Content Objective: Chest Pain

By the end of the Family Medicine Clerkship, the medical student will be able to:

1. Conduct a rapid cardiac assessment to identify patients requiring emergency care.
   
   
2. Describe the family physicians role in the stabilization and initial management of patients identified to require emergent cardiac care.
   
   
3. Conduct a focused cardiac history (including cardiac risk factors) and a relevant physical exam.
   
   
4. Develop a concise differential diagnosis for patients with chest pain including cardiac and non-cardiac causes.
   
   
5. Describe the key clinical characteristics of the following chest pain etiologies: angina (stable and unstable), embolism, gastroesophageal reflux, costochondritis, anxiety, pneumonia.
   
   
6. Identify patients at elevated risk for IHD and calculate their 10-year cardiovascular risk using the Framingham risk score.
   
   
7. Propose a patient-centred initial management plan for primary prevention of IHD.
   
   
8. Identify which patients’ required further investigation to confirm a diagnosis of IHD.
   
   
9. Describe an early post-ischemic event management plan including lifestyle changes, medications, psychosocial support, cardiac rehabilitation, etc.
   
   
10. Propose a surveillance and management plan for secondary prevention of cardiovascular events in patients with IHD.

Mandatory Clinical Encounter

• Chest pain

Resources*

• LearnFM, Chest pain clinical cards
• Cardiovascular Disease Risk, TOP 2019
• Hall, S et al.  Secondary Prevention of Coronary Artery Disease, Am Fam Physician 2010 Feb 1;81(3):289-296 (note that BP target to 130/80 for patients with chronic kidney disease is no longer correct)
• Look for Canadian Cardiovascular Society Lipids Guidelines App- has Framingham calculator 
• See also resources under Metabolic Syndrome/Obesity/Dyslipidemia

* Where a specific resource is not listed for a particular objective, please refer to recommended general texts/websites. Resources have often been selected from the Clinical Practice Guidelines and Protocols in British Columbia and Alberta’s Towards Optimized Practice Clinical Practice Guidelines. These are often concise summaries of national guidelines.