Acute Coronary Syndrome
Course #40944 - $90 -
- Participation Instructions
- Review the course material online or in print.
- Complete the course evaluation.
- Review your Transcript to view and print your Certificate of Completion. Your date of completion will be the date (Pacific Time) the course was electronically submitted for credit, with no exceptions. Partial credit is not available.
Acute coronary syndrome (ACS) is a spectrum of life-threatening disorders that includes unstable angina (UA), non-ST-segment elevation MI (NSTEMI), and ST-segment elevation MI (STEMI). Mortality rates have declined considerably over the past decade as therapeutic options have expanded and evidence-based guidelines have been developed for the diagnosis and treatment of NSTEMI and STEMI. The course begins by providing a context for ACS through a discussion of the epidemiology of coronary heart disease (CHD) and ACS, a description of the pathophysiology of ACS, and the primary prevention of CHD, which helps to lower the prevalence of ACS. The course then focuses on the diagnosis of UA/NSTEMI and STEMI and risk stratification in the emergency department setting. Although many of the same classes of drugs are used to treat UA/NSTEMI and STEMI, the therapeutic approaches vary considerably. The treatment of ACS is a complex issue because of the wide scope of cardiac disease related to ACS and the extensive treatment decisions involved. As such, the content is limited to an overview of the diagnosis, treatment, and secondary prevention in an uncomplicated course of ACS.
This course is designed for physicians, physician assistants, and nurse practitioners to enhance their knowledge of the diagnosis, assessment, management, and secondary prevention of acute coronary syndrome.
The pace at which acute coronary syndrome guidelines are updated make it challenging for clinicians to remain current with the recommendations that lead to improved outcomes for this substantial patient population. The purpose of this course is to reduce the widening gap between care according to guidelines and actual care delivered by providing healthcare professionals with knowledge necessary to implement the most appropriate approach to diagnosis and treatment.
Upon completion of this course, you should be able to:
- Discuss the prevalence and definition of coronary heart disease (CHD) and acute coronary syndrome (ACS).
- Explain the pathophysiology of ACS, including the role of plaque formation and rupture.
- Devise a strategy for screening and evaluation of asymptomatic individuals at risk for ACS.
- Describe the various clinical presentations of ACS and the differential diagnosis of chest pain, including considerations for non-English-proficient patients.
- More effectively utilize ECG and cardiac biomarkers in the diagnosis of ST-segment elevation myocardial infarction (STEMI) and unstable angina/non-ST-segment elevation myocardial infarction (UA/NSTEMI).
- Discuss the factors involved in risk stratification of individuals with suspected ACS.
- Assess the consistency of your and your team's adherence to guidelines for the acute treatment of UA/NSTEMI.
- Select the optimal anti-ischemic, antiplatelet, and anticoagulant agents for the treatment of UA/NSTEMI.
- Distinguish between the clinical indications for an ischemia-guided or invasive strategy for patients with UA/NSTEMI.
- Discuss the issue of timing in selecting reperfusion therapy for patients with STEMI.
- Describe the role of percutaneous coronary intervention (PCI) for STEMI.
- Identify contraindications and cautions for fibrinolysis in the treatment of STEMI.
- List other reperfusion therapies used in the treatment of STEMI, and identify the appropriate therapy for individual patients.
- Outline appropriate secondary prevention measures for patients with ACS.
- Discuss the relationship between guideline adherence in practice and patient outcomes.
Lori L. Alexander, MTPW, ELS, MWC, is President of Editorial Rx, Inc., which provides medical writing and editing services on a wide variety of clinical topics and in a range of media. A medical writer and editor for more than 30 years, Ms. Alexander has written for both professional and lay audiences, with a focus on continuing education materials, medical meeting coverage, and educational resources for patients. She is the Editor Emeritus of the American Medical Writers Association (AMWA) Journal, the peer-review journal representing the largest association of medical communicators in the United States. Ms. Alexander earned a Master’s degree in technical and professional writing, with a concentration in medical writing, at Northeastern University, Boston. She has also earned certification as a life sciences editor and as a medical writer.
John M. Leonard, MD, Professor of Medicine Emeritus, Vanderbilt University School of Medicine, completed his post-graduate clinical training at the Yale and Vanderbilt University Medical Centers before joining the Vanderbilt faculty in 1974. He is a clinician-educator and for many years served as director of residency training and student educational programs for the Vanderbilt University Department of Medicine. Over a career span of 40 years, Dr. Leonard conducted an active practice of general internal medicine and an inpatient consulting practice of infectious diseases.
Contributing faculty, Lori L. Alexander, MTPW, ELS, MWC, has disclosed no relevant financial relationship with any product manufacturer or service provider mentioned.
Contributing faculty, John M. Leonard, MD, has disclosed no relevant financial relationship with any product manufacturer or service provider mentioned.
John V. Jurica, MD, MPH
Ronald Runciman, MD
The division planners have disclosed no relevant financial relationship with any product manufacturer or service provider mentioned.
Sarah Campbell
The Director of Development and Academic Affairs has disclosed no relevant financial relationship with any product manufacturer or service provider mentioned.
The purpose of NetCE is to provide challenging curricula to assist healthcare professionals to raise their levels of expertise while fulfilling their continuing education requirements, thereby improving the quality of healthcare.
Our contributing faculty members have taken care to ensure that the information and recommendations are accurate and compatible with the standards generally accepted at the time of publication. The publisher disclaims any liability, loss or damage incurred as a consequence, directly or indirectly, of the use and application of any of the contents. Participants are cautioned about the potential risk of using limited knowledge when integrating new techniques into practice.
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The role of implicit biases on healthcare outcomes has become a concern, as there is some evidence that implicit biases contribute to health disparities, professionals' attitudes toward and interactions with patients, quality of care, diagnoses, and treatment decisions. This may produce differences in help-seeking, diagnoses, and ultimately treatments and interventions. Implicit biases may also unwittingly produce professional behaviors, attitudes, and interactions that reduce patients' trust and comfort with their provider, leading to earlier termination of visits and/or reduced adherence and follow-up. Disadvantaged groups are marginalized in the healthcare system and vulnerable on multiple levels; health professionals' implicit biases can further exacerbate these existing disadvantages.
Interventions or strategies designed to reduce implicit bias may be categorized as change-based or control-based. Change-based interventions focus on reducing or changing cognitive associations underlying implicit biases. These interventions might include challenging stereotypes. Conversely, control-based interventions involve reducing the effects of the implicit bias on the individual's behaviors. These strategies include increasing awareness of biased thoughts and responses. The two types of interventions are not mutually exclusive and may be used synergistically.