Knowledge/Skills:
Intermediate Objectives:
1. Identify and describe a systematic approach to the patient with suspect or definite acute myocardial infarction
2. Understand the clinical approach to the patient with congestive heart failure from a variety of etiologies
3. Identify selected arrhythmias and their pharmacologic therapy
4. Utilize ancillary diagnostic tools (serum enzymes, exercise testing, echocardiography, nuclear cardiology testing, and cardiac catheterization)
5. Assist in the long term management of these patients
Enabling Objectives:
1. Take a concise history to identify the major causes of chest pain and its differential diagnosis and formulate a diagnostic and therapeutic plan for patients with this complaint.
2. Identify and describe the major physical findings of ischemic heart disease and its major complications, infarction, congestive heart failure, and cardiogenic shock, and formulate a treatment plan.
3. Advance one's skills in the interpretation of the 12-lead electrocardiogram, with particular attention to the diagnostic power of sequential electrocardiograms.
4. Advance one's skills in the interpretation of simple and complex cardiac arrhythmias.
5. Understand the pharmacologic action, pharmacokinetics, short and long term side effects, and indications for the major anti-arrhythmic drugs.
6. Understand the role of hemodynamic monitoring of the acutely ill cardiac patient.
7. Be familiar with the major parenteral and oral anti-coagulants and the use of laboratory studies to minimize their side effects.
8. Describe the natural history of ischemic heart disease and its complications, and to understand the role of cardiac re-vascularization in altering the natural history.
9. Understand the indications for and methods of temporary and permanent cardiac pacing.
10. Demonstrate the ability to review the literature from journals and identify key articles.
11. Understand the basic principles of pre-load and afterload reduction, the drugs used to achieve each, and their side effects.
12. Become proficient in the acute management of malignant arrhythmias.
13. Learn the indications for non-invasive testing and review interpretation of these studies (electrocardiography, exercise testing and exercise nuclear cardiologic studies) in this population.
14. Understand basics of interventional therapeutic efforts (percutaneous transluminal angioplasty, thrombolytic therapy, etc.) in treatment of ischemic heart disease.
15. Have a basic understanding of the role of major risk factors for ischemic heart disease and the role of primary and secondary prevention.
16. Understand the role of cardiac rehabilitation, educational techniques for behavior modification in diet, smoking, exercise, and medication compliance.
17. Develop an understanding of the role of non-invasive testing in patient assessment (nuclear testing, echocardiographic interpretation, exercise testing, and radiographic assessment).
18. Develop a more complete understanding of the role of enzyme testing in the assessment of chest pain syndromes.
19. Enhance understanding of cholesterol metabolism and the current treatment of lipid disorders.