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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