This edition of FP EssentialsTM will cover recent updates in diagnosis and management of acute coronary syndrome (ACS). The content should include: prehospital evaluation and management of ACS; emergency department (ED) evaluation and management of ACS; inpatient management of myocardial infarction (MI); and posthospital outpatient management of ACS.
This edition of FP Essentials should be approximately 10,000 words in length, divided into 4 sections of approximately 2,500 words each, plus an abstract of no more than 200 words for each section, key practice recommendations, a maximum of 15 tables and figures, recommended readings, and references. This edition should focus on what is new in each topic and should answer the key questions listed for each section. Each section should begin with an illustrative case, similar to the examples provided, with modifications to emphasize key points; each case should have a conclusion that demonstrates resolution of the clinical situation. The references suggested here include information that should be considered in preparation of this FP Essentials. However, these references are only a useful starting point that should be used to identify additional information to review.
Example case: It is a routine day at your office. The schedule is light, as it is Friday, and you are planning to leave for the weekend. The receptionist alerts you that a patient walked in and says he’s having chest pain. The nurse brings him back to an examination room. There, you find Ethan, a 64-year-old man clutching his chest. He is diaphoretic and says he feels like someone is squeezing his chest. He has no known medical conditions.
Example case: You are on an airplane, flying home from a medical meeting. The flight attendant asks on the public address system if there is a physician on the airplane. You respond and are asked to examine Mrs. Johnson, a 71-year-old woman sitting a few rows in front of you. She is pale, diaphoretic, dyspneic, and says she feels a strange sensation in her left arm. She says she had a myocardial infarction several years ago, and it felt like this. The flight attendant asks you whether the pilot should divert the airplane to the nearest airport.
Key questions to consider:
Initial references to consider:
Example case: Ethan, the 64-year-old male patient described in Section 1, whom you sent to the emergency department (ED) because of chest pain, arrives by ambulance and is quickly evaluated. In addition to aspirin and oxygen, he was given nitroglycerin twice in the ambulance, and it relieved his chest pain. Ethan’s vital signs are now stable. He is diaphoretic, but his examination results are otherwise reassuring.
Key questions to consider:
Example case: When evaluated in the emergency department, Ethan, the patient described in Section 1 and Section 2, undergoes an electrocardiogram (ECG) that shows sinus rhythm with 2-mm ST-segment depression in leads V3 and V4. Initial cardiac troponin testing shows a normal result, but he is admitted to the intensive care unit. Repeat cardiac troponin testing 8 hours later shows a significantly elevated level.
Example case: During hospitalization, Ethan, the patient described in Sections 1, 2, and 3 undergoes cardiac catheterization. The procedure reveals two-vessel disease, for which medical management is advised. The patient is discharged home with many new drugs, including aspirin, ticagrelor (Brilinta), isosorbide mononitrate, carvedilol (Coreg), losartan (Cozaar), eplerenone (Inspra), rosuvastatin (Crestor), esomeprazole, and bupropion. He reports feeling better but states that he cannot afford all of the new drugs, and he has difficulty adhering to the drug regimen.
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Acute Coronary Syndrome