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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_2669_Библиотеки_им_академика_М_И_Перельмана
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TRC Healthcare Calls to Action
21. We call upon the federal government to provide sustainable funding for existing and new Aboriginal
healing centres to address the physical, mental, emotional, and spiritual harms caused by residential schools,
and to ensure that the funding of healing centres in Nunavut and the Northwest Territories is a priority.
22. We call upon those who can effect change within the Canadian health-care system to recognize the
value of Aboriginal healing practices and use them in the treatment of Aboriginal patients in
collaboration with Aboriginal healers and Elders where requested by Aboriginal patients.
23. We call upon all levels of government to:
i. Increase the number of Aboriginal professionals working in the health-care field.
ii. Ensure the retention of Aboriginal health-care providers in Aboriginal communities.
iii. Provide cultural competency training for all healthcare professionals.
24. We call upon medical and nursing schools in Canada to require all students to take a course dealing with
Aboriginal health issues, including the history and legacy of residential schools, the United Nations
Declaration on the Rights of Indigenous Peoples, Treaties and Aboriginal rights, and Indigenous teachings and
practices. This will require skills-based training in intercultural competency, conflict resolution, human rights,
and anti-racism.
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Education and Support
Physicians should learn more per TRC calls to action.
INTERESTED IN READING MORE AS AN INTERNIST?
THIS WEBSITE THROUGH THE NORTHERN ONTARIO SCHOOL OF MEDICINE HAS A DECENT COMPENDIUM OF OPEN-
ACCESS REFERENCES
https://www.nosm.ca/education/rehabilitation-studies/resources/indigenous-health-learning-resources
INDIGENOUS MENTAL HEALTH SUPPORTS
INDIGENOUS MENTAL HEALTH SUPPORTS
The National Indigenous Residential School Crisis Line 24-hour crisis support line 1-866-925-4419 for
Residential school students and their families
Hope for Wellness support for any First Nation, Metis or Inuit
1-855-242-3310 /online chat at
https://www.hopeforwellness.ca
/
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CARDIOLOGY
December 2, 2023
Dr. Michael Ruiz
© Internal Medicine Review 2024
www.internalmedicinereview.ca
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Guiding Principles
Broad strokes:
• Help symptomatic patients feel better
• Help patients live longer
• Identify and treat risk factors
• Practice evidence-based medicine
RC tips:
• Use Canadian Guidelines (CCS) when possible
• Do not worry about understanding advanced cardiovascular techniques
(ablation, angiography, etc.)
• Be safe!
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Outline
1. Coronary artery disease
2. Heart failure / cardiomyopathy
3. Valvular heart disease
4. Aortopathy
5. Pericardial disease
6. Arrhythmias and implantable cardiac
devices
7. Peripheral arterial disease
NB. ECGs will be self study online
ACS Acute Coronary Syndrome
CRT (D)
vs. (P)
Cardiac Resynchronization Therapy (with Defibrillator) vs. (Pacing only)
CCTA Coronary CT angiography
DAPT Dual Antiplatelet Therapy (ASA + clopidogrel or prasugrel or ticagrelor)
EST Exercise Stress Test
METs Metabolic Equivalents
DOACs Direct Oral Anticoagulants (ex apixaban, dabigatran, rivaroxaban)
NSTEACS Non ST Elevation Acute Coronary Syndrome
OAC Oral Anticoagulants (Includes VKA, DOAC)
OMT Optimal Medical Therapy
POBA Plain Old Balloon Angioplasty
PCI Percutaneous Coronary Intervention
VKA Vitamin K Antagonist (warfarin)
SAPT Single Antiplatelet Therapy (ASA OR Clopidogrel)
SPECT Single photon emission computed tomography
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Coronary Artery Disease
Key resources:
• CCS 2014 Guidelines – Diagnosis and management
of stable ischemic heart disease
• ACC/AHA 2023 Guidelines – Chronic CAD
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Coronary Artery Disease (CAD)
Two major presentations:
Chronic stable CAD
2014 CCS guidelines on stable ischemic heart disease
2023 ACC/AHA Guideline on Management of Patients with Chronic
Coronary Disease
Acute coronary syndromes
Various CCS/ACC/AHA guidelines on ACS, antiplatelets
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How Do Patients Present?
Ischemic cascade – with increasing ischemic time:
1. Blood flow changes (can be seen on myocardial perfusion)
2. Diastolic, then systolic dysfunction (wall motion abnormalities)
3. ECG changes
4. Symptoms
5. Myocardial necrosis
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Diagnostic Tests for CAD
• Functional
Non-invasive stress tests:
– STRESS = exercise,
drugs (inotropes,
vasodilators)
– TEST = ECG, ECG+echo,
ECG+nuclear
• Structural
– Coronary angiography
– CT coronary
angiography
• STRESS: pick exercise whenever possible!
– Provides prognostic info: e.g. duration of exercise, METs
– Not possible if physical limitations or contraindications
(e.g. critical aortic stenosis)
• TEST: consider functional imaging (e.g. nuclear) if:
– Cannot accurately assess for ischemia on ECG
• LBBB, paced rhythm, preexcitation, significant ST changes at
rest à the ECG is not interpretable in these cases
– RBBB interpretable generally
– Need specific anatomic correlation (e.g. prior
revascularization)
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Able to exercise and no
contraindications?
YES
ECG Normal à
Exercise Stress TEST
ECG Abnormal
NO LBBB or V- Paced
rhythm
Exercise ECHO
Exercise
myocardial
perfusion Image
LBBB or V paced
rhythm
Vasodilator
myocardial
perfusion imaging
NO
ECG normal or
abnormal
No LBBB or V paced
Rhythm
Dobutamine or vasodilator
echo
LBBB or V
paced rhythm
Vasodilator
myocardial
perfusion imaging
Cardiac CT
Angiography
Adapted from 2014
CCS – Stable Ischemic
Heart Disease
Principles
of Non-
Invasive
Testing
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