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by Craig M. Oliner, M.D., F.A.C.C. - Jefferson Medical College, Thomas Jefferson University; Associate Professor of Medicine, Section of Cardiology; Medical Director, Coronary Care Unit, Albert Einstein Medical Center, Philadelphia, PA; and by Alyson N. Owen, M.D. - Jefferson Medical College, Thomas Jefferson University; Assistant Professor of Medicine, Section of Cardiology; Director of Quality Assurance, Echocardiography Laboratory, Thomas Jefferson University Hospital, Philadelphia, PA.

OVERALL OBJECTIVES: The overall objective is to provide the participant with practical and clinically relevant information. Upon completion of this CME activity, the physician or healthcare provider should be able to describe the current approach to formulating differential diagnoses, diagnostic, therapeutic, and preventive management of the various disciplines presented.

EDUCATIONAL GAP AND NEEDS ANALYSIS STATEMENT: Heart disease and Cardiac disorders commonly present initially to the Primary Care setting. They are stabilized when necessary and then referred for definitive diagnosis and treatment to the Cardiologist. In addition, subsequent long-term follow-up care is largely being provided by Primary Care Providers. Therefore, Primary Care Providers must maintain adequate knowledge to diagnose, refer and effectively treat commonly seen cardiac conditions, many with possible serious and even fatal consequences if not properly managed.
Needs analysis specifically identifies Risk Factors and Risk Reduction as being the first step in improving care and outcomes. However, the ability to diagnose HTN and CHF, which are increasing in incidence, as well as Valvular Disease, Atrial Fibrillation, cardiac causes of Syncope, Stable and Unstable Angina and various Cardiac Emergencies are also vital skills to be communicated to the Primary Care Provider. Educational gap analysis has identified two areas that must be addressed: increased knowledge and increased confidence on the part of Primary Care Physicians in managing disorders in Cardiology. To address these needs and close these gaps, an annual update, presenting current thinking and new information, will help Primary Care physicians obtain adequate knowledge and provide them with the confidence to diagnose, refer and provide follow-up treatment for their patients’ cardiac conditions. Updating the clinical skills and knowledge of the PCP can reduce the reliance upon specialty referral and will help improve the continuity of patient care and clinical outcomes while curtailing the rising costs of medical care today relative to the specialty of Cardiology.

SPECIFIC OBJECTIVES
TOPIC 1	Risk Factors - Upon completion of this session, the participant should be able to: 1. Recognize risk factors for coronary artery disease. 2. Distinguish between modifiable and non-modifiable risk factors. 3. Describe how emerging risk factors affect cardiovascular risk. 4. Become familiar with current understanding of causes and consequences of obesity.
TOPIC 2	Risk Reduction - Upon completion of this session, the participant should be able to: 1. Recognize national guidelines for primary and secondary risk reduction. 2. Develop a stepwise plan for the treatment of lipid disorders. 3. Describe how major trials affect decisions on pharmacologic reduction of risk.
TOPIC 3	Unstable Angina Pectoris, Non ST-Elevation Myocardial Infarction, and Stable Angina - Upon completion of this session, the participant should be able to: 1. Recognize the patient with unstable angina or non ST-elevation infarction and tailor therapy to the degree of risk. 2. Identify who benefits from revascularization. 3. Identify the determinants of myocardial oxygen demand and supply, and the effects of medications on these determinants. 4. Outline a step-wise approach to the treatment of stable angina.
TOPIC 4	Women and Coronary Artery Disease - Upon completion of this session, the participant should be able to: 1. Describe how coronary risk factors affect women. 2. Outline a strategy for evaluating chest pain in women. 3. Identify the different clinical profiles of men and women with acute myocardial infarction. 4. Assess the risks and benefits of therapeutic modalities in women with coronary disease.
TOPIC 5	Aortic Valve Disease: Aortic Stenosis, Chronic Aortic Regurgitation - Upon completion of this session, the participant should be able to: 1. Identify the patient with aortic valve disease through history and physical examination. 2. Describe the role of non-invasive and invasive testing in diagnosis and management. 3. Define appropriate medical therapy and indications for aortic valve replacement.
TOPIC 6	Atrial Fibrillation - Upon completion of this session, the participant should be able to: 1. Grasp the importance of anticoagulation in the management of atrial fibrillation. 2. List various pharmaceutical and non-pharmaceutical methods of normalizing ventricular rate. 3. Compare two possible strategies for cardioversion in atrial fibrillation. 4. Recognize the potential benefit and harm of antiarrhythmic therapies.
TOPIC 7	Mitral Valve Disease: Mitral Stenosis, Chronic Mitral Regurgitation, Mitral Valve Prolapse - Upon completion of this session, the participant should be able to: 1. Identify the patient with mitral valve disease through history and physical examination. 2. Describe the role of non-invasive and invasive testing in diagnosis and management. 3. List appropriate medical therapy and indications for mitral valve replacement and repair. 4. Recognize the symptoms and adverse outcomes that do and do not result from mitral valve prolapse.
TOPIC 8	Palpitations and Supraventricular Tachycardia - Upon completion of this session, the participant should be able to: 1. Outline a simple diagnostic algorithm for differentiating various supraventricular tachycardias. 2. Describe how to acutely treat and chronically manage reentrant supraventricular tachycardias. 3. Describe a diagnostic approach for the patient with palpitations. 4. Recognize benign from potentially life-threatening causes of palpitations.
TOPIC 9	Perioperative Cardiac Evaluation and Management - Upon completion of this session, the participant should be able to: 1. Identify what the surgical team wants to know. 2. Characterize the cardiovascular effects of anesthesia and surgery. 3. Identify the elements of appropriate preoperative evaluation, including the role of non-invasive testing for coronary artery disease, using national guidelines. 4. Identify perioperative measures which may reduce the risk of cardiac complications.
TOPIC 10	Acute ST-Elevation Myocardial Infarction - Upon completion of this session, the participant should be able to: 1. Relate the differences in plaque morphology to the differences between stable angina and acute coronary syndromes. 2. Identify the patient with acute ST-elevation myocardial infarction, including the use of newer markers of cardiac injury. 3. Recognize those treatment strategies that reduce mortality, and the importance of minimizing time delay. 4. Recognize and treat complications of acute infarction. 5. Assess post-infarction risk.
TOPIC 11	Interesting Clinical Cases - Upon completion of this session, the participant should be able to: 1. Review the most important clinical aspects in the diagnosis, evaluation and management of patients with cardiac risk factors. 2. Review the most important clinical aspects in the diagnosis, evaluation and management of patients with cardiac symptoms. 3. Review the most important clinical aspects in the diagnosis, evaluation and management of patients with known cardiac diseases. 4. Recognize when to refer complex patients for subspecialty care.
TOPIC 12	Hypertension: Beyond the Guidelines - Upon completion of this session, the participant should be able to: 1. Define hypertension for the general population and various subgroups. 2. Recognize the importance of isolated systolic hypertension. 3. Recognize that low diastolic pressure may be prognostically good or bad.
TOPIC 13	Sudden Cardiac Death, Bradycardia and Atrioventricular Block - Upon completion of this session, the participant should be able to: 1. Identify which patients need additional evaluation and treatment of ventricular arrhythmias. 2. Describe which patients need additional evaluation and treatment of cardiac conduction abnormalities. 3. Recognize indications for permanent electronic pacemakers.
TOPIC 14	Syncope - Upon completion of this session, the participant should be able to: 1. Recognize the common underlying pathophysiology for all causes of syncope. 2. Distinguish between benign and life-threatening causes of syncope. 3. Maximize the diagnostic yield in the work-up of syncope. 4. Use the clinical history to help focus the work-up for syncope.
TOPIC 15	Congestive Heart Failure - Upon completion of this session, the participant should be able to: 1. Identify the cardiac etiologies of pulmonary congestion. 2. Discriminate between ejection fraction and stroke volume. 3. List common causes of systolic heart failure. 4. Outline current standard-of-care therapies, differentiating between those treatments which reduce mortality and those that improve symptoms.
TOPIC 16	Diastolic Heart Failure and Hypertrophic Cardiomyopathy - Upon completion of this session, the participant should be able to: 1. Describe the prevalence and pathophysiology of diastolic heart failure. 2. Identify effective treatment strategies for diastolic heart failure. 3. Assess prognosis in patients with hypertrophic cardiomyopathy. 4. Describe appropriate treatment strategies in patients with hypertrophic cardiomyopathy.

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