1High-yield associations
| Finding or trigger | Classic association | The exam point |
|---|---|---|
| De Winter T waves | Proximal LAD occlusion | An ACOMI pattern (NHFA/CSANZ 2025): emergency reperfusion despite no precordial ST elevation. |
| ST depression in V1 to V3 with dominant R waves | Posterior MI | Record posterior leads; posterior MI is an ACOMI pattern (NHFA/CSANZ 2025). |
| ACS in a young woman with few risk factors, peripartum | Spontaneous coronary artery dissection | If stable, routine revascularisation is not recommended (NHFA/CSANZ 2025). |
| Irregular broad-complex tachycardia, delta wave | Pre-excited AF (Wolff-Parkinson-White) | Avoid AV nodal blockers; DC cardioversion if unstable; ablate the pathway. |
| Coved ST elevation in V1 and V2, unmasked by fever | Brugada syndrome | Treat fever early, avoid sodium channel blockers; ICD after arrest or arrhythmic syncope. |
| Murmur louder on standing and Valsalva | Obstructive hypertrophic cardiomyopathy | Avoid nitrates and vasodilators. PBS lists mavacamten for symptomatic obstructive HCM. |
| Thick LV, low ECG voltages, carpal tunnel | ATTR cardiac amyloidosis | Bone scintigraphy plus light chain tests to exclude AL. PBS lists tafamidis for ATTR cardiomyopathy. |
| Hypotension, raised JVP, pulsus paradoxus | Cardiac tamponade | Urgent pericardiocentesis; avoid diuretics and vasodilators. |
| Widespread concave ST elevation, PR depression | Acute pericarditis | NSAID or aspirin plus colchicine; colchicine reduces recurrence. |
| New AV block during endocarditis | Aortic root abscess | Urgent transoesophageal echo and early cardiac surgical referral. |
| Aortic stenosis with gastrointestinal bleeding | Heyde syndrome (angiodysplasia) | Acquired von Willebrand disease; bleeding often settles after valve replacement. |
2Australia-only high-yield (won't be in UK or US banks)
Acute coronary syndromes (NHFA/CSANZ 2025). Beyond STEMI, ACOMI includes posterior, right ventricular and high lateral MI, De Winter T waves and LBBB with modified Sgarbossa criteria: consider emergency reperfusion. Primary PCI within 120 minutes of first medical contact, else fibrinolysis.
After ACS (NHFA/CSANZ 2025). LDL-C under 1.4 mmol/L and at least 50% lower: statin, then ezetimibe, then a PCSK9 inhibitor. Consider withholding beta-blockers if LV function is preserved after revascularisation; ARNI is not recommended for ACS. On an anticoagulant: add aspirin and clopidogrel for 1 to 4 weeks, then stop aspirin.
Atrial fibrillation (NHFA/CSANZ 2018). Australia uses the sexless CHA2DS2-VA score: no anticoagulation at 0, anticoagulate at 2 or more, with a NOAC in preference to warfarin. Opportunistic screening from age 65.
CVD risk (Aus CVD Risk Calculator, 2023). Five-year risk: high 10% or more, low under 5%. Assess at 45 to 79, from 35 with diabetes and from 30 in First Nations people. Skip the calculator in moderate to severe CKD or FH: already high risk.
Heart failure (NHFA/CSANZ 2018; MJA consensus 2022). HFrEF: an ACE inhibitor or ARNI (the 2022 consensus prefers the ARNI), a beta-blocker, an MRA and an SGLT2 inhibitor. PBS lists dapagliflozin, empagliflozin and sacubitril-valsartan for chronic heart failure.
Lipids (PBS and TGA, October 2026). PBS lists evolocumab (heterozygous and homozygous FH, non-familial hypercholesterolaemia) and inclisiran (heterozygous FH and non-familial only). Alirocumab and bempedoic acid were not found in the PBS medicine index; bempedoic acid has TGA product information.
Rheumatic heart disease (RHDAustralia guideline, edition 3.3, 2025). Benzathine benzylpenicillin G 1,200,000 units deep IM every 28 days, for at least 10 years after the last ARF or to age 35 (moderate RHD) or 40 (severe), whichever is longer. Endocarditis prophylaxis (eTG 2019, adapted there) covers RHD in all populations, prosthetic valves or repair material, prior endocarditis and selected congenital disease, for listed procedures only. See Physify's Rheumatic Fever and Rheumatic Heart Disease course.
3Sample questions (Physify format)
1. A 72 year old woman has newly diagnosed non-valvular atrial fibrillation. She has hypertension and type 2 diabetes, with no heart failure, stroke or vascular disease. Using the stroke risk score in the Australian guideline, what is her score and the most appropriate management?
- A. Score 2; anticoagulation is optional
- B. Score 3; start a NOAC
- C. Score 4; start a NOAC
- D. Score 3; start warfarin over a NOAC
- E. Score 4; aspirin alone
Answer: B
B. Correct. CHA2DS2-VA (NHFA/CSANZ 2018) gives one point each for age 65 to 74, hypertension and diabetes: 3. Anticoagulate at 2 or more, with a NOAC in preference to warfarin.
A. Omits the age point, and at 2 or more anticoagulation is recommended, not optional.
C. Adds a point for female sex, the CHA2DS2-VASc approach the Australian guideline dropped.
D. Right score, but a NOAC is preferred to warfarin in non-valvular AF.
E. Aspirin is not adequate stroke prevention in AF, and the score is wrong.
2. A 74 year old man taking apixaban for atrial fibrillation (CHA2DS2-VA 3) has a non-ST-elevation ACS and undergoes PCI with a drug-eluting stent. He has no other bleeding risk factors. Which discharge antithrombotic plan follows the 2025 Australian ACS guideline?
- A. Apixaban, aspirin and ticagrelor for 12 months, then apixaban alone
- B. Apixaban, aspirin and clopidogrel for 1 to 4 weeks, then stop aspirin
- C. Aspirin and ticagrelor for 12 months, with apixaban withheld until they stop
- D. Warfarin, aspirin and clopidogrel for 12 months, then warfarin alone
- E. Apixaban and aspirin for 12 months, then apixaban alone long term
Answer: B
B. Correct. NHFA/CSANZ 2025: anticoagulant plus aspirin and clopidogrel for 1 to 4 weeks, then stop aspirin; stop antiplatelet therapy at 6 to 12 months and continue the anticoagulant alone.
A. With an anticoagulant the guideline prefers clopidogrel, and 12 months of triple therapy adds bleeding.
C. Withholding apixaban leaves his stroke risk untreated; dual antiplatelet therapy does not replace it.
D. A NOAC is preferred to warfarin, and 12 months of triple therapy is too long.
E. Omits the P2Y12 inhibitor, which is the antiplatelet kept once aspirin stops.
3. A 24 year old Aboriginal woman has severe rheumatic mitral regurgitation without heart failure, arrhythmia or valve surgery. Her last acute rheumatic fever was at 17, and she has benzathine benzylpenicillin G every 28 days. Under the 2025 Australian guideline, until when should prophylaxis continue before it is reassessed?
- A. Age 22, five years after her last ARF
- B. Age 27, ten years after her last ARF
- C. Age 35
- D. Age 40
- E. For life, with no reassessment
Answer: D
D. Correct. Severe RHD (Priority 1): at least 10 years after the last ARF or until age 40, whichever is longer, then reassess (RHDAustralia 2025).
A. Five years (or to age 21) applies to definite ARF without cardiac involvement.
B. Ten years alone ignores the age floor; whichever is longer applies.
C. Age 35 is the floor for moderate (Priority 2) RHD.
E. Prophylaxis is reassessed, not open-ended, though some people need it beyond 40.