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VA Cardiology Policies for Medicine Residents

Do not write “ r/o ACS” in your assessment/plan. Instead, if you think the patient may be having acute coronary syndrome, write “chest pain,” “probable CAD” or “symptomatic CAD,” for example.

All troponin results >0.04 must be commented on by the cardiology fellow or attending physician.

When there is high suspicion for ACS: (for CP, EKG changes, etc.) place a consult in CPRS for Cardiology and call the cardiology fellow personally to discuss the patient. In addition:

  • ASA must be given immediately.
  • Beta block must be given within 24 hours, if tolerated.
  • If there is any contraindication to either of the above medications, state that in your progress note or in a separate note titled “Medicine Contraindication.”

When there is low suspicion of ACS (no symptoms or EKG changes, but troponin is 0.041, for example):

  • During the day, call the cardiology fellow to notify them of the elevated troponin.
  • At night, sign out to the primary team that they must call the cardiology fellow early in the morning to notify him or her of the elevated level.

Patients with the diagnosis of CHF:

  • State the EF in progress notes and discharge summary. A repeat EF determination on each admission is not required.
  • In the discharge instructions, check the box “CHF is one of the patient’s discharge diagnoses” and fill out any additional information required. If any of the CHF medications (for example, BB, ACEi, ASA, etc.) could not be used, please state the reason in the discharge instructions.