901 N. Washington Avenue Lansing, MI 48906 Phone: (517)485-5484 Fax: (517)485-0801 cord@cordem.org

CARDIOVASCULAR

1. Demonstrate the ability to stabilize patients who present in cardiopulmonary arrest.
2. Develop skills in the evaluation of patients who present with chest pain.
3. Demonstrate the ability to evaluate, stabilize, treat, and arrange for appropriate disposition of patients with cardiac disease processes.
4. Demonstrate the ability to develop a differential diagnosis for patients presenting with cardiac symptomat ology (chest pain, shortness of breath, weakness, palpitations), etc.
5. Demonstrate skill in the interpretation of diagnostic modalities (ECG, chest x-ray and cardiac ultrasonography).
6. Develop a familiarity with cardiac pharmacologic agents.
7. Demonstrate skill at cardiac related procedures: venous line and CVP pressure monitoring, pericardiocentesis, defibrillation and cardioversion, Swan ganz catheterization, and ultrasonography.
8. Demonstrate the ability to diagnose, stabilize, and apply thrombolytic therapy to patients presenting with acute early myocardial infarction.

1. Demonstrate the ability to perform an appropriate history and physical examination on the patient presenting with cardiac symptomatology. (1)
2. List items elicited from the history of patient with chest pain to suggest a risk for cardiac etiology. (1)
3. Discuss limitations in differentiation of cardiac chest pain from non-cardiac pain in patients with risk factors. (1)
4. Describe the pathophysiology of cardiac ischemia, acute angina chest pain, and acute myocardial infarction. (1)
5. Describe the typical electrocardiograph findings of patients with myocardial ischemia, subendocardial infarction and myocardial and transmural infarction. (1)
6. Discuss differential diagnosis of atypical chest pain. (1)
7. Discuss atypical presentations for acute cardiac ischemia and myocardial infarction. (1)
8. Discuss the sensitivity and specificity of ancillary studies for chest pain presentations including EKG, chest x-ray, cardiac enzymes, and arterial blood gases. (1)
9. Differentiate between stable and unstable angina and outline the initial treatment of patients with unstable angina including the use of nitrates, beta blockers, calcium channel blockers, etc. (1)
10. Discuss the concept of "silent" myocardial infarction and ischemia. (1)
11. Differentiate between transmural versus subendocardial infarction. (1)
12. Discuss the significance of acute complete atrio-ventricular block with inferior myocardial infarction versus anterior myocardial infarction. (1)
13. Demonstrate knowledge of AHA recommendation for the treatment of acute ventricular fibrillation, ventricular tachycardia, asystole, pulseless electrical activity, atrial flutter and fibrillation, junctional ectopy, pre-exitation, supraventricular tachycardia, and bradycardia, sick-sinus syndrome, atrial ventricular blocks (first degree, second degree and third degree) and bundle branch blocks. (1)
14. Describe the clinical findings of cardiogenic shock and outline therapy for cardiogenic shock. (1)
15. Differentiate cardiogenic shock from other etiologies for shock. (1)
16. Describe the clinical presentation for pericardial disease and outline the appropriate initial therapy and management for pericardial disease. (1)
17. Describe the presentations for myocardial infarction and their association with vessel involvement. (1)
18. List the indications, contraindications and complications of thrombolytic therapy for acute myocardial infarction. (1)
19. Describe the clinical presentation, etiologies for pathophysiology of, and current therapy for acute congestive heart failure. (2)
20. Describe the valvular anatomy of the heart and list etiologies for valvular heart disease. (2)
21. Describe the clinical findings of a mitral valve prolapse, valvular aortic stenosis, aortic regurgitation, tricuspid stenosis, tricuspid regurgitation, and pulmonary stenosis, and discuss management of each of these valvular abnormalities. (2)
22. List complications of prosthetic cardiac valves and appropriate emergency department management. (1)
23. Differentiate between congestive cardiomyopathy, hypertrophic cardiomyopathy and restrictive cardiomyopathy and discuss therapy for each. (2)
24. Define myocarditis and describe the EKG findings and acute management of myocarditis. (2)
25. Discuss the pathophysiology of acute pulmonary embolism and the predisposing factors for pulmonary embolism. (1)
26. Discuss the sensitivity and specificity of the various tests used to diagnosis pulmonary embolism including arterial blood gases, EKG, chest x-ray, etc. (1)
27. Discuss the sensitivity and specificity of ventilation perfusion scan in acute pulmonary embolism.
28. Outline treatment for acute pulmonary embolism. (1)
29. Differentiate between acute hypertensive emergencies, hypertensive urgency, and uncomplicated hypertension. (1)
30. Discuss the indications for treatment of hypertension in the emergency department. (1)
31. Describe the syndrome of hypertensive encephalopathy. (1)
32. Outline the treatment for acute hypertensive emergency and differentiate treatment in the setting of thoracic aortic dissection. (1)
33. Differentiate between primary agents for hypertensive emergency to include their advantages and disadvantages. (1)
34. Describe the clinical presentation of acute mesenteric ischemia and discuss the inherent difficulties in the diagnosis as well as the emergency department management. (1)
35. Discuss the pathophysiology, etiology, and overall morbidity and mortality of patients presenting with acute aortic dissection. (1)
36. Explain the emergency department management of acute aortic dissection. (1)
37. Differentiate between expanding, ruptured, and dissecting aortic aneurysms. (1)
38. Describe the pathophysiology and clinical presentation for acute peripheral ischemia and outline the emergency department management. (1)
39. Differentiate between superficial and deep venous thrombosis. (1)
40. Outline the emergency management of acute thrombophlebitis. (1)
41. Discuss the pathophysiologic connection between thrombophlebitis and pulmonary embolism. (1)
42. Discuss the use of thrombolysis in acute thrombophlebitis. (2)