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Ischemic Heart Disease Objectives and References


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.


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Note that HTN treatment should not target BP to 130/80 for pts with chronic kidney disease (this article is slightly out of date, but still good)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