Cardiology
I.
Rationale
As cardiovascular disease is the most common disease state encountered in medicine, residents will
understand the psycho-social implications of cardiovascular disease on the patient and the family. Residents
will understand the need for an integrated approach to prevention and rehabilitation including nutritionists,
behavioral scientists, exercise, physiologists, educators, cardiologists, and family physicians.
II.
Competencies
Patient Care
Goal: Provide Evidence Based Care to patients with Cardiovascular Conditions
Objectives:
A. Learn incorporation of health promotion and disease prevention into patient care.
1. Know risk factors for cardiovascular disease and counsel patients regarding risk factors.
2. Understand how to implement programs to modify cardiovascular disease risk factors:
smoking cessation, weight management, lipid management including dietary intake and
exercise. Be able to use for primary and secondary prevention of cardiovascular disease.
3. Understand indications and proper techniques for screening for HTN / Lipid abnormalities
and CAD.
B. Develop knowledge of the diagnosis and initial management of additional problems anticipated
to require cardiologist assistance.
1. Acute coronary syndromes ( Unstable Angina / Acute Myocardial Infarction)
2. Hypertensive emergency
3. Cardiac trauma
4. Acute severe congestive heart failure
5. Unstable tachy or brady arrhythmias
6. Pericardial tamponade
C. Learn a set of procedural skills essential to the practice of family medicine and select advanced
procedural skills appropriate to anticipated future practice needs.
1.
2.
3.
4.
5.
EKG mechanics and interpretation
Routine treadmill stress testing
Exercise prescription for the cardiac and non-cardiac patient
Basic and advanced cardiac life support
Interpretation of results from stress and non-stress nuclear imaging, pharmacologic stress
testing, echocardiography.
6. Types and indications for internal and external pacing devises.
7. Interpretation of results from arterial and venous doppler studies.
8. Elective and emergency cardioversion.
Learning Activities
X
Attending Rounds
X
Multidisciplinary Rounds
X
Grand Rounds
Sub-Specialty Conference
X
Morning Report
Last Updated March 7, 2013
X
X
X
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
Faculty Supervision
X
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
Didactics
Other
Evaluation Methods
X
Attending Evaluation
X
Program Dir
Review
X
360 ᵒ evaluation
Other
X
Procedures
X
X
Directly Supervised Procedures
In-Training Exam
X
X
Videotape Review
Morning Report
Faculty Supervision
and Feedback
Quarterly Review
Medical Knowledge
Goal: Develop a broad knowledge base of symptoms, physical exam, diagnoses and interventions
Objectives:
A. Attain mastery of the following knowledge areas:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
Normal anatomy and physiology
Common variants of growth and development
Detailed history and physical
Evaluation of the pre-operative patient for cardiovascular disease and management of the
cardiac patient pre-operatively.
Coronary artery disease- stable and unstable angina, myocardial infarction, and sudden
death
Hypertension- mild, moderate, severe, urgent, and emergency
Congestive heart failure-systolic and diastolic
Common cardiac murmurs
Cardiac risk stratification
Indications for non-invasive and invasive cardiac evaluation
Indications for SBE prophylaxis
Common arrhythmia's/palpitations
Stable cardiomyopathy
Understand issues in selection and risks of performing PTCA and bypass grafting
Thromboembolic disease
Peripheral vascular disease
Cardiovascular changes in the athlete
Pericarditis
Endocarditis
Learning Activities
X
Attending Rounds
X
Multidisciplinary Rounds
X
Grand Rounds
Sub-Specialty Conference
X
Morning Report
X
Didactics
Other
Evaluation Methods
Last Updated March 7, 2013
X
X
X
X
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
Faculty Supervision
Procedures
X
X
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
X
X
Attending Evaluation
Program Dir
Review
360 ᵒ evaluation
Other
X
X
Directly Supervised Procedures
In-Training Exam
X
X
Videotape Review
X
Morning Report
Faculty Supervision
and Feedback
Quarterly Review
Practice Based Learning and Improvement
Goal: The resident should develop skills in evaluating their own patient care, appraising and assimilation of
scientific evidence to improve patient care.
Objectives:
A.
B.
C.
D.
E.
Identify resources for personal education.
Develops a plan for ongoing education.
Identify Point of Care learning resources.
Utilize Electronic Medical Records Decision aid tools and templates for patient care.
Recognizes strengths and weaknesses of knowledge and skills in self and others.
Learning Activities
X
Attending Rounds
X
Multidisciplinary Rounds
X
Grand Rounds
Sub-Specialty Conference
Morning Report
X
Didactics
Other
Evaluation Methods
X
Attending Evaluation
X
Program Dir
Review
X
360 ᵒ evaluation
Other
X
X
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
Faculty Supervision
Procedures
Directly Supervised Procedures
In-Training Exam
Videotape Review
X
X
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
Morning Report
Faculty Supervision
and Feedback
Quarterly Review
Interpersonal and Communication Skills
Goal: Residents will develop and demonstrate effective information exchange and teaming with patients,
their families, and other health professionals.
Objectives:
A. Develop skills for interviewing that allow accurate, complete collection of information regarding
symptoms, family, and community environment that affect the patient's cardiovascular health.
B. Develop skills in communicating results, educating patients and their families, dealing with
sensitive issues for patients and families, and negotiating a plan of treatment with the patient
and family.
Last Updated March 7, 2013
C. Residents will understand the need for an integrated approach to prevention and rehabilitation
including nutritionists, behavioral scientists, exercise, physiologists, educators, cardiologists, and
family physicians.
Learning Activities
X
Attending Rounds
X
Multidisciplinary Rounds
Grand Rounds
Sub-Specialty Conference
X
Morning Report
Didactics
Other
Evaluation Methods
X
Attending Evaluation
X
Program Dir
Review
X
360 ᵒ evaluation
Other
X
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
Faculty Supervision
Procedures
X
X
Directly Supervised Procedures
In-Training Exam
X
X
X
Videotape Review
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
Morning Report
Faculty Supervision
and Feedback
Quarterly Review
Professionalism
Goal: Residents will demonstrate a commitment to carrying out professional responsibilities, adherence to
ethical principles, and sensitivity to a diverse patient population.
Objectives:
A. Demonstrate integrity, honesty, respect and a commitment to excellence in all activities.
B. Demonstrate sensitivity, respect and adapt appropriately to the social and cultural issues of each
patient.
C. Display initiative and resourcefulness in patient care and in solving problems.
D. Be timely in attendance of activities and completion of tasks.
Learning Activities
X
Attending Rounds
X
Multidisciplinary Rounds
X
Grand Rounds
Sub-Specialty Conference
X
Morning Report
Didactics
Other:
Evaluation Methods
X
Attending Evaluation
X
Program Dir
Review
X
360 ᵒ evaluation
Other
Last Updated March 7, 2013
X
X
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
Faculty Supervision
Procedures
X
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
Directly Supervised Procedures
In-Training Exam
X
X
Videotape Review
X
Morning Report
Faculty Supervision
and Feedback
Quarterly Review
Systems Based Practice
Goal: demonstrate an awareness of and responsiveness to the larger context and system for health care
and the ability to effectively call on system resources to provide care that is of optimal value
Objectives:
A. Utilize and understand the importance of appropriate referral or consultation with cardiologists
or cardiothoracic surgeons.
B. Support of the individual and family through consultation, evaluation, treatment, and
rehabilitation.
C. Understand the psychosocial and economic impact of cardiovascular disease on the individual
and family and use of the health care system to assist as needed.
D. Learns most cost effective ways to manage cardiovascular patients.
Learning Activities
X
Attending Rounds
X
Multidisciplinary Rounds
Grand Rounds
Sub-Specialty Conference
Morning Report
Didactics
Other
Evaluation Methods
X
Attending Evaluation
X
Program Dir
Review
X
360 ᵒ evaluation
Other
III.
X
Outpatient Clinics
Ethics/Comm Conference
Specialty Conference
Noon Conference
Faculty Supervision
Procedures
X
Direct Patient care
Resident Seminar
Journal Club
Readings
Directly Supervised Procedures
In-Training Exam
Videotape Review
X
X
Morning Report
Faculty Supervision
and Feedback
Quarterly Review
Instructional Strategies (see above)
A.
B.
C.
D.
E.
F.
IV.
X
X
Research Conference
Direct patient care of cardiology service patients
Direct patient care of continuity clinic patients
Teaching during patient rounds
Cardiology lectures / conferences
Independent reading
Procedural learning (see above list)
Evaluation Strategies (see above)
A.
B.
C.
D.
E.
F.
H.
Observation by Attending, fellow and residents
End of rotation evaluation from the inpatient cardiology service at CLH.
Procedure documentation by the resident
Conference attendance
In-training exam profiles
Resident evaluation of rotation and faculty
Completion of required readings and scoring >90% on open book Monograph quizzes
Last Updated March 7, 2013
V.
Implementation Strategies
Interns rotate on the inpatient cardiology service at Crawford Long Hospital for a four week
block.
Location: Crawford Long Hospital
Internal Medicine Morning Report is located in Classroom 5 of the Medical Office
Tower.
Report at 8:00 on first day of rotation.
Refer to intern survival guide for specific instructions to finding the classroom
(Resident link under www.fpm.emory.edu)
Contact: Crawford Long Internal Medicine Chief Resident
Family Practice Center: Continuity clinic is ½ day week
Call: There is no call responsibility at CLH
Call responsibility is with the Emory Dunwoody Hospital on the Family Medicine Service,
typically 2 weekend calls in the block. No weekday call
Supervision: CLH Cardiology Service Attending / Fellow / Resident
Responsible Party:
Jerre Lutz, MD
Medical Director
The Emory Clinic
1365 Clifton Road
Emory Campus
(404) 778-4351 ofc
(404) 778-3417 fax
Contact: Michelle (assistant)
michelle.d.brown@emoryhealthcare.org
404-778-2165 ofc #
Conferences: Morning report on M-F @ CLH
Grand Rounds on Tuesday @ EUH
Thursday AM didactics @ Emory Dunwoody Hospital
Noon conferences at CLH
VI.
Bibliography
Reading list: AAFP Monographs Update on Heart Failure (#298), Hypertension (#305),
Perioperative Care (#263), CAD/MI (#270), Valvular Heart Disease (#397), Arrythmias (#391)
Dubin D. Rapid Interpretation of EKG's: An Interactive Course: Cover Pub.; 2000.
American Family Physician Collection of Articles on Coronary Artery Disease/Coronary Heart Disease
available at http://www.aafp.org/afp/topicModules/viewTopicModule.htm?topicModuleId=4
Accessed on December 3, 2012. Last Update: 11/29/2012
Screening and Diagnosis
1. The Use of Coronary Computed Tomography Angiography to Rule Out CAD in the ED [AFP
Journal Club] (11/15/2012)
Last Updated March 7, 2013
2. Using Nontraditional Risk Factors in Coronary Heart Disease Risk Assessment [Putting Prevention
into Practice] (02/15/2011)
3. Using Nontraditional Risk Factors in Coronary Heart Disease Risk Assessment: Recommendation
Statement [U.S. Preventive Services Task Force] (02/15/2011)
4. Can ECG Rule Out ACS if Performed While the Patient Is Having Chest Pain? [AFP Journal Club]
(11/15/2010)
5. Global Risk of Coronary Heart Disease: Assessment and Application (08/01/2010)
6. AHA Guidelines on Cardiac CT for Assessing Coronary Artery Disease [Practice Guidelines]
(03/01/2008)
7. Cardiomyopathy: An Overview (05/01/2009)
8. Diagnosis of Acute Coronary Syndrome (07/01/2005)
9. Noninvasive Cardiac Imaging (04/15/2007)
10. Update on Exercise Stress Testing (11/15/2006)
11. Radiologic Evaluation of Acute Chest Pain—Suspected Myocardial Ischemia (08/15/2007)
12. Contemporary Management of Angina: Part I. Risk Assessment (12/01/1999)
Prevention
1. AHA Updates Guidelines on CVD Prevention in Women [Practice Guidelines] (01/01/2012)
2. Aspirin for the Prevention of Cardiovascular Disease: Recommendation Statement [U.S.
Preventive Services Task Force] (06/15/2011)
3. Aspirin for the Prevention of Cardiovascular Disease [Putting Prevention into Practice]
(06/15/2011)
4. Primary Prevention of CVD: Physical Activity [Clinical Evidence Handbook] (07/15/2010)
5. Diets for Cardiovascular Disease Prevention: What Is the Evidence? (04/01/2009)
6. Preventing Cardiovascular Disease in Women (10/15/2006)
7. Hormone Therapy for the Prevention of Chronic Conditions in Postmenopausal Women [Putting
Prevention into Practice] (12/15/2005)
8. Hormone Therapy for the Prevention of Chronic Conditions in Postmenopausal Women [U.S.
Preventive Services Task Force] (07/15/2005)
9. Should We Use Multiple Risk Factor Interventions for the Primary Prevention of Coronary Heart
Disease? [Cochrane for Clinicians] (07/15/2002)
Treatment
ACUTE
1. Drug-Eluting Coronary Artery Stents (12/01/2009)
2. ACC/AHA Guideline Update for the Management of ST-Segment Elevation Myocardial
Infarction (06/15/2009)
3. Acute Coronary Syndrome (Unstable Angina and non-ST Elevation Myocardial Infarction)
[Clinical Evidence Handbook] (08/15/2009)
4. Unstable Angina and Non-ST- Segment Elevation Myocardial Infarction: Part I. Initial
Evaluation and Management, and Hospital Care (08/01/2004)
5. Unstable Angina and Non-ST-Segment Elevation Myocardial Infarction: Part II. Coronary
Revascularization, Hospital Discharge, and Post-Hospital Care (08/01/2004)
6. Heparins for Unstable Angina and Non-ST-Segment Elevation Myocardial Infarction [Cochrane
for Clinicians] (04/01/2009)
7. Early Invasive Therapy or Conservative Management for Unstable Angina or NSTEMI?
[Cochrane for Clinicians] (01/01/2007)
8. Aspirin Combined with Clopidogrel (Plavix) Decreases Cardiovascular Events in Patients with
Acute Coronary Syndrome [Cochrane for Clinicians] (12/01/2007)
CHRONIC
1. Adding ACE Inhibitors or ARBs to Standard Therapy for Stable Ischemic Heart Disease
[Implementing AHRQ Effective Health Care Reviews] (07/01/2012)
Last Updated March 7, 2013
2. Medical Management of Stable Coronary Artery Disease (04/01/2011)
3. AHA Releases Guidelines for Hypertension Management in Adults with or at Risk of CAD
[Practice Guidelines] (07/15/2008)
4. Secondary Prevention of Coronary Artery Disease (02/01/2010)
5. Exercise-Based Rehabilitation for Coronary Heart Disease [Cochrane for Clinicians]
(08/01/2004)
6. Cardiovascular Risk Reduction in Children [Practice Guidelines] (06/15/2007)
7. Ranolazine (Ranexa) for Chronic Angina [STEPS] (02/15/2007)
8. Nutritional Assessment and Counseling for Prevention and Treatment of Cardiovascular
Disease (01/15/2006)
9. Cardiac Rehabilitation (11/01/2009)
10. Prognosis for Patients Undergoing Coronary Angioplasty [Point-of-Care Guides] (11/15/2004)
11. Is Prasugrel More Effective Than Clopidogrel in Patients with Acute Coronary Syndrome
Scheduled for PCI? [AFP Journal Club] (12/01/2008)
12. Contemporary Management of Angina: Part II. Medical Management of Chronic Stable Angina
(01/01/2000)
13. ACC/AHA Revise Guidelines for Coronary Bypass Surgery [Practice Guidelines] (05/01/2000)
Complications and Special Situations
1. AHA Releases Statement on Sexual Activity and Cardiovascular Disease [Practice Guidelines]
(12/01/2012)
2. Beta Blockers and Noncardiac Surgery: Why the POISE Study Alone Should Not Change
Your Practice [AFP Journal Club] (03/15/2010)
3. Preparation of the Cardiac Patient for Noncardiac Surgery (03/01/2007)
4. Right Ventricular Infarction: Specific Requirements of Management (10/15/1999)
Last Updated March 7, 2013