Acute Coronary Syndrome

Course Overview
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.

Learning Outcomes 
Upon the completion of this course, the learner 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.

About the Author/Presenter 
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.

Audience/Accreditations and Approvals 
TRC Healthcare/ NetCE 
In support of improving patient care, this activity has been planned and implemented by TRC Healthcare/ NetCE. TRC Healthcare/NetCE is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. 
This course is designed for the following healthcare professions (select your profession for details): 
Physician

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