historic milestones in the management of ischemic heart disease by ian l. macdonald md frcpc
TRANSCRIPT
Historic Milestones in the Management of Ischemic Heart Disease
June 10, 2016Ian L. Macdonald MD FRCPC
Abbreviated CV
▪ MD Queen’s May 1966▪ Internship U of Alberta▪ Resident Medicine Queen’s▪ Family Practice Kitimat BC 7 years▪ Residency St. Paul’s Vancouver▪ Residency Toronto Western Hospital▪ FRCPC – Internal Medicine, Cardiology▪ Cardiologist St. Paul’s 36 years▪ Currently in office practice
Annual Causes of Death
USA – CDC 2013▪ Total 2.6 million▪ Heart disease 614,000▪ Myocardial infarction 450,000▪ Cancer 600,000▪ Stroke 130,000
Diagnosis of Acute Myocardial Infarction
▪ Chest pain▪ Other symptoms▪ ECG changes▪ Biomarkers (enzymes)▪ Other lab data▪ Autopsy
Complications of Acute MI
▪ Rate and Rhythm▪ Fast▪ Slow▪ Hemodynamic▪ CHF▪ Hypotension, shock (Killip class)
▪ Thromboembolic▪ Destruction of
myocardium▪ Pericardial▪ Valvular▪ Psychological▪ Lifestyle adaptation
Outline of MI Care in 1969
▪ Admit to hospital▪ Medical ward, ECG
monitoring▪ Bed rest▪ Special nurse▪ IV Line▪ O2 by mask
▪ Pain relief▪ Lidocaine▪ Anticoagulation
(heparin)▪ Coronary angiography
(rarely)▪ Temporary pacemaker
(1973)▪ Invasive monitoring
(1976)
Long Term Management
▪ Risk Factor Treatment▪ Smoking▪ Diabetes▪ Obesity▪ Hyperlipidemia
▪ Cardiac rehab programs (later)▪ Coronary bypass graft surgery (later)▪ Job modification / retirement
(note – 2 US Presidents)
▪ Sexual activity
THANK YOU