Ines Hernandez, 46, was having a heart attack for nearly four days before symptoms worsened enough for her to seek help at her local emergency department. Then, she was told she was having a panic attack.

Common symptoms of a heart attack include pain in your left arm and heartburn, but being a middle-aged female and an exercise fanatic, Ines thought nothing of it when her symptoms presented.

“I thought it was muscle pain,” says Ines about the “annoying pain” that radiated throughout her left arm while she was exercising. “I took some over-the-counter pain killers and continued my workout.”

When heartburn set in, she assumed it was side-effects of the drugs. It wasn’t until three days later when she felt a strange sensation in her chest while at work and colleagues called 9-1-1.

“It was a mix of nausea, pain, and like someone punched me in my chest,” says Ines. “The paramedics said I was probably having a panic attack but took me to the emergency department anyway.”

She was in the emergency department at a local hospital for 12 hours, as doctors ran several tests and gave her morphine to manage the pain that waxed and waned. But around midnight, her symptoms worsened, and she was sent to Sunnybrook Health Sciences Centre for an emergency coronary angiogram to check her heart. The angiogram confirmed that she was having a heart attack caused by spontaneous coronary artery dissection, otherwise known as SCAD.

What is SCAD?

SCAD is an uncommon emergency condition that happens when a coronary artery tears or there is bleeding within the coronary artery wall. The bleeding can block blood supply to the heart, causing a heart attack.

SCAD predominantly affects women in their 30s, 40s and 50s, although it can sometimes occur in men as well. It causes up to 35 per cent of heart attacks in women 50 years of age and younger.

“Patients who have SCAD are often given an unclear explanation of their diagnosis and uncertain prognosis,” says Dr. Madan, an interventional cardiologist at Sunnybrook’s Schulich Heart Centre and the medical director of a specialized clinic for patients affected by SCAD.

Unlike traditional risk factors known to cause heart attacks, like smoking and high blood pressure, SCAD can be triggered by severe emotional distress or exertion. It can happen spontaneously in young, active, and otherwise healthy individuals.

The Importance of Listening

“I heard many times throughout my journey that day that I was having a panic attack,” says Ines. “The worst thing that can happen to you is the uncertainty or the fact that you feel that no one understands what is happening to you. You feel hopeless.”

“When you’re young, it can be challenging to get people to listen to your medical concerns, even when experiencing symptoms like chest pain and shortness of breath. You can be misdiagnosed as anxious or neurotic,” says Dr. Mina Madan, who admits several of her patients from across Ontario visited emergency rooms multiple times before being taken seriously.

While knowledge of the condition among the medical community is improving, Dr. Madan encourages her patients to advocate for themselves: “If you experience chest pain and have had SCAD, go to the emergency room and say, ‘I have chest pain and I’ve had a SCAD related heart attack.’ ”

She adds, it’s equally important to listen to yourself: “It’s easy to get caught up in the craziness of life and we forget to prioritize ourselves. Don’t ignore what your body is telling you.”

“Here’s the thing: If my husband tells me that he’s having a left arm pain and heartburn, I’d take him to the hospital right away and he will be treated as a heart attack,” says Ines. “I know what the symptoms are for a man, but it was happening to me and I never, ever thought that I was having a heart attack.”

At Sunnybrook, Ines received an emergency angioplasty where a catheter (thin tube) with a guidewire was fed up an artery near her groin and into her heart. A small balloon was then inflated to open up the artery and restore blood flow to the heart. During the procedure, patients are awake but mildly sedated.

“Instantly, I felt like an elephant was lifted off my chest,” says Ines.

Now, more than one year later, Ines says she is grateful to be alive.

“I used to associate strength with being able to do whatever I want to really challenge my body – run faster, grab more weight, work longer hours. I had to learn that it is OK to be tired. It is OK to take a break. It is not because you’re weak or incapable. You have to be aware and listen to your body.”

For more information about SCAD and the SCAD Clinic at Sunnybrook, visit Sunnybrook.ca/SCAD.

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Dr. Harindra Wijeysundera, chief of Sunnybrook’s Schulich Heart Program, recently led a study published in the Canadian Journal of Cardiology showing fewer patients were referred for heart disease procedures and surgeries during the pandemic. The study also revealed more patients died on waitlists during the same timeframe.

Why did you look at this issue?

Dr. Wijeysundera: During the first wave of the COVID-19 pandemic, we kept hearing stories from patients and other doctors that there were delays in care for patients with heart disease. We decided to look deeper at the Ontario data that tracks waitlists and wait times for people living with heart disease who require a procedure or surgery.

What did you find?

Dr. Wijeysundera: The data was distressing – we learned that there was a significant decline in referrals and procedures in Ontario for common heart interventions after the pandemic started. Patients waiting for coronary bypass surgery or stenting were at a higher risk of dying while waiting for their procedure compared to before the pandemic. We found this to be consistent across patients with stable coronary artery disease, acute coronary syndrome and emergency referral.

Can you explain why this happened?

Dr. Wijeysundera: We are very interested in the “why” behind referrals decreasing so dramatically. We believe there are a number of reasons, some of which are patient factors such as fear of contracting COVID-19 in the hospital, or worries about missing work or family commitments. We suspect there are also system factors at play, such as delays in testing for heart conditions, as well as hospital bed and staffing pressures.

What is your advice for people who are noticing a change in their health?

Dr. Wijeysundera: Our biggest fear is that people are ignoring symptoms like chest tightness, or feeling lightheaded or short of breath, and not seeking care as they’re worried about placing burden on the health-care system. Or they may be afraid of contracting COVID-19 if they come to the hospital.

Hospitals are safe places to be – over a year and half into the pandemic, we have learned so much and know how to protect and care for you. Even if you feel like it’s not an emergency, please let us assess you. Yes, this may be virtually at first, but if we need to see you in person, we’ll make sure it’s done safely.

Where should patients start if they’re feeling new symptoms?

Dr. Wijeysundera: Your family doctor is always a good place, or your heart specialist if you’re already seeing one. Heart disease and stroke are time-sensitive conditions. We are committed to getting you the care you need, when you need it.

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When Adrianus Moerman learned about a new virtual patient education session for his heart condition, he jumped at the chance to attend.

“Curiosity drew me,” says Adrianus, who has arrhythmia, an irregular heart beat that can cause the heart to beat too fast, too slowly, or with an irregular rhythm. “There’s not really a lot in the media about arrhythmia and I was keen to see it there was new information from a trusted source: cardiologists who specialize in this area.”

He joined the International Arrhythmia School virtual event on November 21 from the comfort of his home in northern Ontario. The event featured a session for medical professionals, followed by a tailored presentation for patients and families, covering alcohol use and unrelated procedures in arrhythmia patients.

“These are two hot topics for patients,” explains Dr. Eugene Crystal, the founder of the International Arrhythmia School and a cardiologist at Sunnybrook. “From a physician’s perspective, it’s challenging when you’re seeing 20 to 30 patients a day to address questions that those living with arrhythmia may have. The session we hosted is a pragmatic and efficient way to present an overview of the latest evidence, in layperson language, and also have time for questions from patients.”

Participants were provided with practical tips on drinking alcohol with an arrhythmia, such as ensuring two full days of abstinence and avoiding heavy consumption. Procedures covered included MRI tests, radiation procedures and general tips on what could impact the functioning of patients’ pacemakers and implantable cardioverter-defibrillators (ICDs).

Suzette Turner is a nurse practitioner with the Arrhythmia Clinic at Sunnybrook’s Schulich Heart Centre and assisted with the event. “The opportunity to virtually learn – although not a new phenomenon – is one of the silver linings of this pandemic. It’s beneficial to both patients and staff and allows for a wider demographic reach, especially during the winter months,” says Suzette.

For Adrianus, the opportunity to engage with experts was a big draw. “Hearing from heart doctors who are on the leading edge of this type of heart issue was really valuable. And the topics were relevant – many of us wonder about having a glass of wine from time-to-time. At the same time, arrhythmia patients will at some point have another medical procedure, like an MRI, and are concerned our condition or heart device may be impacted.”

The International Arrhythmia School was founded when Dr. Crystal spotted a gap between arrhythmia knowledge, rising technology, medical techniques and saw an opportunity to develop an organization specializing in innovation and education. Dr. Crystal hopes that the patient engagement section will continue each year, and notes that the response from patients who attended the inaugural session was overwhelmingly positive.

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It is sudden. It strikes without warning. And it is often fatal. Sudden cardiac death, often caused by a condition called ventricular tachycardia (VT), kills about 40,000 Canadians each year. Scientists at Sunnybrook Research Institute (SRI) are hard at work advancing imaging techniques to identify and reverse this ticking time bomb.

When a person has ventricular tachycardia, faulty electrical signals in the ventricles of the heart cause their heart to beat too fast or irregularly, impeding proper blood flow to the body. “This is a very urgent problem,” says Dr. Fumin Guo, a postdoctoral fellow working in the cardiovascular imaging lab of Dr. Graham Wright at SRI. “Most of these events occur, without previous symptoms, at home or in a public space, not in hospital. And they can be fatal within minutes. We are trying to improve diagnosis and therapy to prevent sudden cardiac death.”

One of the current treatments for ventricular tachycardia is radiofrequency ablation, which involves guiding a device into the heart and using an electrical current to heat up and destroy a small area of tissue that may lead to the abnormal electrical signals (arrhythmia). But about 35 per cent of ablation procedures result in either initial failure or later recurrence.

Preclinical work by Dr. Guo and others in Dr. Wright’s lab is focused on improving the outlook for those with VT in three ways: identifying the underlying structural and functional issues in the hearts of individuals, pinpointing damaged tissue with greater precision, and delivering treatment with more accuracy and efficiency.

The lab has demonstrated success using 3D magnetic resonance imaging (MRI) to guide radiofrequency ablations with improved precision. “Imaging, and in particular MRI, shows great promise in helping to improve management in this patient population, and we are working at the state of the art to look at all aspects from identifying those at risk, to improving the effectiveness of procedures,” says Dr. Wright, who is a senior scientist in the Physical Sciences Platform and Schulich Heart Research Program at SRI.

Dr. Guo recently won the prestigious Polanyi Prize in Physiology and Medicine for his significant contribution to this work. With his background in biomedical engineering, he is developing, using artificial intelligence and computer vision methods, automated image analysis systems that map the heart and pinpoint the damaged tissue. He is also advancing computer algorithms to plan, guide and assess VT treatment.

“Fumin’s work means the image analysis needed to guide procedures will be more repeatable, faster, and hopefully more accessible to others,” says Dr. Wright. “The Polanyi Prize is very prestigious. Winning the prize is emblematic of the clinical relevance of the work and the excellence of Sunnybrook’s program in image-guided, personalized, precision therapy.”

Dr. Wright adds that his lab is collaborating with clinical heart programs and partnering with industry to ensure the preclinical work can be translated to patient care as quickly as possible.

For his part, Dr. Guo is enthusiastic about what lies ahead. “Our ultimate objective is to cure patients with ventricular tachycardia conditions. We want patients to live longer, healthier and happier.”

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As a cardiologist, Dr. Dennis Ko knows that people who are South Asian or East Asian have different risks of heart disease. As a healthcare researcher, Dr. Ko wants to understand more and find ways to help.

“My late mentor Dr. Jack Tu had a long-standing interest in cardiovascular outcomes research with respect to ethnic background given that we live in such a diverse country,” he said. “We need to do more research so that we know what is happening, and so we can find the best ways to prevent disease and care for patients from different backgrounds.”

During the COVID-19 pandemic, Dr. Ko worked with a team to look at how COVID-19 affects people with different ethnic backgrounds.

But, he says, conducting this kind of work isn’t easy.

“It’s difficult to do because of the lack of data,” Dr. Ko says. “There’s no standardized way of collecting demographic data such as race and ethnic background, and that lack of information makes it really hard. Maybe this stems from fear of stigmatization. But more data is important so that we can find out what is happening and we can design ways to help.”

He says while many healthcare institutions have shied away from collecting demographic data in the past, it’s important that we find an appropriate way of asking for this information.

Dr. Ko says there are increasing conversations happening across Canada about how important this data is, and how to start to collecting and using it. Here in Toronto, Sunnybrook is working together with partners to ensure our efforts to collect and use demographic data are aligned across the system, and are designed to support action and accountability.

A pilot survey has launched on several units, wherein patients are asked to self-identify their ethnic background. Dr. Ko says it’s a step in the right direction.

“Without adequate data, we are just guessing around outcomes and needs,” Dr. Ko said.

With COVID-19, for example, it became clear quite quickly that some groups of people had poorer outcomes.

“Early in the pandemic, in long-term care homes, more Chinese seniors were impacted by COVID. In the community and workplaces, large numbers of South Asian men contracted the virus,” Dr. Ko explained. “This is really important information.”

“Toronto is so diverse, people come from many places and countries and we try to accept and celebrate each other’s differences. We know there are differences in health outcomes among people based on their ethnicity, but we lack the data to really understand why. By collecting that data and doing the research, we can then better determine ways to ensure everyone has access to the prevention programs, screening and care they need.”

Dr. Ko says Asian Heritage Month is a good time to reflect on this and to celebrate members of the Asian community who have made valuable contributions to the field of medicine.

“I have been afforded wonderful opportunities in Canada. I feel that it is important to have a chance to celebrate and value our diversity.”

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A new study of younger heart attack survivors found while the health care system delivers high quality care, disparities remain between men and women.

Investigators from Sunnybrook Health Sciences Centre studied 38,071 heart attack survivors aged 18 to 55 years who were hospitalized in Ontario, Canada in a 10-year period (2009-2019). They discovered that young women are more likely to be readmitted to hospital following a heart attack compared to young men, and that risk factors for heart disease for young women continue to rise.

Their findings appear in the Canadian Journal of Cardiology published by Elsevier.

Dr. Mina Madan, lead investigator and cardiologist at Sunnybrook, shares insight on what this latest research could mean for the health care system and what younger women can do to prevent heart disease.

What inspired you to pursue this research?

Dr. Madan: There’s been a lot in the literature about how women are getting the short end of the stick: they don’t get to the hospital on time, and when they do arrive maybe they aren’t taken seriously. Or there are delays in diagnosis and procedures. I wanted to look with an objective eye as to what’s happening now in Ontario.

How are younger women doing compared to younger men?

Dr. Madan: The good news is that younger women are universally getting coronary angiography when they come to the hospital with a heart attack, similar to their male counterparts; and mortality rates are now very similar. The bad news is that women have more cardiac risk factors relative to men, and they’re being readmitted to hospital for both cardiovascular and non-cardiovascular causes at a much higher rate.

The reason they are being readmitted to hospital or may not be receiving certain procedures could be due to the cause of their heart attack. While coronary artery disease or blockages in the heart are more common for men, younger women are more likely to experience heart attacks from conditions caused by a tear in the coronary artery (SCAD, Spontaneous Coronary Artery Dissection), stress (stress cardiomyopathy), or a dysfunction of tiny blood vessels (micro vascular dysfunction), for example.

What is really concerning, is that our findings showed younger women have more cardiac risk factors. Over the 10-year period, we discovered a 10 per cent increase in the rate of diabetes in younger women, compared to a four per cent increase in younger men. This underscores the need for ongoing efforts from the entire health system to improve our prevention strategies.

What can the health care system do better?

Dr. Madan: Overall, the health care system is providing high-quality of care for both men and women following a heart attack, but with the significant disparities in hospital readmission and comorbidities, more needs to be done. Perhaps women have different needs after they go home from a heart attack. They may benefit from more frequent or earlier check-ins after hospitalization, or earlier intake into cardiac rehabilitation programs. It may also help to screen for heart conditions and risk factors earlier in a woman’s life, maybe in their 30s or 40s to help prevent a bad outcome.

What can women do to help prevent heart disease?

Dr. Madan: People, regardless of their sex, need to take care of themselves and make sure that they are living the best life possible in terms of physical activity, eating properly, reducing stress, and avoiding smoking. Speak to your doctor if you are concerned about your heart health, even if you consider yourself too young.

» Read the full study in the Canadian Journal of Cardiology

This study identifies sex and gender as reported by the patient. For the purpose of this study, “young” is defined as individuals aged 55 years or younger.

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Ever wonder if your doctor or specialist follows their own advice? Sunnybrook experts get candid with the approaches they take in their personal lives.

Dr. Maria Terricabras is an Electrophysiology Fellow in the Sunnybrook Schulich Heart Program.  

You specialize in problems with the heart’s rhythms, which is really interesting. Do you come from a family of doctors?

No, and I’m actually the only one in my family. I became interested in medicine when I was about 14 years old, and remember telling my parents then that I wanted to become a doctor. They thought I would eventually change my mind, but here I am!

So do you actively avoid things that send your heartbeat into overdrive, like rollercoasters?

I love rollercoasters! I have a healthy heart, so have no reason to be afraid of them. I grew up in Spain and remember going to Eurodisney a lot when I was younger. I haven’t been to any theme parks in Canada yet, though. I also love watching scary movies. The Shining is my favourite because it builds tension without being too explicitly violent.

Diet can have a huge impact on our hearts. What’s your approach?

Being from Barcelona, I’m used to eating a Mediterranean diet. That means lots of lentils and beans, having fish once a week and not eating a lot of red meat. Just like back at home in Spain, I don’t fry anything and bake it or grill it instead. I try to avoid foods that are higher in fat, like sauces. On salads, all you need is a bit of balsamic vinegar and some olive oil! I also normally have fruit for breakfast and most desserts. I’ve been raised on this approach to eating so it’s not hard to do.

There must be some cheat days in there…

I love cheese like blue, brie and camembert, so that’s my pleasure on the weekends. My husband and I really enjoy food and like to go out to restaurants on the weekend as well. I’m careful during the week so I can indulge a bit more for a day or two.

What about exercise? That’s also an important part of heart health.

Getting in exercise every day is hard because of my schedule. When I’m in the lab, my work days can be up to 12 hours long. When I’m at the hospital, I do make a point of avoiding elevators and taking the stairs as much as possible. On weekends, my husband and I like to go on hikes and get over to the gym a few times.

Do you sleep well?

For sure, I make sleep a priority and aim for at least eight hours per night. That often means I’m going to bed early, but I don’t function well if I’m tired.

It sounds like you practice what you preach to your patients.

I think I walk that balance well, but I don’t do some things I often advise my patients. I have a healthy heart so I don’t have to strictly avoid salt. I also never wear a smartwatch to monitor my own heart rate, which some people find surprising. While these can be great tools for some people, especially those living with and at higher risk for heart issues, some people can become a bit obsessed with them.

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February is Heart Month, which is always a good time to consider our heart health and actions we can take in our everyday lives to care for our heart as best as possible.

One of those actions could be visiting your doctor for a simple stethoscope check, something you’ve likely seen your doctor perform many times. But even though it’s simple, it can have a big impact on preventative care. Dr. Rahul Jain, family physician at Sunnybrook, shares what a stethoscope check can detect and what it can tell your doctor about your overall heart health.

What is a stethoscope check?

A stethoscope check can tell your doctor a lot about your heart health.

“The heart contains four valves — or doorways — that help push blood in one direction,” Dr. Jain says. “When your heart valve closes, it makes a lub dub sound.”

By listening to those sounds during a stethoscope check, your doctor can hear your heart rate, your heart rhythm and the health of your heart valves.

What your doctor is listening for

Your doctor will typically listen to four areas over the heart.

“Every time we hear a lub dub, we’re hearing one full heartbeat,” says Dr. Jain, adding most adults typically have 60-100 heartbeats per minute.

During the stethoscope check, your doctor can also hear your heart rhythm.

“In a normal heart rhythm, we hear regular heartbeats, which sound like lub-dub…lub-dub…lub-dub, but if the heart rate is irregular, we might hear something like lub-dub…lub-dub…lub-dub/ lub-dub/lub-dub…lub-dub,” Dr. Jain says.

Something else a doctor can detect through a stethoscope check is a heart murmur.

“A murmur creates a whooshing or swishing sound when blood flows abnormally over the heart valves,” says Dr. Jain. “It may sound something like lub-shhh-dub…lub-shhh-dub.”

The importance of early detection 

One of the most important reasons to see your doctor for a stethoscope check is early detection of conditions that can cause significant issues.

“Irregular heart rhythms can sometimes cause people to feel as though their heart is racing, and they can even increase the risk of stroke in a condition known as atrial fibrillation,” says Dr. Jain. “In the case of heart murmurs, some can be abnormal and may start without symptoms, but as the heart valve’s condition worsens, some people may feel breathless, have chest pain or even pass out.”

But it’s also important because it can alert your doctor to something abnormal in your heart and they can refer you for further treatment.

“A stethoscope check can tell us a lot about heart health, but not everything,” says Dr. Jain. “Further investigation may be needed, such as an ECG, HOLTER monitor, echocardiogram or cardiac stress testing.”

Dr. Jain says heart rhythms can be quite complex and not all abnormal rhythms can be properly identified through a stethoscope check alone. In addition, blockages in the heart that can lead to heart attacks can’t be picked up on a stethoscope check.

Who should get a stethoscope check

Dr. Jain says anyone from newborns to older adults can see their doctor for a stethoscope check, although it is highly recommended for individuals over 65 years of age and anyone who is experiencing symptoms of chest pain, breathlessness, heart racing, fatigue or dizziness. This brief check can help screen or detect any problems early on so you can get the right treatment at the right time.

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Smartwatches can’t take the place of your doctor, but that doesn’t mean they can’t tell you useful information about your health. These handy (and addictive) tools are well known to support healthy lifestyle behaviours – monitoring your activity levels and even your heart rate.

More recently, smartwatches have added capabilities that can flag potentially dangerous, fast or irregular heartbeats, known as atrial fibrillation (a type of arrhythmia). But should we trust these devices to tell us such important details about our hearts? Dr. Christopher Cheung, a cardiac electrophysiologist (cardiologist specializing in heart rhythm) in the Schulich Heart Program at Sunnybrook, shares his expert advice.

What is atrial fibrillation and why does it matter?

Dr. Cheung: Atrial fibrillation is the most common abnormal heart rhythm, affecting approximately 200,000 Canadians. If treated, most people with atrial fibrillation lead active, normal lives; but left untreated, it can lead to stroke and heart failure, not to mention interfere with your daily quality of life. According to the Heart and Stroke Foundation, one quarter of all strokes after age 40 are caused by atrial fibrillation. So, if we can detect atrial fibrillation early, we can prevent stroke and other life-threatening circumstances.

How do smartwatches capture your heart rhythm vs. traditional tests?

Dr. Cheung: Smartwatches use a technology called photoplethysmography. Light from the device flashes against your skin to detect blood flow and measures your heart rate using elaborate algorithms. The technology is used in other medical devices such as oxygen monitors (oximeters) and is generally accurate when you have a regular pulse.

Some smartwatches have an added feature of recording an electrocardiogram (ECG), which is the electrical signal of the heartbeat. This provides much more information, including not only heart rate but also heart rhythm. Unlike traditional cardiac tests, however, the ECG feature in a smartwatch is not always active: the user must manually record an ECG. When diagnosing an arrhythmia, we use longer-term ECG monitors, like Holter monitors, that record your ECG signals continuously for 24-48 hours. It gives us an accurate recording of your heart rate and heart rhythm during a longer period so we can assess any irregularities.

How accurate is the information from my smartwatch?

Dr. Cheung: For most healthy users, studies have shown that the heart rate measured on your smartwatch matches well with the heart rate measured with our cardiac tests – usually within five beats per minute. When it comes to irregular heart rate monitoring for atrial fibrillation, the accuracy is lower.

There have been a few large studies using the Apple Watch, FitBit, and Huawei watches to evaluate their ability to detect arrhythmia and the results have been promising, but these studies are done with mostly healthy individuals.

The challenge is that the algorithms are not perfect, so there is a risk that the watch may alarm you with an incorrect result (called a “false-positive”). Until we know more, pay attention to the information, but don’t rely on it to diagnose you.
 

What should I do if my smartwatch flags an irregular heartbeat?

Dr. Cheung: You don’t need to run to your doctor the second a notification of an irregular heartbeat pops up on your smartwatch but take into consideration your heart health, such as any pre-diagnosed atrial fibrillation and any symptoms you may be feeling. If you are noticing episodes of heart racing that come unexpectedly while you are at rest, a sensation of an irregular heart rate or fluttering in your chest, or even the sense of a panic attack, these can sometimes be signs of a heart arrhythmia. Take note and speak to your doctor. They may choose to order a medical-grade heart monitor to document one of these episodes and determine whether you really are having an arrhythmia.

The post Smartwatches as heart monitors: yay or nay? appeared first on Your Health Matters.

February is heart month, a good time to focus on how to protect our hearts and reduce the risks that can impact our cardiovascular health. At the latest Sunnybrook Speaker Series, interventional cardiologist Dr. Mina Madan discussed the particular risks faced by younger women.

While heart health is important for everyone to think about, it is especially significant for women. According to the Heart and Stroke Foundation, heart disease and stroke are the leading cause of premature death in women in Canada.

At Sunnybrook Health Sciences Centre, many doctors and scientists are engaged in clinical work and research focused on how to better understand, prevent and treat heart disease in women.

When it comes to heart attacks, several studies have shown that women in Canada tend to have worse outcomes than men – although in Ontario there is some evidence this gap is narrowing.

Younger women are considered an especially high-risk group yet they often experience more delays in diagnosis and treatment.

Over the past decade, more attention has been paid to heart attacks in women in an attempt to address these treatment disparities. However, more research and education are needed.

One condition that is seeing increased awareness within the medical community is Spontaneous Coronary Artery Dissection, also known as SCAD.

SCAD is an uncommon, underdiagnosed emergency condition that occurs when a coronary artery tears or bleeding occurs within the coronary arterial wall. It can block blood supply to the heart, causing a heart attack. This is different from a traditional heart attack resulting from “cholesterol plaque” build-up or rupture.

SCAD most commonly affects women in their 30s, 40s and 50s. It can be seen in up to a third of cases of younger women with heart attacks.

People who develop SCAD often have predisposing conditions such as fibromuscular dysplasia (a condition that narrows or enlarges the arteries) or precipitating stress factors like intense exercise or emotional strain.

Patients seen in emergency rooms will often have symptoms identical to a regular heart attack, such as chest pain radiating down the arm, nausea and vomiting. The best way to diagnose SCAD is with an angiogram (an X-ray of the coronary arteries and vessels).

Luckily, unlike regular heart attacks, SCAD often heals without invasive intervention and can be treated and managed with medication and lifestyle changes.

In 2018, Sunnybrook’s Schulich Heart Program opened a SCAD clinic to better serve people with this condition by providing specialized evaluation and treatment and coordination of long-term follow-up care.

Learn more about the clinic at sunnybrook.ca/SCAD.

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