Last updated on 21 Jan 2016 at 4:05 PM (CVS02)

Acute chest pain
A 75 year old Māori man presents to the Emergency Department with central chest pain. It has been present for the past 40 minutes and came on while he was resting. He feels terrible.

 

Applied Science for Medicine
Anatomy of coronary arteries and veins
Physiological changes in cardiac function associated with ageing
Pathophysiology of atherosclerosis, plaque rupture and myocardial infarction
Changes in cardiac enzymes post-myocardial infarction
Pharmacology of glyceryl trinitrate (GTN), aspirin, clopidogrel, statins, low molecular weight heparin, unfractionated heparin, tissue-plasminogen activator, abciximab
Mechanism of action and dose-response relationship for beta adrenoceptor blocking drugs; define agonist, antagonist, partial agonist

Clinical and Communication Skills
History from a patient with acute chest pain; consideration of cardiovascular risk factors
Examination of the cardiovascular system; recognise signs of cardiogenic shock
Differential diagnosis of acute chest pain
Perform and interpret an ECG and recognize ischaemic features (i.e. STEMI and NSTEMI)
Interpret troponin, cardiac enzymes, C-reactive protein
Indications for: echocardiogram, angiography, CT angiogram, exercise tolerance test, dobutamine stress echocardiogram, myocardial perfusion studies
Management of acute coronary syndrome (STEMI, NSTEMI and unstable angina)
Complications of acute coronary syndrome
Role of cardiovascular rehabilitation
Management of cardiovascular risk factors post-acute coronary syndrome: pharmacological (including side-effects) and non-pharmacological
Outline the management of myocarditis, pericarditis and aortic dissection

Personal and Professional Skills
Awareness of own stress when managing a patient with acute illness
Effectively communicate information about lifestyle changes, including smoking cessation
Legal requirement for maintaining motor vehicle licences after acute coronary syndromes; issues of confidentiality

Hauora Māori
Awareness of differing risk profiles for cardiovascular disease in Māori (and other disadvantaged populations) compared with non-Māori in New Zealand (higher smoking rates and hypertension, reduced access to primary prevention)
Understanding of inequities in cardiovascular disease outcomes for Māori compared with non-Māori including higher incidence of cardiovascular disease and higher mortality; application of this to clinical decision making and management
Understanding of inequities in access to health services and quality of medical care for Māori including reduced likelihood of receiving surgical intervention, and application of this to clinical decision making and management
Understanding of the role of kaupapa Māori health policies, services and research in reducing inequalities such as the Unequal Treatment Research at Eru Pomare and the Heart Guide Aotearoa service for cardiac rehabilitation

Population Health
Epidemiology of acute coronary syndrome, aortic dissection, pericarditis and myocarditis
Access to timely treatment/referral; provision of primary percutaneous coronary intervention for patients in regional-rural locations
Screening for risk factors
Primary and secondary prevention strategies for coronary artery disease

 

Conditions to be considered relating to this scenario

Common

acute coronary syndrome (STEMI, NSTEMI and unstable angina), pulmonary embolism, gastro-oesophageal reflux disease, pericarditis, pleuritis, costochondritis, fibromyalgia, hyperventilation syndrome, generalised anxiety disorder, panic attack, depression

Less common but 'important not to miss'

cardiac tamponade, oesophageal rupture, pneumothorax, aortic dissection

Uncommon

achalasia, radiculopathy