A case study is only worth reading if the reasoning is still visible in it. Cases written up after the fact, with the diagnosis known and the uncertainty tidied away, teach the reader nothing they could apply to a patient in front of them. The Academy’s cases are written in the order the treating team met them, and the moment of genuine doubt is left in.
How each case is structured
- Presentation. What the patient came in with, and the history that was available at the time — not the history that emerged later.
- Initial assessment. Examination findings and the first working diagnosis, including where it was wrong.
- Investigations. ECGs, echocardiographic images, angiographic runs and laboratory values, with the diagnostic feature identified rather than left for the reader to hunt.
- The decision point. The moment where competent clinicians would have differed, stated as a choice rather than resolved in advance.
- What was done, and why. Including the reasoning that turned out to be mistaken.
- Outcome and follow-up. Reported honestly, including poor outcomes.
- Teaching points. Three or four transferable lessons, anchored to guideline positions or named trial evidence.
The subject areas covered
- Acute coronary syndromes. Atypical presentations, the ECG that was called normal, and the delay that changed the outcome.
- Complex intervention. Bifurcation and left main disease, calcified lesions, and the complication recognised early enough to manage.
- Heart failure. Diagnostic uncertainty in preserved ejection fraction, titration in patients who will not tolerate it, and the referral that was made too late.
- Arrhythmia. Broad-complex tachycardia misclassified, syncope of uncertain cause, and device decisions made on incomplete information.
- Valve disease. Low-flow low-gradient aortic stenosis, discordant measurements, and timing of intervention in asymptomatic severe disease.
- The mimics. Takotsubo taken for anterior infarction, myocarditis taken for acute coronary syndrome, aortic dissection taken for either.
How to use them
Read to the decision point, stop, and commit to an answer before reading on. A case worked through passively confirms what you already believe; a case where you have committed and been wrong is the one you will remember. Candidates preparing for a viva should practise saying the reasoning aloud, because the examination tests articulation as much as knowledge.
Contributing
Members are encouraged to submit. Use the case submission form; every case must be fully de-identified, including the DICOM header. Accepted cases are published with attribution to the submitting clinician and institution.
Live discussion of cases runs four times a week at the case discussion forum. Shorter member-submitted cases are in the case library, single-image challenges in the image of the month, and case collections in book form in the diagnosis and imaging reading list.