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Exam standard · Referral · Nursing

Cardiac rehabilitation after a heart attack

This case practises: Choosing which medicines to mention · A specific request · Leaving out what the reader doesn't need

Writing task

Today's date: 24 November 2026. You are the registered nurse on the Cardiology Ward, Northfield General Hospital. Write a letter to Ms Laura Kowalski, Cardiac Rehabilitation Coordinator, Northfield Heart Health Programme, Northfield Community Hospital, 30 Elm Road, Northfield, referring Mr Shetty to the cardiac rehabilitation programme before his discharge today. Write in full sentences, not note form, using letter format. Aim for a body of about 180–200 words.

Case notes

In the test you get 5 minutes to read, then 40 minutes to write.

Patient details
- Mr Vikram Shetty, DOB 03/01/1972 (54 y.o.)
- 88 Station Road, Northfield
- Admitted 18/11/2026; discharge 24/11/2026

Social background
- Taxi driver (self-employed), works night shifts
- Lives with wife and 2 teenage children
- Wife does the cooking - family diet high in fried food
- Smokes 20 cigarettes/day for 30 years; wants to quit
- Drinks alcohol rarely
- Keen cricket fan; plans family trip to Mangalore in March 2027
- Grows vegetables on an allotment at weekends
- Father had cataract surgery at 70; mother well

Medical history
- Type 2 diabetes (2018) - metformin 1 g BD; HbA1c 64 mmol/mol (18/11)
- Knee pain - uses ibuprofen occasionally
- Appendicectomy 1995

Admission
- 18/11: central chest pain at rest, 2 h; troponin raised
- Dx: NSTEMI
- 19/11: angiogram - 90% stenosis LAD; drug-eluting stent inserted
- Echo: LVEF 50%
- No further chest pain; mobilising around ward and up 1 flight of stairs
- LDL cholesterol 4.2 mmol/L

Medications on discharge
- Aspirin 75 mg OD (lifelong)
- Ticagrelor 90 mg BD for 12 months
- Atorvastatin 80 mg nocte (new)
- Bisoprolol 2.5 mg OD (new)
- Ramipril 2.5 mg OD (new)
- Omeprazole 20 mg OD (new, stomach protection)
- GTN spray PRN
- Metformin 1 g BD (unchanged)
- Ibuprofen stopped - avoid NSAIDs
- Nicotine patch 21 mg/24 h started 20/11

Discharge plan
- Cardiac rehab programme: start within 2 weeks - supervised exercise, education
- Smoking cessation support; continue nicotine replacement
- Dietary advice for pt and wife (lipids, diabetes)
- Advise on return to driving/work per national guidance
- Cardiology clinic 6 weeks (05/01/2027); GP review diabetes control

Write your letter

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Model answer Try writing your own letter first
Ms Laura Kowalski
Cardiac Rehabilitation Coordinator
Northfield Heart Health Programme
Northfield Community Hospital
30 Elm Road
Northfield

24 November 2026

Dear Ms Kowalski,

Re: Mr Vikram Shetty, DOB 03/01/1972

I am writing to refer Mr Shetty, a 54-year-old man who had a non-ST-elevation myocardial infarction, to your cardiac rehabilitation programme, starting within two weeks of his discharge today.

Mr Shetty was admitted on 18 November with chest pain at rest, and on 19 November a drug-eluting stent was inserted into his left anterior descending artery. His ejection fraction is 50%. He has had no further chest pain and can manage a flight of stairs. He is taking dual antiplatelet therapy, aspirin with ticagrelor for 12 months, and high-dose atorvastatin, as his LDL cholesterol was 4.2 mmol/L.

His main risk factors need attention. He has smoked 20 cigarettes a day for 30 years, wants to stop and has started nicotine patches. He also has type 2 diabetes, with an HbA1c of 64 mmol/mol, and his family's diet is high in fried food.

I would be grateful if you could provide supervised exercise, smoking cessation support and dietary advice for him and his wife, who does the cooking. As a taxi driver, he will also need advice on returning to driving.

Yours sincerely,

Registered Nurse
Cardiology Ward
Northfield General Hospital

What the reader needs

  • NSTEMI on 18 November; drug-eluting stent to the LAD on 19 November
  • Stent inserted
  • Left ventricular ejection fraction 50%; no further chest pain
  • Dual antiplatelet therapy: aspirin and ticagrelor for 12 months
  • Smokes 20 a day, wants to quit; nicotine patch started
  • Type 2 diabetes with HbA1c 64; family diet high in fried food; diet advice for him and his wife
  • Request: start the programme within two weeks with exercise, smoking cessation support and dietary advice

Details to leave out

  • Cricket and the trip to Mangalore
  • Teenage children
  • Appendicectomy
  • Allotment
  • Parents' health
  • Knee pain
  • Rare alcohol use
  • Omeprazole and GTN spray listed individually
  • Ramipril and bisoprolol doses listed individually

One good way to write this letter, not the only one. Written by Kurippu; awaiting nurse review.