Orientation to Cardiology Practice

You’re a licensed clinician — this module isn’t here to re-teach you medicine. It’s a short tour of the practice context cardiology APPs work in: reading stability, the diagnoses that can’t be missed, when and how to escalate, how consults work, and the bar for a strong note. The cardiology itself starts in Level 1.

Before any differential, answer one question: is this patient stable? Instability changes everything — it moves the encounter from “work it up” to “get help and stabilize now.”

• •Unstable signals: hypotension, hypoxia, altered mental status, ongoing severe chest pain, signs of poor perfusion (cold, mottled, confused), or a dangerous rhythm.
• •Stable: normal/at-baseline vitals, comfortable, protecting airway, no active ischemic or hemodynamic crisis.
• •When in doubt, treat as unstable until proven otherwise.

The bulk of cardiology presentations cluster into a short list. Learn the can’t-miss diagnosis hiding behind each.

• •Chest pain — can’t-miss: ACS, aortic dissection, PE.
• •Shortness of breath — can’t-miss: decompensated heart failure, ACS, PE.
• •Palpitations — can’t-miss: sustained VT, AFib with RVR, pre-excitation.
• •Dizziness / syncope — can’t-miss: arrhythmia, structural disease (AS, HOCM), PE.
• •Edema / leg symptoms — can’t-miss: heart failure, DVT, CLTI.

These don’t wait for the rest of your workup.

• •Ongoing chest pain with diaphoresis, dyspnea, or hemodynamic change.
• •Suspected STEMI or dynamic ischemic EKG changes.
• •Sustained wide-complex tachycardia or any unstable arrhythmia.
• •New high-grade AV block or symptomatic bradycardia.
• •Hypotension, hypoxia, or signs of shock.
• •Tearing chest/back pain or an arm-to-arm BP/pulse differential (dissection concern).
• •Syncope with exertion or without prodrome.

When something triggers concern, run these steps.

1. 1.Recognize: name the concern out loud — "this could be ACS / unstable arrhythmia / shock."
2. 2.Stabilize: ABCs, monitor, IV access, oxygen if hypoxic, EKG — what you can start now.
3. 3.Call: notify the physician and activate the right pathway (rapid response, code, cath lab).
4. 4.Communicate: hand off with SBAR so the responder is oriented in seconds.
5. 5.Close the loop: confirm the message was received and the plan is shared.
6. 6.Document: what you saw, when, who you called, and the response.

Consults are specific. "Eval and treat" still has a real question behind it — find it and answer it directly, up front.

• •"Is this chest pain cardiac?" → give your read and the recommended workup.
• •"Rate control for AFib" → give the strategy, agents, and anticoagulation plan.
• •"Pre-op cardiac risk" → answer the surgical team’s real question: is it safe to proceed, and what optimizes risk?
• •"Manage the troponin" → classify the injury and recommend next steps.

Inpatients decompensate. Some findings go to the attending immediately.

• •Hemodynamic instability, new shock, or rising pressor requirement.
• •New ST elevation, dynamic ischemic changes, or a large troponin rise.
• •Sustained or unstable arrhythmia; new high-grade AV block.
• •Any patient whose trajectory is worsening faster than the current plan accounts for.

The visit isn’t over when the patient leaves. Results return for days afterward, and they are your responsibility until acted on.

• •Review every result you ordered and document the action taken.
• •Communicate abnormal results to the patient with a clear plan.

Documentation gets its own depth later in the track. For orientation, one worked exemplar shows the bar a cardiology assessment and plan should clear.