Cardiology
Chest pain, acute coronary syndromes, heart failure, arrhythmias, hypertension and cardiovascular risk. AMC questions focus on recognising the dangerous presentation and choosing the first-line management.
High-yield points
STEMI: aim for primary PCI within 90 minutes of first medical contact; if PCI cannot happen within 120 minutes, give fibrinolysis (ideally within 30 minutes) unless contraindicated.
Suspected ACS: aspirin 300 mg chewed early; oxygen only if SpO2 below 93%; serial high-sensitivity troponin and ECGs.
HFrEF: the four pillars are ACE inhibitor/ARB or sacubitril-valsartan, a heart-failure beta blocker, an MRA and an SGLT2 inhibitor; loop diuretic for congestion.
AF: rate or rhythm control plus stroke prevention. Australian guidelines use CHA2DS2-VA (sex removed); DOACs are preferred over warfarin in non-valvular AF.
Warfarin, not a DOAC, for mechanical valves and moderate-severe mitral stenosis.
Absolute CVD risk (Australian CVD risk calculator): assess people aged 45-79, and First Nations people from 30. High risk is 10% or more over 5 years and warrants BP- and lipid-lowering treatment.
Aortic dissection: tearing pain radiating to the back, BP difference between arms, widened mediastinum; do not thrombolyse, get a CT aortogram.
Infective endocarditis: take 3 sets of blood cultures before antibiotics; use modified Duke criteria.
India vs Australia
Where the answer the AMC marks correct differs from what’s usually taught in Indian MBBS.
| Aspect | India (MBBS)What you learn in MBBS | Australia (AMC)What the exam marks as correct |
|---|---|---|
| Rheumatic heart disease | Still common nationally; taught as a leading cause of mitral stenosis in young adults. | Rare overall but very high in remote Aboriginal and Torres Strait Islander communities. Secondary prophylaxis is IM benzathine benzylpenicillin every 28 days (21 for some). |
| Deciding to treat risk factors | Often treat each risk factor (BP, cholesterol, glucose) against its own threshold. | Treatment is guided by absolute CVD risk using the Australian risk calculator, with assessment starting earlier for First Nations people. |
| STEMI reperfusion | Fibrinolysis is common where PCI is not available; streptokinase may still be used. | Primary PCI within 90 minutes if possible. If PCI can't happen within 120 minutes (common rurally), give tenecteplase, sometimes pre-hospital. |
| Units | Cholesterol and glucose in mg/dL. | Lipids and glucose in mmol/L; troponin as high-sensitivity ng/L. Convert your reference ranges. |
Rheumatic heart disease
India (MBBS)
Still common nationally; taught as a leading cause of mitral stenosis in young adults.
Australia (AMC): what the exam expects
Rare overall but very high in remote Aboriginal and Torres Strait Islander communities. Secondary prophylaxis is IM benzathine benzylpenicillin every 28 days (21 for some).
Deciding to treat risk factors
India (MBBS)
Often treat each risk factor (BP, cholesterol, glucose) against its own threshold.
Australia (AMC): what the exam expects
Treatment is guided by absolute CVD risk using the Australian risk calculator, with assessment starting earlier for First Nations people.
STEMI reperfusion
India (MBBS)
Fibrinolysis is common where PCI is not available; streptokinase may still be used.
Australia (AMC): what the exam expects
Primary PCI within 90 minutes if possible. If PCI can't happen within 120 minutes (common rurally), give tenecteplase, sometimes pre-hospital.
Units
India (MBBS)
Cholesterol and glucose in mg/dL.
Australia (AMC): what the exam expects
Lipids and glucose in mmol/L; troponin as high-sensitivity ng/L. Convert your reference ranges.
The Australian context
Rheumatic heart disease is still common in remote Aboriginal and Torres Strait Islander communities, even though it is rare in the rest of Australia. Secondary prophylaxis is benzathine benzylpenicillin IM every 28 days (21 days for some high-risk patients). Absolute CVD risk calculation, not single risk factors, drives treatment decisions, and assessment starts 15 years earlier for First Nations people.