Chronic heart failure (CHF) is a common syndrome of breathlessness and fatigue in the presence of left ventricular (LV) dysfunction. Its prevalence increases with age, reaching 10% in patients >80 years. Despite advances in medical and device therapies, patients with CHF still have frequent readmissions to hospital and an annual mortality rate approaching 10-15% per year.

Cardiovascular disease (CVD) continues to be the leading cause of mortality, accounting for one in three deaths in England and Wales. In 2005, there were 124,000 deaths attributed to CVD. Around 39,000 of these fatalities were in patients under 75.  multifactorial approach to risk management is of paramount importance to prevention.

The mechanisms of cardiac arrhythmias are complex and recognising these conditions can be difficult. When an arrhythmia is suspected, prompt recording of an ECG is vital, even if symptoms have subsided, as this may be useful for future reference, diagnosis and therapy.

In an average sized practice of 6,000 patients, GPs should expect 12 cases of hypertrophic cardiomyopathy, three cases of nonischaemic dilated cardiomyopathy and one case of arrhythmogenic right ventricular cardiomyopathy.

In some patients chest discomfort may be clearly pleuritic or musculoskeletal in nature and does not require referral. However, in other patients who describe a history of chest discomfort, particularly of recent onset, related to exercise and radiating to the arms and neck, there should be a high suspicion that this represents coronary artery disease.