Objectives
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
References
Recommended Resources Addressing the Objectives
Cardiovascular risk (8 pages) *Might change with time
Objectives covered: 1, 2
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2125.2012.04219.x/pdf
Payne RA. Cardiovascular risk. Br J Clin Pharmacol 2012 Sep;74(3):396-410.
PMID:22348281
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
http://www.aafp.org/afp/2005/0701/p119.pdf
Achar SA, Kundu S, Norcross WA. Diagnosis of acute coronary syndrome. Am Fam Physician 2005 Jul 1;72(1):119-126.
PMID:16035692
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Note that HTN treatment should not target BP to 130/80 for pts with chronic kidney disease (this article is slightly out of date, but still good)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
http://www.ncbi.nlm.nih.gov/pubmed/20112887
Hall SL, Lorenc T. Secondary prevention of coronary artery disease. Am Fam Physician 2010 Feb 1;81(3):289-296.
PMID:20112887
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
http://www.ncbi.nlm.nih.gov/pubmed/24830613
Wallace ML, Ricco JA, Barrett B. Screening Strategies for Cardiovascular Disease in Asymptomatic Adults. Prim Care 2014 Jun;41(2):371-397.
PMID:24830613
Secondary Prevention of Cardiovascular Disease in Older Adults Might be good future resource with the aging population
Objectives covered: 4, 5
www.sciencedirect.com/science/article/pii/S0033062014000413
Rich MW. Secondary Prevention of Cardiovascular Disease in Older Adults. Prog Cardiovasc Dis (0).
New publication, not yet on PubMed
Patient Information