Practical Exercise/Instruction:

• Participants turn in their narrative histories.
• Preliminary considerations about resident's selecting and working up patients, in preparation for Session #8.

Summary:

We first briefly revisit the points raised in Session I on the Occupational Cardiologic Approach, in light of the materials presented thus far. We seek thereby to demonstrate how the occupational history focusing upon exposure to cardionoxious work stressors informs clinical assessment and management. This is illustrated by the first of the clinical cases, a physician specialist in neurology and psychiatry working in a public hospital who presents with paroxysmal supraventricular tachycardia, clinic-diagnosed hypertension and hyperlipidemia. The participants are first asked to evaluate the clinical data and to propose treatment plans for this patient. We then provide a series of outcomes, each with management strategies for this patient, as well as how insights from this patient could be viewed in light of on-going surveillance of the worksite and efforts of physicians and other health professionals to improve patient care and working conditions. We end the session with a discussion of occupational stressors among physicians and possibilities for Participatory Action Research.

Basic Readings:

(1) Adams SL, Roxe DM, Weiss J, Zhang F, Rosenthal JE. Ambulatory blood pressure and Holter monitoring of emergency physicians before, during, and after a night shift. Academic Emergency Medicine 1998; 5: 871-877.

(2) Belkic K, Schnall P. Paroxysmal supraventricular tachycardia and the workplace: Need for an occupational cardiologic approach. The Job Stress Network Website: Center for Social Epidemiology (www.workhealth.org), 2000.

(3) Assessment of the cardiovascular system at the workplace: Obtaining a CVD history: Obstacles and challenges. In: Schnall PL, Belkic K, Landsbergis PA, Baker D (eds.) Occupational Medicine: State of the Art Review. The Workplace and Cardiovascular Disease. 2000; 15 (1): 189-190.

Supplemental:

(4) Josephson ME, Zimetbaum P, Buxton A, Marchlinski FE, Paroxysmal Supreventricular Tachycardia. In Fauci AS, Braunwald E, Isselbacher K, et al. (Eds). Harrison's Principles of Internal Medicine. McGraw-Hill, New York, 1998, pp. 1265-1268.