01.07 Cardio
01.07 Cardiology [PDF link]: Hypertrophic obstructive cardiomyopathy (HoCM / HCM). Arrhythmogenic right ventricular cardiomyopathy (ARVC). Dilated cardiomyopathy – Takotsubo cardiomyopathy. Chronic heart failure – congestive heart failure / CHF, cor pulmonale, high output heart failure.
More on heart failure
NICE guideline NG106 (updated Sep 2025)
BNP for diagnosing HF
Can be falsely low in
Obese pts.
African or African-Caribbean people
Drug treatment: diuretic, ACEI/ARB, B-blocker, mineralocorticoid receptor antagonist (eg spironolactone)
Can be falsely elevated in other diseases, eg in lung, kidney and liver disease, in sepsis, etc.
Left vs right heart failure (or both)
Left sided heart failure - Icardiac output to body and pulmonary oedema (backlog into lungs). S/smx thus include dyspnoea (fluid overload in lungs), orthopnoea, PND, and crackles on lungs.
Right sided heart failure often develops secondary to left sided heart failure
Right heart has to remodel to increase ability to pump blood through the lungs and to the left side of the heart
Pathological remodelling then results in right sided heart failure
S/smx would be due to "backlog" of blood into right side of heart (increasing preload) - peripheral oedema, raised JVP, hepatomegaly, etc
First line treatment for HFrEF – NICE guidelines updated in Sep 2025 (see point 1.4)
4 drugs regime recommended now: ACEI + β-blocker + MRA + SGLT2I
Not mentioned but I assume these would be introduced one drug at a time
If pt is already on all 4 drugs but still continue to have smx, ACEI can be switched to ARNI (eg sacubitril)
ACEls/ARBs/ARNIs/MRA
Monitoring renal function
1-2 weeks after starting
1-2 weeks after each dose increase
Every 3-6 months once max tolerated dose reached
Any time renal function may be affected
Monitor and treat for hyperkalaemia
More on cardiomyopathies
There are no NICE guidelines on this topic specifically
Arbelo E, Protonotarios A, Gimeno JR, Arbustini E, Barriales-Villa R, Basso C, et al. 2023 ESC Guidelines for the management of cardiomyopathies: Developed by the task force on the management of cardiomyopathies of the European Society of Cardiology (ESC). Eur Heart J 2023;44:3503–626. https://doi.org/10.1093/eurheartj/ehad194.
Runs through HoCM, ARVC, dilated cardiomyopathy, etc
Unfortunately I am not a cardiologist and do not have enough knowledge to dive into the guidelines.
More on HOCM
Mavacamten has been approved since Sep 2023 for treatment of HoCM (TA913)
Only drug approved for treatment
Only to be used in more severe disease after standard medical options have been maximally used.
MOA: allosteric and reversible inhibitor of cardiac myosin. End result is to reduce left ventricular outflow obstruction and improve cardiac filling pressures. (Info from Uptodate)
