Clinical Scenarios

Clinical Scenario

Ischemic Heart Disease


By the end of Family Medicine Clerkship, students will be able to:

1. Identify patients at elevated risk for IHD and calculate their 10-year cardiovascular risk using the Framingham Risk Score.
2. Propose a patient-centered initial management plan for primary prevention of IHD.
3. Identify which patients’ required further investigation to confirm a diagnosis of IHD.
4. Describe an early post-ischemic event management plan including lifestyle changes, medications, psychosocial support, cardiac rehabilitation, etc.
5. Propose a surveillance and management plan for secondary prevention of cardiovascular events in patients with IHD.

Clinical Cards


Recommended Resources Addressing the Objectives

Cardiovascular risk (8 pages) *Might change with time

Objectives covered: 1, 2
Payne RA. Cardiovascular risk. Br J Clin Pharmacol 2012 Sep;74(3):396-410.

Overview of diagnosis and tx of acute coronary syndrome (8 pages) *Might change with time – Note that by “substernal pain” on page 1 of this article, they likely meant “retrosternal” – as that is a sign of typical angina.

Objectives covered: 2, 3
Achar SA, Kundu S, Norcross WA. Diagnosis of acute coronary syndrome. Am Fam Physician 2005 Jul 1;72(1):119-126.

Secondary Prevention of Coronary Artery Disease (6 pages) *Might change with time Note that HTN treatment should not target BP to 130/80 for pts with chronic kidney disease (this article is slightly out of date, but still good)

Objectives covered: 4, 5
Hall SL, Lorenc T. Secondary prevention of coronary artery disease. Am Fam Physician 2010 Feb 1;81(3):289-296.

Foundational Knowledge

The Calgary Guide – Cardiology section on Atherosclerosis and Ischemic heart disease – explains the pathophysiology behind ischemic heart disease and how it relates to risk factors and clinical findings

Additional Resources

Screening Strategies for Cardiovascular Disease in Asymptomatic Adults (pages 371-387, 390-391 – 18 pages) *Might change with time In-depth, evidence-based reading on strategies for primary prevention of IHD (including drawbacks of Framingham)

Objectives covered: 1, 2, 3
Wallace ML, Ricco JA, Barrett B. Screening Strategies for Cardiovascular Disease in Asymptomatic Adults. Prim Care 2014 Jun;41(2):371-397.

Secondary Prevention of Cardiovascular Disease in Older Adults Might be good future resource with the aging population

Objectives covered: 4, 5
Rich MW. Secondary Prevention of Cardiovascular Disease in Older Adults. Prog Cardiovasc Dis (0).
New publication, not yet on PubMed

Patient Information