The Heart Under Stress – St. Emlyn’s at SMACC Gold

The (1)



Chris Nickson (@precordialthump) is a genius in many ways. Not only does he organise arguably the best healthcare conference in the world right now, but he’s also a very clever chap when it comes to thinking of imaginative titles for speakers. Last year Chris invited me to talk at SMACC Gold. Now, it seems that asking speakers to give their own title just isn’t the SMACC thing to do. Instead, Chris sent me an email to let me know that my title would be ‘The Heart Under Stress’ and I’d be talking in a session entitled ‘Cardiovascular Catastrophes’. That seemed pretty brilliant to me!

But I’ve never, ever given a talk that’s caused me so much anguish. Even when I was on the plane to Australia, I was still agonising about what I was going to talk about. Talk about ‘The Heart Under Stress’. This was more like ‘The [Rick] Body Under Stress’. You see, with SMACC not being a normal conference, you can’t just give your run of the mill academic presentation, show some fancy graphs and try to impress your audience about how brilliant your recent research is. At SMACC, they don’t want data. They want interpretation. They don’t want a rigorous academic structure. They want a story. And they definitely don’t want death by Powerpoint. They want carefully designed slides that complement the speaker’s message. Most of all, the take home message has to be clear.

'The Heart Under Stress' at SMACC Gold

‘The Heart Under Stress’ at SMACC Gold

Knowing how much the SMACC audience would love the adrenaline of a good resuscitation, it was really tempting to present cases – some genuine ‘cardiovascular catastrophes’. But, much as cases like that are interesting, they don’t make for a great talk. As I pointed out in the talk, there are actually only three things you need to know about a heart that’s so stressed that it’s screaming out at you that it’s about to die. Sim Wars can make those points much better.


So I decided to stick to what I do best – and I took the audience on a tour through how to make the best use of the history, examination and – yes – troponin testing (!) – when trying to decide whether your patient has an acute coronary syndrome.

I even furnished the talk with a virtually impromptu Tommy Cooper tribute – which I decided to go with just before taking to the stage! As you listen to the podcast, you’ll have to imagine how I first sat down and then lay down on the stage as I brought the talk to an end. I was a little lucky that Oli Flower moved a table on the stage backwards just before I did – otherwise it may have gone a bit wrong!

I’d love to hear your thoughts about this talk. What’s your experience of using the history and examination to diagnose ACS? Do you have stories (devoid of any patient details that could even be vaguely identifiable, of course!) that illustrate points that we could all learn from?

The Podcast

The Slides

Until next time!





  2. gagan

    Thanks Rick, really interesting and informative


Thanks so much for following. Viva la #FOAMed

Translate »