Given a specific clinical scenario in the office or emergency setting, diagnose presentations of ischemic heart disease (IHD) that are:
classic
atypical (e.g., in women, those with diabetes, the young, those at no risk).
In a patient with modifiable risk factors for ischemic heart disease (e.g., smoking, diabetes control, obesity), develop a plan in collaboration with the patient to reduce her or his risk of developing the disease.
In a patient presenting with symptoms suggestive of ischemic heart disease but in whom the diagnosis may not be obvious, do not eliminate the diagnosis solely because of tests with limited specificity and sensitivity (e.g., electrocardiography, exercise stress testing, normal enzyme results).
In a patient with stable ischemic heart disease manage changes in symptoms with self-initiated adjustment of medication (e.g., nitroglycerin) and appropriate physician contact (e.g., office visits, phone calls, emergency department visits), depending on the nature and severity of symptoms.
In the regular follow-up care of patients with established ischemic heart disease, specifically verify the following to detect complications and suboptimal control:
symptom control.
medication adherence.
impact on daily activities
lifestyle modification.
clinical screening (i.e., symptoms and signs of complications).
In a person with diagnosed acute coronary syndrome (e.g., cardiogenic shock, arrhythmia, pulmonary edema, acute myocardial infarction, unstable angina), manage the condition in an appropriate and timely manner.
Diagnosis
Ischemic heart disease diagnosis is based on pretest probability (symptoms, risk, noninvasive testing)
CAD diagnosis is established if history of ACS or presence of obstructive lesions on angiography
Anginal Symptoms
Classical chest pain
Dull RSCP (discomfort, heaviness, aching, pressure; not changing in intensity with inspiration, cough or position change; with or without radiation into jaw, neck, shoulders, arms)
Provoked by exertion or emotional stress (lying down, post-prandially)