Cardiovascular Therapeutics

The first module of Cardiovascular Therapeutics. It covers the stepwise approach to treating hypertension, how age, ethnicity and comorbidity steer the choice between ACE inhibitors, angiotensin receptor blockers, calcium channel blockers and thiazide-like diuretics, the recognition and initial management of hypertensive emergencies, and when statins are offered for primary prevention. Teaching examples use British National Formulary doses and NICE-style guidance, with notes where practice varies by region or formulary.

1. The Stepwise Treatment Algorithm for Hypertension: Targets, Lifestyle and Sequential Drug AdditionPreview

   This first lesson in the module sets out the stepwise approach to treating primary hypertension in UK practice. It covers how hypertension is defined, staged and confirmed using clinic, ambulatory and home measurements, then how treatment thresholds and targets vary with age, frailty and comorbidity. Lifestyle measures are reviewed as treatment in their own right. The core of the lesson is the four-step algorithm: starting an ACE inhibitor or ARB, then adding a calcium channel blocker and a thiazide-like diuretic, with the age and ethnicity adjustments that determine which drug comes first. The lesson closes with annual review, adherence and monitoring, resistant hypertension and indications for specialist referral. Practice varies by region and formulary, so always check local guidance and the current British National Formulary.

   10 min
2. Choosing Antihypertensives by Age, Ethnicity and Comorbidity: ACE Inhibitors, ARBs, Calcium Channel Blockers and Thiazide-Like Diuretics

   In UK practice the first antihypertensive is chosen by the patient's age, ethnicity and comorbidities rather than by blood pressure alone. This lesson explains why ACE inhibitors and ARBs are preferred in people under 55 and in those with diabetes or albuminuria, and why calcium channel blockers or thiazide-like diuretics suit people aged 55 and over and those of Black African or Black Caribbean heritage. It covers compelling indications for each class, contraindications and cautions, the monitoring needed after starting or titrating treatment, adverse effects to counsel on, and which combinations are safe. Teaching doses follow the British National Formulary; practice varies by region and formulary.

   10 min
3. Hypertensive Emergencies and Statins for Primary Prevention: Recognition, Initial Management and Shared Decision Making

   This lesson covers two linked areas of cardiovascular therapeutics. First, it distinguishes hypertensive emergency from severe asymptomatic hypertension, describes immediate assessment and controlled blood pressure reduction, and reviews parenteral medicines by clinical context. It explains why rapid or excessive lowering can compromise organ perfusion, using aortic dissection to illustrate the balance between urgency and safety. Second, it covers statins for primary prevention: how to estimate cardiovascular risk, when to offer treatment, how to choose a statin and dose intensity, what baseline tests and monitoring are needed, common adverse effects and interactions, and how to support shared decision making. Practice varies by region and formulary, so local guidance and current product information should be checked.

   10 min
4. Case: A 62-year-old man with tearing interscapular pain and hypertension
   20 min
5. Prescribing: Hypertension in a 58-year-old woman with type 2 diabetes and albuminuria
   15 min
6. Prescribing: Hypertension in a Black African Man: First-Line Therapy
   15 min
7. OSCE station: Counselling a Patient Starting Ramipril for Hypertension
   11 min
8. OSCE station: Starting Atorvastatin: Counselling and Safety
   11 min
9. Quiz: Hypertension and Cardiovascular Risk: Stepwise Therapy, Drug Choice and Statin Prophylaxis
   9 min

Covers the acute presentation of ACS in UK practice: history and ECG triage into STEMI and NSTEMI, emergency reperfusion, antithrombotic therapy in the acute phase, and the drugs started before discharge to reduce recurrent events. Builds on the hypertension and lipid module and prepares learners for the STEMI, NSTEMI discharge and ECG practice activities.

1. Recognising Acute Coronary Syndrome: History, Examination, ECG Triage and Initial Investigations

   Acute coronary syndrome spans unstable angina, NSTEMI and STEMI, and the first clinical task is recognition. This lesson covers typical and atypical ischaemic chest pain, cardiovascular risk factors and pre-test probability, the main differential diagnoses of acute chest pain, and the 12-lead ECG changes that define ST-elevation myocardial infarction together with the coronary territories they localise to. It then covers serial high-sensitivity troponin and the other initial investigations, and stresses the situations in which a normal early ECG or a single normal troponin does not exclude acute coronary syndrome. Teaching doses elsewhere in the module are illustrative only; the platform, not the reader, decides whether a prescription is safe.

   10 min
2. Immediate Management and Reperfusion in STEMI and High-Risk NSTEMI

   This lesson covers the first hours of care for a patient with ST-elevation myocardial infarction (STEMI) or high-risk non-ST-elevation acute coronary syndrome. It sets out initial resuscitation, oxygen and analgesia decisions, then compares primary percutaneous coronary intervention (PCI) with fibrinolysis and explains the time windows that govern each strategy. It reviews fibrinolysis eligibility, contraindications and the requirement for early transfer for angiography afterwards. It then covers the emergency drug regimen: aspirin, a P2Y12 inhibitor and a parenteral anticoagulant, with the practical points that affect prescribing in the first hour.

   10 min
3. Secondary Prevention after Acute Coronary Syndrome: The Discharge Prescription

   This lesson covers the secondary prevention bundle prescribed at discharge after acute coronary syndrome: aspirin with a P2Y12 inhibitor and the duration of dual therapy after stenting, high-intensity statin therapy, an ACE inhibitor or ARB, and a beta blocker. It shows how comorbidity, drug allergies, bleeding risk, renal function and adherence shape the final choice, and how the plan is documented and reviewed before the prescription is signed. Doses quoted are teaching examples, and responsibility for checking safety rests with the platform's rules and local protocols.

   10 min
4. Case: Crushing Chest Pain: An Anterior ST-Elevation Myocardial Infarction in a 58-Year-Old Man
   20 min
5. Prescribing: Discharge Prescription after NSTEMI and Stenting
   15 min
6. OSCE station: Chest Pain History (Acute Coronary Syndrome)
   11 min
7. OSCE station: ECG Interpretation: Inferior ST-Elevation Myocardial Infarction
   9 min
8. Quiz: Acute Coronary Syndromes: Diagnosis, Acute Reperfusion and Antiplatelet Therapy, and Secondary Prevention at Discharge
   9 min

Heart failure for final-year medical and pharmacy students and foundation doctors: chronic heart failure with reduced ejection fraction and the four pillars of therapy, acute pulmonary oedema, the loop and thiazide diuretics used to relieve congestion, and safe monitoring of potassium and renal function. Doses are given as British National Formulary teaching examples; local formularies and protocols vary.

1. Chronic Heart Failure with Reduced Ejection Fraction: Diagnosis and Building the Four Pillars

   This lesson explains how heart failure with reduced ejection fraction (HFrEF) is confirmed in UK practice, then works through the four drug classes that improve prognosis: an ACE inhibitor or ARB, a beta-blocker, a mineralocorticoid receptor antagonist and an SGLT2 inhibitor. It covers what each class achieves, how each is started and titrated, the order in which they are introduced, review intervals and blood test monitoring, and the common reasons patients remain on suboptimal doses. Doses are teaching examples only; always check the current BNF and local protocols.

   10 min
2. Acute Pulmonary Oedema: Recognition, Immediate Treatment and Escalation

   Acute cardiogenic pulmonary oedema is a medical emergency in which a sudden rise in left atrial and pulmonary capillary pressure causes fluid to flood the alveoli. This lesson covers how to recognise it from the history and examination, the immediate priorities of upright positioning, oxygen to a target saturation range, intravenous access and monitoring, and the place of intravenous loop diuretics and nitrates. It explains when opiates and non-invasive ventilation may be considered, the monitoring and review that follow the first hour, and the points at which local protocols and formularies diverge. Doses are teaching examples only; the platform's rules, not this text, decide whether a prescription is safe.

   10 min
3. Loop and Thiazide Diuretics, Potassium and Renal Function in Heart Failure

   This lesson covers the mechanism, potency and dosing differences between loop and thiazide diuretics, their roles in congestion and hypertension, diuretic resistance and combination use, and the monitoring and management of hypokalaemia, hyperkalaemia and declining renal function when diuretics are combined with ACE inhibitors or ARBs and mineralocorticoid receptor antagonists. Teaching uses British National Formulary dosing examples and NICE-style guidance for UK practice. Doses are illustrative only; prescribing safety is determined by local protocols and the platform's checks.

   10 min
4. Case: Acute Pulmonary Oedema: A 74-Year-Old Woman in the ED
   20 min
5. Prescribing: Newly diagnosed heart failure with reduced ejection fraction: initiation of therapy
   15 min
6. Prescribing: Hyperkalaemia in an elderly patient with chronic heart failure and renal impairment
   15 min
7. Prescribing: Hypokalaemia in Heart Failure on Furosemide: Oral Potassium Replacement
   15 min
8. OSCE station: Full cardiovascular examination of a 70-year-old man with a known murmur
   11 min
9. Quiz: Heart Failure: The Four Pillars, Diuretics and Electrolyte Safety
   9 min

This module covers the pharmacological and clinical management of cardiac rhythm disorders in UK practice. It addresses rate and rhythm control in atrial fibrillation with anticoagulation decisions, bradyarrhythmias and drug-induced heart block, the assessment of syncope and collapse, and the clinical pharmacology of amiodarone, digoxin and beta-blockers. It prepares learners for the prescribing and viva activities that follow, with doses given as teaching examples only.

1. Atrial Fibrillation: Rate Control, Rhythm Control and Anticoagulation

   Atrial fibrillation is the most common sustained arrhythmia and appears in every prescribing exam. This lesson covers recognising AF on the ECG, classifying it as paroxysmal, persistent, long-standing persistent or permanent, and choosing between rate control and rhythm control. You will work through the agents used for each approach: beta-blockers, rate-limiting calcium channel blockers, digoxin, amiodarone and flecainide, plus electrical and pharmacological cardioversion. It then covers stroke risk assessment with CHA2DS2-VASc, bleeding risk, and anticoagulant selection with direct oral anticoagulants and warfarin. Special attention goes to situations that change the standard plan, including asthma, heart failure with reduced ejection fraction, valvular AF and renal impairment. Doses are teaching examples; always check the current British National Formulary and local guidance.

   10 min
2. Bradyarrhythmias, Drug-Induced Heart Block and Syncope

   Bradyarrhythmias range from benign sinus bradycardia to complete atrioventricular block, and drugs are a common cause. This lesson covers sinus node dysfunction, systematic grading of atrioventricular block on the ECG, and the medicines that slow the sinus node or the conducting system: beta-blockers, digoxin, rate-limiting calcium channel blockers, amiodarone and ivabradine. It sets out when to stop or adjust a drug, when to call for pacing, and the indications for temporary and permanent pacemaker insertion. The final section builds a structured history and examination that separates cardiac syncope from vasovagal collapse and seizure, with the red flags that change management.

   10 min
3. Clinical Pharmacology of Amiodarone, Digoxin and Beta-Blockers: Mechanism, Monitoring, Toxicity and Prescribing Safety

   This final lesson in the arrhythmia module covers the clinical pharmacology of amiodarone, digoxin and beta-blockers. It explains mechanisms, indications, dosing principles, monitoring, interactions and toxicity, with focused sections on amiodarone thyroid, pulmonary, ocular and hepatic adverse effects, digoxin toxicity and its management, and beta-blocker selectivity in relation to bronchospasm. The lesson closes with prescribing safety checks used in Prescribing Safety Assessment and pharmacology viva settings. Doses discussed are teaching examples and safety decisions follow local protocols and formularies.

   10 min
4. Case: Unstable Atrial Fibrillation: Rapid Decision-Making
   20 min
5. Case: Complete Heart Block in an 80-Year-Old on Digoxin and Bisoprolol
   20 min
6. Prescribing: Rate Control and Anticoagulation in Persistent Atrial Fibrillation with Asthma
   15 min
7. OSCE station: Focused History: 28-year-old woman with intermittent palpitations
   11 min
8. OSCE station: Collapse at the Bus Stop: History to Distinguish Cardiac Syncope from Seizure and Vasovagal Causes
   11 min
9. OSCE station: Pharmacology Viva: Amiodarone
   9 min
10. Quiz: Arrhythmias, Rate and Rhythm Control, and Syncope
    8 min