearing chest pain radiating to his back. His blood pressure is 180/100 mmHg in the right arm and 120/70 mmHg in the left arm. His heart rate is 95 bpm. On examination, a diastolic murmur is noted. A chest X-ray shows a widened mediastinum. Which of the following is the most appropriate immediate diagnostic investigation?
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