Original case exhibits · faculty and assessment review
Pregnancy Is Heart History
Progressive cases and proposed transfer decisions
These original review exhibits make the grant’s teaching method concrete. The existing learner activity and scored assessment are unchanged. New vignettes are proposed parallel forms, not validated instruments or additional completion requirements. Faculty should revise or reject any item that changes the clinical construct or adds unintended difficulty.
Application narrative bank · Proposed transfer items · CSV · Case design map · CSV
Case 1
Nina: postpartum transition
The case develops
The obstetric summary arrives after the initial visit; a prevention appointment is still unconfirmed.
Faculty reasoning and feedback
Ask the learner to reconcile the pregnancy complication with current risk and retain responsibility until the receiving team accepts the plan.
Try a different patient
A 51-year-old woman’s archived obstetric record documents preeclampsia with delivery at 32 weeks. Her current chart lists only parity and no ASCVD diagnosis. At a preventive visit, which action best uses the new record?
- Document the complication and timing, assess current risks, and agree on prevention and follow-up.
- Refer to cardiology and defer the primary care prevention assessment until that visit.
- Start lipid-lowering medication based on the pregnancy history before completing the assessment.
- Record the history in the obstetric section and use the current risk estimate without further discussion.
Review the proposed answer and rationale
A. Document the complication and timing, assess current risks, and agree on prevention and follow-up.
Pregnancy history informs prevention; it does not establish an ASCVD diagnosis or a drug indication by itself. [1,6]
Assessment map: baseline Q1 → proposed TR1; objective 1. The current course reference list supports the key; verify the current guideline or label during clinical review.
Case 2
Maria: midlife prevention
The case develops
A family-history discussion reveals that no Lp(a) result is available.
Faculty reasoning and feedback
Require an explanation of what the test adds and why it does not replace the complete risk assessment.
Try a different patient
A 48-year-old woman asks whether her usual cholesterol panel already includes inherited lipoprotein risk. She has no previous Lp(a) measurement. Which testing approach best fits current adult prevention guidance?
- Repeat Lp(a) after each lifestyle change to judge the prevention response.
- Measure Lp(a) at least once in adulthood and interpret it within the complete risk assessment.
- Measure Lp(a) only if LDL-C remains above goal despite treatment.
- Use Lp(a) instead of a standard lipid panel when pregnancy complications are present.
Review the proposed answer and rationale
B. Measure Lp(a) at least once in adulthood and interpret it within the complete risk assessment.
Lp(a) testing adds inherited-risk information; repeated routine testing is generally unnecessary. [6,7]
Assessment map: baseline Q4 → proposed TR2; objective 2. The current course reference list supports the key; verify the current guideline or label during clinical review.
Case 3
Elena: secondary prevention
The case develops
A patient brings a headline equating a large biomarker reduction with fewer heart attacks.
Faculty reasoning and feedback
Have the learner identify the actual endpoint, evidence maturity and limits before communicating a treatment implication.
Try a different patient
During follow-up after MI, a woman asks if the September 2026 Lp(a)HORIZON sponsor announcement proves that lowering Lp(a) prevents cardiovascular events. The announcement reports a biomarker reduction but a missed primary cardiovascular endpoint. Which response is most defensible?
- Explain that the sponsor-reported trial missed its primary cardiovascular endpoint and appraise detailed data when available.
- Treat the biomarker reduction as sufficient evidence of cardiovascular benefit.
- Use the result to conclude that Lp(a) is no longer relevant to risk assessment.
- Apply the trial conclusion to every investigational Lp(a)-lowering medicine.
Review the proposed answer and rationale
A. Explain that the sponsor-reported trial missed its primary cardiovascular endpoint and appraise detailed data when available.
Biomarker change and clinical benefit are distinct; this trial result does not erase risk associated with Lp(a). [11]
Assessment map: baseline Q8 → proposed TR3; objective 4. The current course reference list supports the key; verify the current guideline or label during clinical review.
Full proposal, objectives and clinical source register
Review the assessment before release
The current baseline and first posttest share three items. Report paired n, absolute percentage-point change, item-level results and uncertainty, with retries separate. The 15-percentage-point gain is a planning target; high baseline scores may create a ceiling. Repeated items measure immediate learning with recall limitations. The proposed transfer form changes the clinical surface while preserving the mapped concept. Before using it for a Moore level 4 claim, independent clinical and assessment reviewers must approve the key, equivalence, difficulty and analysis, then pilot it with representative learners. Use it to replace matched posttest slots only after approval, preserving six final questions and the time target. It is not an additional required test in the present activity. Report unpaired data and nonresponse; do not infer causality, observed clinical performance or patient benefit.
For each case, check clinical realism, fair balance, one defensible best answer, comparable option length, plausible distractors and absence of irrelevant reading burden. Review safety errors separately. Keep a versioned record of reviewer decisions and pilot findings; unresolved ambiguity blocks use of that item.