Tuesday, November 28, 2023
In compliance with EBAC/EACCME guidelines, all speakers/chairpersons participating in this programme have disclosed potential conflicts of interest that might cause a bias in the presentations. The Organising Committee is responsible for ensuring that all potential conflicts of interest relevant to the programme are declared to the audience prior to the CME activities.
Professor of Cardiology, Department of Cardiovascular Science, University of Sheffield; Academic Director and Honorary Consultant in Cardiology, The Cardiology and Cardiothoracic Surgery Directorate, Sheffield Teaching Hospitals, Sheffield, United Kingdom
This educational activity is intended for an international audience of non-US healthcare professionals, specifically interventional cardiologists, general cardiologists, emergency department physicians, internists, and primary care physicians involved in the management of patients with acute coronary syndromes (ACS).
The goal of this activity is to apply the current European Society of Cardiology guidelines for the use of dual antiplatelet therapy for the secondary prevention of myocardial infarction and the use of evidence-based therapies for comorbid cardiovascular (CV) disease with the goal of improving the clinical care of patients with ACS.
Upon completion of this activity, participants will be able to:
In compliance with EBAC/EACCME guidelines, all speakers/chairpersons participating in this programme have disclosed potential conflicts of interest that might cause a bias in the presentations. The Organising Committee is responsible for ensuring that all potential conflicts of interest relevant to the programme are declared to the audience prior to the CME activities.
Professor of Cardiology, Department of Cardiovascular Science, University of Sheffield; Academic Director and Honorary Consultant in Cardiology, The Cardiology and Cardiothoracic Surgery Directorate, Sheffield Teaching Hospitals, Sheffield, United Kingdom
The Internet Course “Preventing Recurrent CV Events: Role of Antithrombotic Therapy” is accredited by the European Board for Accreditation in Cardiology (EBAC) for 1.00 hours of External CME credits.
Each participant should claim only those hours of credit that have actually been spent in the educational activity. EBAC works according to the quality standards of the European Accreditation Council for Continuing Medical Education (EACCME), which is an institution of the European Union of Medical Specialists (UEMS).
For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]
There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.
This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page.
Follow these steps to earn CME/CE credit*:
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CME Released: 6/10/2016
Valid for credit through: 6/10/2017, 11:59 PM EST
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Gordon Bowyer is a 67-year-old obese man with a 10-year history of hypertension; he has compromised kidney function with an estimated glomerular filtration rate (eGFR) of 58 mL/min. Gordon was diagnosed 5 years ago with unstable angina. An angiogram at that time revealed multivessel disease with 30% stenosis in the right coronary artery, 40% disease in the mid left anterior descending artery, and 90% stenosis of a 2.5-mm diagonal branch of the left anterior descending artery. His angina was effectively managed with medication alone.
However, 9 months ago, he suffered a non-ST-segment elevation myocardial infarction (MI). A repeat angiogram found 95% stenosis of the right coronary artery. He received a drug-eluting stent and was placed on dual antiplatelet therapy. A recent echocardiogram shows preserved left ventricular function and a ventricular septum diameter of 12 mm. We'll now join Mr Bowyer during a follow-up visit with his cardiologist.
Doctor: Hello, Mr Bowyer. How are you today?
Patient: Hello, doctor. I'm alright; thank you.
Doctor: It's been 9 months now since you had the stent put in. Have you had any symptoms of angina since then?
Patient: No, not that I can recall.
Doctor: Any chest pain or unexplained pain in your shoulder, arm, jaw, neck, etc? Any shortness of breath or discomfort that feels like tightness or squeezing, say?
Patient: No, nothing like that.
Doctor: Your cholesterol looks pretty good -- everything is within normal range.
Patient: Oh, that's good news.
Doctor: But I am concerned about your weight, Mr Bowyer.
Patient: Yes, it's just so difficult. I have been dealing with this all of my life -- even when I was a kid I was heavy. And I never really understood why. I did the same kinds of activities as all of the other kids, and I don't think that I ate any more than anybody else.
Doctor: I understand, Mr Bowyer. Sometimes genetics can make controlling our weight an uphill battle.
Patient: Exactly. My father was heavy as well, so what chance do I have?
Doctor: Well, even though your genetics make it more difficult to lose weight, they don't mean that it's impossible. And even if you could lose just a few pounds through increased exercise and restricting your calorie intake, it would help to reduce your risk of having another heart attack.
Patient: It was easier when I was younger, of course -- I used to play rugby every week, and I wasn't nearly as heavy then. But I'm much too old for that sort of thing now.
Doctor: Yes, Mr Bowyer, I do think that your rugby-playing days are probably behind you now! But it doesn't mean that you can't do any exercise at all. Are you doing anything active at the moment?
Patient: No, not really -- I'm just so busy. My son keeps asking me to start playing golf with him again on the weekends. Maybe I should do so.
Doctor: That would be an excellent place to start. You'll get some exercise and spend time with your son. Bear in mind, it doesn't have to be a major investment of your time -- if you could just walk for 30 minutes a day, it would be beneficial. Perhaps after you've eaten dinner, before you settle down for the evening.
Patient: I suppose I could try that.
Doctor: Please do -- it really would make a difference to your risk of having something happen. What about your diet? The nurse previously provided you with information about nutrition. How closely have you been following those recommendations lately?
Patient: My wife is pretty good about staying on top of that. She tries to cook healthier food. She doesn't let me have fried food very often any more.
Doctor: What about drinks -- sugar in your tea, soda, beer?
Patient: I stopped putting sugar in my tea a while ago, and I don't drink soda anymore. But I suppose I do go to the pub once in a while and have a couple of pints.
Doctor: Well, I don't have to tell you that beer will make it harder to control both your weight and your blood sugar.
Patient: Yes, I've definitely cut back a lot.
Doctor: That's a start. Well, you are currently taking atenolol 25 mg a day, ramipril 2.5 mg a day, rosuvastatin 40 mg a day, glyceryl trinitrate spray as needed, low-dose aspirin, and ticagrelor 90 mg twice daily. Now, I see that when the nurse took your blood pressure today, it was 142 over 89. So despite the medication, we still haven't got it down to where it needs to be.
Patient: Oh, really?
Doctor: You're taking your blood pressure tablets every day, right?
Patient: Yes, exactly as I'm supposed to.
Doctor: A number of things can make it difficult to get blood pressure under control and keep it there, as I'm sure you know. Again, if you can get your weight down a little, that should help with your blood pressure as well.
Patient: Yes, of course.
Doctor: And just not getting enough exercise or being active enough, in general, can lead to higher blood pressure. We just talked about diet, and it's good that you've cut down on fatty foods and sugar. But, when it comes to blood pressure, too much salt may also contribute to raised blood pressure, and it is best to avoid salty foods or adding salt to your meals.
Patient: Alright, I'll ask my wife where we can try to cut down on salt.
Doctor: Wonderful. I think that we should also try to give you a bit of help. Let's adjust your medications to see if we can get your blood pressure down to where it should be.
Patient: Ok.
