Presentations
- Arrhythmia
- Diaphoresis
- Effort intolerance
- Nausea
- Shortness of breath
- Syncope
- Typical angina pain
(i.e. chest, jaw, back, arm)
Conditions
- Acute coronary syndromes:
- non-ST elevation
myocardial infarction
(NSTEMI, type 1 versus
type II)
- ST-elevation myocardial
infarction (STEMI)
- unstable angina
- Angina:
- microvascular
- stable
- vasospastic
- Asymptomatic coronary
artery disease
- Chronic coronary syndrome
- Non-cardiac chest pain (GORD,
musculoskeletal, oesophageal
spasm, pleurisy, stress/anxiety)
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients' needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
Conditions
- Anomalous coronary arteries
- Aortic dissection
- Coronary spasm
- Myocardial bridging
- Myocardial infarction with
non-obstructive coronary arteries
- Myocarditis
- Pericarditis
- Spontaneous coronary artery
dissection (SCAD)
- Takotsubo cardiomyopathy
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients* and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients' needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
- Epidemiology of ischaemic heart disease
- Key medications:
- anti-anginal medications
- antiplatelet medications (e.g. aspirin, ADP inhibitors, IIB/IIIa
inhibitors, P2Y12 inhibitors)
- antithrombin medications (e.g. heparin, LMWH)
- fibrinolysis in a non-percutaneous coronary interventions (PCI)
setting for acute STEMI
- lipid-lowering medications (e.g. HMG CoA reductase inhibitors,
ezetimibe, PCSK9 inhibitors)
- Pathophysiology of coronary artery disease:
- acute plaque rupture
- coronary atherosclerosis
- coronary artery dissection
- coronary artery spasm
- microvascular dysfunction
- Risk factors:
- Aboriginal and Torres Strait Islander background
- chronic kidney disease
- diabetes mellitus
- familial hypercholesterolemia
- high serum level of c-reactive protein (CRP)
- high serum level of low-density lipoprotein (LDL) cholesterol
- low serum level of high-density lipoprotein (HDL) cholesterol
- physical inactivity
- significant family history of IHD
- smoking
- systemic hypertension
- Understand patient-tailored antithrombotic (antiplatelet/anticoagulation)
regimens and duration according to their ischaemic and bleeding risk
- Understand the role of coronary calcium scoring in patients as
a screening tool
- 12-lead ECG
- Cardiac CT
- Coronary artery bypass graft surgery (CABG) (know indications for)
- Coronary physiology:
- invasive coronary angiography
- Echocardiography/Stress ECG
- Hyperaemic and non-hyperaemic indices
- Intracoronary imaging
- Invasive coronary physiology
- Myocardial perfusion imaging (MPI)
- positron emission tomography (PET)
- single photon emission computed tomography (SPECT)
- Percutaneous coronary intervention (PCI)
- Troponin and other biomarkers measurements
General management considerations
- Goals of therapy
- Individual patient clinical indications to determine patients' needs,
and the most appropriate approach to investigations and care
- Impact of comorbidities on diagnosis and management
- Patient demographics, including geographical location, socioeconomic
status, ethnicity, and cultural background, and the considerations
when managing and following up these patients (e.g. travel from
rural to metropolitan areas)
- Principles of treatment and counselling of women with heart disease
who are or are planning to become pregnant
- Sex-based differences in how patients present with myocardial
infarction
- The timing of decisions and risks for the individual patient
Specific management considerations
- Appropriate referral to cardiac rehabilitation after an acute coronary
syndrome or post-CABG
- Awareness of driving restrictions post-acute coronary syndrome
or revascularisation
- Consider MRI when diagnosis is unclear
- Ongoing secondary prevention and medical management, including
risk factor treatment to target
- Primary prevention of coronary artery disease
- Referral to palliative care when all appropriate treatment options
have been exhausted
