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