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18 Annual Clinical Day in Cardiology Sydney, Nova Scotia June 5th 2015 Cape Breton University

A MESSAGE FROM THE CHAIRMAN As chairman for the 18th Annual Clinical Day in Cardiology, I would like to welcome my fellow colleagues in cardiovascular medicine. Modern medical practice has become very complicated but also has positively evolved as a team-based approach and a multidisciplinary group of healthcare specialists involved in chronic disease management. The purpose of our annual educational day in cardiac medicine is to enrich and support the healthcare team and review opportunities for improvement in healthcare delivery for the patients of Cape Breton. In the past this program, which was founded by Dr. Robert Baillie, has been very well received and supported by the local medical community. This year we have brought together an excellent group of specialists from across the Maritimes and country to bring new approaches and ideas which can have an immediate impact on healthcare delivery. I would like to thank our Planning Committee and organizers for their support in bringing you this program and hope this day has a meaningful impact for all participants. Yours truly, Paul MacDonald, M.D., FRCPC Symposium Chairman “In keeping with CMA Guidelines, program content and selection of speakers are the responsibility of the Planning Committee. Support is directed towards the cost of the courses and not to individual speakers.”

THURSDAY EVENING SYMPOSIUM JUNE 4, 2015

HOLIDAY INN Sydney-Waterfront, Mariner Ballroom “Dr. Robert Baillie Lecture” Moderator: Dr. Paul MacDonald 1800 HRS Opening remarks Presentation of the Dr. Robert Baillie award. 1815 HRS - “Ten Steps to Better Heart Health.” Dr. Paul Oh Dr. Paul Oh is Medical Director of the Cardiovascular Prevention and Rehabilitation Program at the Toronto Rehabilitation Institute. He will discuss the key behaviours and risk factors that are in our control to improve our health and help us live longer. Dr. Oh will address smoking cessation and exercise as well as touch on nutrition, cholesterol, blood pressure and stress management.

There is no charge to attend.

CLINICAL DAY IN CARDIOLOGY AT CAPE BRETON UNIVERSITY June 5, 2015 0815 HRS. – Opening Remarks – Dr. Paul MacDonald Moderator: Dr. Sabe De 0830 – 0900 HRS. – Dr. Miroslaw Rajda - “Congestive Heart Failure” Congestive heart failure is a serious and important reason for patients presenting to the Emergency Room or doctor’s office with dyspnea. Dr. Rajda will review key clinical features in the history and presentation as well as physical exam. He will also review the potential use of biomarkers, bedside ultrasound and other rapid assessment techniques. Door to Lasix time may be just as important for heart failure patients as for myocardial infarction.

The Royal College of Physicians and Surgeons LectureDr. Paul Oh 0900 – 0930 HRS. – Dr. Paul Oh- “2015 Smoking Cessation Update.” Dr. Oh will present an update on smoking cessation. Unfortunately we have had a rebound in smoking rates in Nova Scotia and very high levels reported at up to 28 percent for Cape Bretoners. Dr. Oh will review best practices in assisting our patients with smoking cessation. This will include both screening and discussion of smoking with our patients and various techniques to consider with smoking cessation. A broad array of treatment options are available including nicotine replacement with gum, inhalers, and patches. We have Champix and there have been significant controversies around electronic cigarettes. Also other techniques may include hypnosis, laser therapy or combinations of the above. This will be an important topic given our high rates of smoking and heart disease in Cape Breton.

0930 – 1000 HRS. – Dr. Miroslaw Rajda- “End of Life Discussions With Cardiac Patients”. Our patients are becoming older and have more multisystem disease. As patient’s severity of disease increases, the likelihood of a sudden severe change in their health increases significantly. Most patients, physicians and healthcare providers tend to avoid the most important discussion in a patient’s life which is how they would choose to die. While more aggressive therapies are available including mechanical hearts, heart transplantation as well as simple intubation and mechanical ventilation, this may not be appropriate or wanted by most of our patients. This is a crucial discussion that cannot be avoided in order to respect patient’s wishes. Dr. Miroslaw will review this challenging transition from aggressive care to palliative care. 1000 – 1030 HRS. –Dr. Paul Oh- “Exercise and Cardiovascular Health.” Exercise is an important component of primary prevention in avoiding heart disease. It may play an important role in managing hypertension, diabetes, obesity. It is also a key component of cardiac rehab but largely underutilized and under prescribed for our patients. Dr. Oh will provide up-to-date recommendations on the advantages of exercising and how a proper prescription should be provided for our patients. 1030 – 1100 HRS.

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Nutrition/Coffee Break

Moderator: Dr. Rick Bedard 1100 -1130 HRS. - Dr. Simon Jackson- “Investigating a Patient Presenting with Dyspnea, Possible Nonischemic Cardiac Causes.” Patients frequently present to the Emergency Room or our offices with a nonspecific complaint of dyspnea. There are a number of important nonischemic possibilities to consider which will be reviewed including key features of patient history, appropriate risk factors to enquire about and specific details in the physical exam. As well, initial investigations screening for important conditions will be included. Dr. Jackson is involved in the Pulmonary Hypertension Clinic in Halifax and has a broad experience in both clinical care and medical education. This will be an informative talk for a common presenting problem and broad differential diagnosis.

Atlantic Cardiovascular Society Lecture – Dr. Yvonne Libbus 1130 – 1200 HRS. – Dr. Yvonne Libbus – “Depression and Burnout Among Healthcare Professionals: How do we Protect Us From Ourselves?” Working in healthcare is a demanding and stressful career. While we spend great effort and energy in caring for our patients, this often has damaging and detrimental effects on caregivers. Dr. Yvonne Libbus will review problems with depression and suicide amongst healthcare workers and suggest important strategies for recognition and support for our healthcare colleagues. 1200 – 1300 HRS. -

LUNCH BREAK Moderator: Carol Ferguson

1300 – 1330 HRS. – Dr. Simon Jackson- “The Three Most Important Clinical Trials in Cardiology in the Past Year.” Dr. Jackson will review 3 of the most practical and clinically important trials that will affect your day-to-day practice and prescribing in the field of cardiovascular medicine. 1330 – 1400 HRS. – Dr. Iqbal Bata - “Are We Using Too Many Beta Blockers and not enough ACE Inhibitors in Our Ischemic Heart Disease Patients?” The COMMIT Trial suggests that the early benefits identified with beta blockers may not exist in the modern era. Our utilization of beta blockers is extremely high but many patients may have side effects without as much benefit. Conversely the use of ACE inhibitors is well established in a modern era and yet one third of our patients discharged with acute ischemic events in Nova Scotia do not have this life-saving medication. Dr. Bata will review current usage and recommendations for who should and shouldn’t be on these important medications.

1400 – 1430 HRS. - Dr. Martin Gardner- “ECGs 101.” Dr. Gardner will review the basics involved with EKG interpretation. ECGs are used to interpret acute ischemic events and acute arrhythmias and he will provide examples of both common and challenging cases for review by Emergency Room physicians, residents, family doctors and allied healthcare professionals. This will be both informative and interactive and has always been one of the highlights of our educational day. 1430 – 1500 HRS. -

Nutrition/Coffee Break

Moderator: Dr. Paul MacDonald 1500 – 1530 HRS. – Dr. Iqbal Bata- “Challenging Cases With the New Oral Anticoagulants.” The use of the new oral anticoagulants in atrial fibrillation has steadily increased. Our experience and understanding of where these are most appropriately used and the risks and benefits continue to grow. The Bata will review cases demonstrating opportunities and challenges in this important area of stroke prevention. 1530 – 1600 HRS. – Dr. Martin Gardner- “Pacemakers and Defibrillators for the Community Practitioner.” Patients frequently present with pacemakers or defibrillators. These devices are becoming increasingly complicated and challenging for interpretation. There is a great variability of programming available and the Emergency Room physician or family doctor may have difficulty in recognizing when the device is functioning appropriately and when there is a problem or concern and more urgent specialized referral and interrogation of the device is necessary. This will be a practical review with cases highlighting clinical challenges.

1600 – Closing Remarks - Dr. Paul MacDonald

SPEAKERS Iqbal Bata, MD, FRCPC Professor, Department of Medicine (Cardiology) Dalhousie University Staff Cardiologist Queen Elizabeth II Health Science Centre Halifax, Nova Scotia

Martin J. Gardner, MD, FRCPC Professor of Medicine, Division of Cardiology Queen Elizabeth II Health Sciences Centre Nova Scotia Health Authority Dalhousie University Halifax, Nova Scotia Simon Jackson, MD, FRCPC, MMedEd Associate Professor Medicine (Cardiology) Deputy Head, Department of Medicine Dalhousie University Staff Cardiologist QEII Health Sciences Centre, Halifax, N.S. Yvonne Libbus, MD FRCPC Chief of Psychiatry and Clinical Director Mental Health Program CBDHA Assistant Professor Dept. of Psychiatry Dalhousie University Cape Breton Regional Hospital, Sydney, Nova Scotia Paul Oh, MD, MSc, FRCPC, FACP Assistant Professor, Internal Medicine, Clinical Pharmacology, University of Toronto Medical Director and GoodLife Fitness Chair Cardiovascular Rehabilitation and Prevention Program University Health Network Toronto Rehabilitation Institute Toronto, Ontario

SPEAKERS

Miroslaw Rajda, MD, FRCPC Medical Director, Heart Failure and Transplant Program Queen Elizabeth II Health Sciences Centre Nova Scotia Health Authority Associate Professor of Medicine, Dalhousie University

PLANNING COMMITTEE

Paul MacDonald, MD, FRCPC Chairman Rick Bedard, MD, FRCPC Bernie Buffett, MD Sabe De, MD, FRCPC Carol Ferguson, RN, BScN Michael Fleming, BSc, MD, CCFP, FCFP Anne Buchanan-Hastie, RN, BSc.N Simon Jackson, MD, FRCPC MMedEd Jim MacKillop, MD, CCFP, FCFP Neil MacVicar, MD, CCFP(EM) Brendan McCarville,BSc. MA, MD, PGY1 Sandra Toner, RN, BSc.N, MN, NP

REGISTRATION INFORMATION Registration fee for physicians is $150.00. The registration for family practice residents and all other allied healthcare professionals is $75.00. There is no same day registration. Please register as soon as possible and no later than June 2, 2015 There is no registration for Thursday evening’s session and there is no charge. As an accredited provider, Dalhousie University CME designates this continuing medical education activity for up to 6.75 credit hours for MAINPRO M-1 of the College of Family Physicians of Canada and as an accredited group learning Section 1 activity as defined by the Maintenance of Certification Program of the Royal College of Physicians and Surgeons of Canada. On receiving your registration fee, we will mail back to you a receipt.

18th Annual Clinical Day in Cardiology June 5, 2015 ~ Cape Breton University SYMPOSIUM REGISTRATION FORM PHYSICIANS/FAMILY MEDICINE RESIDENTS A complete and accurate mailing address is required for your income tax receipt.

Name:

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Physicians  $150

Residents/NPs  $75

Payment must accompany registration form. Please mail completed registration form with cheque payable to Clinical Day in Cardiology . to: Dr. Paul MacDonald Symposium Coordinator Cape Breton Regional Hospital 1482 George Street Sydney, N.S. B1P 1P3 Phone: (902)-567-8007 Fax: (902)-567-8009 E-mail: [email protected] Please register before June 2, 2015. There is no same day registration.

18th Annual Clinical Day in Cardiology June 5, 2015 ~ Cape Breton University SYMPOSIUM REGISTRATION FORM NURSES, TECHNICIANS, OTHER ALLIED HEATHCARE PROFESSIONALS A complete and accurate mailing address is required for your income tax receipt.

Name:

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Address: ___________________________________________ __________________________ P.Code ___________ Please Indicate:

R.N.  Other 

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Registration Fee for Symposium: $75

Payment must accompany the registration form. Please mail completed registration form with cheque payable to: Clinical Day in Cardiology to: Dr. Paul MacDonald Symposium Coordinator Cape Breton Regional Hospital 1482 George Street Sydney, N.S. B1P 1P3 Phone: (902)-567-8007 Fax: (902)-567-8009 E-mail: [email protected] Please register before June 2, 2015, no same day registration. It is the responsibility of each individual to make application for payment if being sponsored.

The 18th Annual Clinical Day in Cardiology gratefully acknowledges the unrestricted educational grants provided for the support of this program by the following companies:

PLATINUM SUPPORTER Bayer

GOLD SUPPORTER AstraZeneca Boehringer Ingelheim Medtronic Merck Mylan Pfizer Servier St. Jude