Cardiology at St. Joseph’s Hospital Acute MI care, guidelines, statistics, and ability to deliver best possible care Mirek Sochanski, MD FACC, FSCAI St. Joseph’s Hospital, Lewiston, ID

Interventional cardiologist’s view of the world The way to the men’s heart, his brain, kidneys and everything else is through his groin

Age of STEMI Patients Decreasing •

ACC 2016 - A study from the Cleveland Clinic analyzed heart disease risk factors among more than 3,900 patients who were treated for ST-elevation myocardial infarction, or STEMI -- the most severe and deadly type of heart attack

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At Cleveland Clinic between 1995 and 2014. “victims of the deadliest form of heart attacks are actually getting younger. The average age now just 60.”

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Investigators “analyzed heart disease risk factors among nearly 4,000 patients who were treated for” an ST-elevation myocardial infarction (STEMI) “from 1995 to 2014.” The researchers found that “the average age of STEMI patients decreased from 64 years old to just 60 between the first five-year span of the study and the last five-year span.”

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“the prevalence of obesity...increased over this time period, from 31 percent to 40 percent, as did the proportion of patients with diabetes (from 24 to 31 percent), high blood pressure (from 55 to 77 percent), and chronic obstructive pulmonary disease (COPD) (from 5 to 12 percent).”

Our Cardiologists

Hanna Konarzewska, MD Board Certified Electrophysiology Cardiology Internal Medicine

Dirk Vandergon,MD Board Certified Interventional Cardiology Cardiology Internal Medicine

Mirek Sochanski, MD Board Certified Interventional Cardiology Echocardiography Cardiology Internal Medicine

Providence Spokane Heart Institute Employed Providers Current Providers

Number of Open Positions

Scheduled Retirees by 2016

Cardiologist

22.0

2

1

Vascular Surgeons

5.2

0

0

Cardiothoracic Surgeons

11.0

1

1

APP - Cardiology

10.3

1

0

APP - Vascular Surgery

4.9

0

0

APP - Cardiothoracic Surgery

9.0

0

0

Total

61.4

4

2.0

Department

The count of current providers includes physicians practicing and those under contract with start date in 2016.

Cardiology appears to be simple

Complexity of Ischemic Heart Disease

Case presentation- Acute Inferior Wall MI • •

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CHIEF COMPLAINT: Chest pain. HISTORY OF PRESENT ILLNESS: The patient is an 81 year-old male who comes in with an one hour history of chest pain that occurred while mowing his yard. It is retro-sternal, non-radiating pressure like pain with some nausea, shortness of breath and diaphoresis. He was brought in by EMS who gave him Aspirin. PAST MEDICAL HISTORY: Significant for hypertension and gastro-esophageal reflux disease. MEDICATIONS: Cozaar 50 mg QD, Omeprazole 40mg QD ALLERGIES: NKDA SOCIAL HISTORY: The patient is not known to be a smoker. REVIEW OF SYSTEMS: negative. PHYSICAL EXAMINATION: VITAL SIGNS: Temperature 97.8, pulse is 90, respirations 18, blood pressure 122/102 sats 100%. GENERAL: The patient is an elderly gentleman in NAD HEENT: normal CHEST: Reveals clear breath sounds. No wheezes, rales or rhonchi. CARDIOVASCULAR: Regular rate and rhythm, S1 S2 S3 was present. ABDOMEN: Soft, non tender. EXTREMITIES: No CCE Skin: warm and dry, normal color. NEUROLOGIC: The patient is alert and oriented. No sensory or motor deficits. X-ray : chest unremarkable LABORATORY: WBC is 11.0, hemoglobin 13.5, hematocrit 39.7, INR is 1.1, Troponin