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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 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.
Learning Objectives
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| EDUCATIONAL GAP AND NEEDS ANALYSIS STATEMENT: The need for updated knowledge in Cardiology is evident from the increasing prevalence of cardiovascular disease and with expanding diagnostic and therapeutic modalities, especially in an aging population. In the managed care environment it is an issue for cost control as well. Due to the expense of testing, the ubiquitous nature of hypertension and the increasing “epidemic proportions” of congestive heart failure, the generalist is used to ease the increasing demand upon the Cardiologist. Treatment and follow-up is becoming the responsibility of the generalist and this is largely due to the increasing recognition of heart disease in women, Congestive Heart Failure, Acute Myocardial Infarction, Hypertension, Pulmonary Edema and other cardiac-related disorders, which are on the rise. These issues will be addressed in this activity and are expected to improve knowledge and behaviors that should result in improved patient outcomes.
| | Day 1 |
Hypertension - Beyond the Guidelines. Chest Pain and Non-Invasive Testing for Coronary Artery Disease. Risk Factors. Risk Stratification. |
| Day 2 |
Risk Reduction. Atrial Fibrillation. Aortic Valve Disease. Mitral Valve Disease. |
| Day 3 |
Congestive Heart Failure. Diastolic Heart Failure and Hypertrophic Cardiomyopathy. Diseases of the Aorta – Abdominal Aortic Aneurysm, Acute Aortic Syndromes. Cardiac Emergencies - Acute Pulmonary Edema and Shock. |
| Day 4 |
Perioperative Cardiac Evaluation and Management. Syncope. Sudden Cardiac Death, Bradycardia and Atrioventricular Block. Palpitations and Supraventricular Tachycardia. |
| Day 5 |
Acute ST-Elevation Myocardial Infarction. Unstable Angina Pectoris/Non ST-Elevation Myocardial Infarction and Stable Angina. Interesting Clinical Cases. Women and Coronary Artery Disease. |
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Cardiology Update in Primary Care Medicine: An Evidence-Based Approach
April 6-10, 2009
Location: Hyatt Regency Sarasota, Florida
OBJECTIVES
| 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. |
| SPECIFIC OBJECTIVES
| | Day 1 | 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.
| | Chest Pain and Non-Invasive Testing for Coronary Artery Disease. - Upon completion of this session, the participant should be able to:
| | 1. | Differentiate life-threatening from more benign chest pain.
| | 2. | Outline a step-wise approach to the patient with chest pain, with the use of probability analysis.
| | 3. | Appreciate the relative merits of the various diagnostic tests for coronary artery disease.
| | 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.
| | Risk Stratification. - Upon completion of this session, the participant should be able to:
| | 1. | Utilize the Framingham Model for assessment of absolute risk.
| | 2. | Recognize the limitations of the Framingham Model.
| | 3. | Utilize the assessment of absolute risk to guide therapy.
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| | Day 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.
| | 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.
| | Aortic Valve Disease. - 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.
| | Mitral Valve Disease. - 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.
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| | Day 3 | 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.
| | 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.
| | Diseases of the Aorta – Abdominal Aortic Aneurysm, Acute Aortic Syndromes. - Upon completion of this session, the participant should be able to:
| | 1. | Define the lethality of aortic rupture and dissection.
| | 2. | Describe screening for and management of patients with aortic aneurysms.
| | 3. | Recognize acute aortic dissection and characterize those at risk for this potentially lethal disease.
| | Cardiac Emergencies – Acute Pulmonary Edema and Shock. - Upon completion of this session, the participant should be able to:
| | 1. | Differentiate cardiac from non-cardiac pulmonary edema.
| | 2. | Differentiate between chronic and acute heart failure.
| | 3. | Outline beneficial therapies for acute pulmonary edema.
| | 4. | Define cardiogenic shock in hemodynamic and clinical terms.
| | 5. | Generate a differential diagnosis for shock.
| | 6. | Recognize the importance of revascularization in the patient with shock due to acute myocardial infarction.
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| | Day 4 | 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.
| | 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.
| | 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.
| | 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.
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| | Day 5 | 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.
| | 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.
| | 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.
| | 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.
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