| Persistent high BP (>140/90) | Essential hypertension, secondary HTN (renal artery stenosis, aldosteronism), white-coat HTN, salt-sensitive HTN | Confirm with home BP log, rule out secondary causes, start ACE-i / ARB / CCB, lifestyle plan, monthly review |
| Chest tightness with exertion | Stable angina, coronary artery disease, anxiety, GERD, costochondritis, anemia | ECG + stress test referral (TMT / stress echo), antianginal therapy, rule out anemia / thyroid, ASCVD risk score |
| Palpitations / racing heart | Sinus tachycardia, atrial fibrillation, SVT, PVCs, hyperthyroidism, anxiety, caffeine excess | Pulse check, ECG, Holter monitor referral, thyroid panel, beta blocker if indicated, anxiety screen |
| Shortness of breath on exertion | Heart failure, anemia, COPD, deconditioning, pulmonary hypertension, valve disease | 2D Echo for ejection fraction, BNP / NT-proBNP, CBC, ECG, treat underlying cause, GDMT for HF |
| Swelling in ankles / feet | Heart failure, venous insufficiency, kidney disease, hypothyroidism, calcium channel blocker side-effect | Daily weight tracking, salt restriction, diuretic adjustment, ECG / Echo, kidney function panel |
| High cholesterol on report | Familial hypercholesterolemia, diet, hypothyroidism, diabetes, alcohol, metabolic syndrome | ASCVD risk calculator, statin (atorvastatin 20-40mg), Lp(a) testing, dietitian referral, 3-month re-test |
| Recurring leg pain on walking | Peripheral arterial disease (PAD), spinal stenosis, venous insufficiency, diabetic neuropathy | ABI (ankle-brachial index) assessment, antiplatelet, statin, supervised exercise referral, smoking cessation |
| Dizziness / fainting (syncope) | Vasovagal syncope, orthostatic hypotension, arrhythmia, aortic stenosis, dehydration | Orthostatic BP measurement, ECG, Echo to rule out structural disease, Holter, hydration plan, medication review |
| Fatigue with breathlessness | Heart failure, anemia, hypothyroidism, depression, sleep apnea, deconditioning | CBC, TSH, BNP, sleep apnea screen (STOP-BANG), Echo, treat underlying cause, exercise prescription |
| Snoring + daytime sleepiness | Obstructive sleep apnea, often coexists with HTN and AFib | STOP-BANG screening, refer for sleep study, weight loss plan, CPAP referral, treat resultant HTN / AFib |
| Family history of MI < 55 (M) / 65 (F) | Familial hypercholesterolemia, premature CAD genetics, lifestyle clustering, Lp(a) elevation | ASCVD risk + Lp(a) + Apo-B, early statin if high-risk, lifestyle modification, cascade screening of family |
| Post-MI / post-stent follow-up needed | Routine cardiac rehab, dual antiplatelet duration, statin titration, BP / sugar control | DAPT review (typically 12 mo post-PCI), high-intensity statin, ACE-i, beta blocker, cardiac rehab referral |