Heart failure is the most rapidly rising cardiovascular disease, and currently affects over half a million Canadians. According to Heart and Stroke Foundation statistics, about 50, 000 Canadians are added to that list every year. At the latest Sunnybrook Speaker Series, Entitled Go With the Flow: Keeping Well With the Schulich Heart Team, Dr. Stephanie Poon talked about the progress being made in treating this prevalent condition.

Heart failure is a growing epidemic that carries a heavy cost to patients, their families and the health care system, says Dr. Poon, cardiologist and medical co-director of the Heart Function and Rapid Cardiology Assessment Clinic. The average life expectancy after being diagnosed is about five years. It’s also a big reason people are admitted and readmitted to hospital.

Heart failure is a gradual decline in the heart’s ability to pump and circulate blood, which occurs when the heart muscle becomes damaged, she says. Some of the common causes of heart failure include:

• heart attack
• chronic high blood pressure
• a viral infection of the heart
• valvular disease (a defect in one of the four heart valves)
• alcoholism or other toxins (i.e. chemotherapy, cocaine)
• congenital conditions
• HIV/AIDS

There are two types of heart failure. In systolic heart failure, the heart becomes dilated and weak and doesn’t pump blood properly. In diastolic heart failure, the heart is stiff and has trouble relaxing. That can cause the left ventricle to fill with blood and move it backward, resulting in lung congestion and shortness of breath. Other symptoms include cough and swelling in the abdomen, legs and feet.

There are a number of medications to treat heart failure, says Dr. Poon. Diuretics, or water pills, help to decrease the fluid buildup in the body. Beta-blockers work to slow the heart rate down, lessening stress on the heart. Angiotensin-converting enzyme (ACE) inhibitors open up the blood vessels to improve blood flow. And aldosterone antagonists reduce salt and water retention. Newer medications are also now being used, like ivabradine, which slows down heart rate without decreasing blood pressure. Research has shown that a lower resting heart rate will decrease the risk of dying, so one important goal of treatment is keeping the resting heart rate at 50-60 beats per minute, or as low as can be tolerated. Dr. Poon says it’s important for each patient to determine with their health care provider the best medication and dose.

About ten percent of Canadians with heart failure have advanced disease, causing severe symptoms that affect overall quality of life. Dr. Poon says there are devices, like the left ventricular assist device (LVAD) that can be implanted to help the heart pump blood to the rest of the body. In some cases, this device can be used to help patients who are waiting for a heart transplant or may become candidates for one.

Despite the growing prevalence of heart disease in Canada, Dr. Poon says there is a lot to be hopeful about. “We have medications that will help you live longer, keep you out of hospital and make your heart stronger. Medical therapy works and I see evidence of this every single day. And if medications are not enough, there are other options.”

Watch the archived webcast of this Speaker Series event:

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From drowsiness to muscle aches, all medications have side effects. But researchers suggest searching the web could be the culprit for triggering these side effects, not the medication itself, according to a new study from Sunnybrook Health Sciences Centre.

In the study published online in the International Journal of Cardiology, researchers reviewed patient intolerance to statins – a common cholesterol-lowering drug – in 13 countries across five continents. They then compared the recorded intolerance rate to the availability of websites that discuss the adverse effects of statins through the country’s Google search engine.

“English-speaking countries – United States, United Kingdom, Canada and Australia – had the largest number of websites about side effects and the highest rate of statin intolerance,” says Dr. Baiju Shah, senior investigator of the study and an endocrinologist at Sunnybrook Health Sciences Centre; compared to countries like Poland, Brazil, Japan and Germany that had a much lower prevalence.

The results could be an indicator of the nocebo effect at work, the study reports.

Considered to be the evil twin of the more familiar “placebo effect,” the “nocebo effect” is where negative expectations of a treatment lead to negative effects from that treatment.

“If, for example, someone reads online about adverse muscle effects related to statins, they may be more likely to notice and attribute any muscle pain they’re feeling to their prescribed statin and stop taking them,” says Dr. Shah. “This could be dangerous.”

Through his clinic, Dr. Shah treats patients with Type 2 diabetes, many of whom take statins to reduce their risk of heart disease and stroke.

“Muscle pain is one of the most common complaints from people taking statins,” he says. “But most randomized controlled studies of statins indicate that muscle pain develops only slightly more often in people taking statins as it does in those taking a harmless sugar pill.

“The benefits of statins in people at risk for heart disease are proven, so patients may be missing out on these life-saving benefits simply because of perceived side effects.”

This doesn’t mean side effects should be ignored.

Karen Lam, a pharmacist at Sunnybrook, suggests ruling out other causes of these side effects, including potential interactions with other medication, food, or supplements, before assuming the medication itself is to blame.

“Grapefruit, for example, can interfere with the body’s ability to break down certain medication,” says Lam. “This can cause medication to build up and lead to toxic side effects.”

Taken with some types of statins, grapefruit can increase the risk of side effects such as muscle damage.

“When choosing to take or not take any prescribed medication, you should always speak with your health-care professional and weigh the risks with the benefits,” says Lam. “Especially when those benefits can save your life.”

If you are taking medication, speak with your pharmacist about what medications, foods or herbal remedies may interact with the ones you are taking.

The post Googling your prescription may lead to medication intolerance, study finds appeared first on Your Health Matters.

For 80 per cent of Canadians with hypertension, medication is a major part of the treatment to lower blood pressure. But one type of anti-hypertensive medication – known as angiotensin receptor blockers (ARBs) – may be giving users the added benefit of protecting the brain against degeneration associated with Alzheimer’s disease.

“Blood pressure medications may have different effects on cognition and the brain structures that control it,” says Dr. Sandra Black, an internationally renowned neurologist at Sunnybrook.

“We suspect they impact brain energy metabolism differently and how the brain processes amyloid, the toxic protein that builds up in the brain to form amyloid plaques – a hallmark of Alzheimer’s disease.”

A recent study authored by Dr. Black and her colleagues showed that people without Alzheimer’s who were treated for hypertension with ARBs had significantly larger overall brain volumes, less shrinkage in the hippocampus (the brain region responsible for memory) and better cognitive performance than those treated with other high blood pressure medications.

Which medication your doctor prescribes depends on the severity of your hypertension, its causes and other health conditions. But with added brain protection, the research suggests that ARBs may be a more desirable option where appropriate.

The post Blood pressure medication may help protect brain appeared first on Your Health Matters.

A 23-year-old footballer dies on the field. A 17-year-old athlete keels over during a basketball game and never gets up. A 31-year-old hockey player collapses on his way to the locker room, minutes after a game. Sudden death in young people is rare, but the stories are heart-breaking head-scratchers that beg the question: What causes the sudden death of seemingly healthy young athletes?

Heart problems are often to blame.

Dr. Robert Myers, a cardiologist at Sunnybrook Health Sciences Centre, says sudden death in young people is rare, but there are several causes that may contribute: “an arrhythmia (irregular heartbeat) disorder; a viral illness that weakens the heart; Marphan syndrome – a connective tissue disorder that can cause the aorta to rupture; to name a few. But the most common cause is hypertrophic cardiomyopathy.”

Hypertrophic cardiomyopathy is a genetic condition where the heart muscle becomes thickened and enlarged. Myers says it is responsible for more than one-third of all sudden deaths in young people.

“A thickened heart muscle can block the flow of blood and, in rare cases, can cause a fatal arrhythmia during vigorous physical activity,” says Myers, who is also the cardiologist for all Toronto sports teams, including the Raptors, Maple Leafs, Marlies, Toronto FC, and Argonauts.

One in 500 people has hypertrophic cardiomyopathy, the majority of which go undiagnosed. Symptoms of the condition can include sudden fatigue, rapid heartbeat, dizziness, chest pain, and fainting. Although symptoms can be managed, there is no cure.

“Unexpected breathlessness, rapid heartbeat, dizziness, losing consciousness – these symptoms are red flags that need to be investigated,” says Myers. “And exercise should be restricted.”

Mandated athlete health screening varies around the world, but in Ontario, official sports league athletes are screened for the condition through family history, physicals, electrocardiograms, and sometimes ultrasounds and stress tests, explains Myers. If any abnormalities of the heart are found, the athlete is benched until their health is cleared for play. If, however, they are diagnosed with hypertrophic cardiomyopathy, they will need to manage the illness with restricted activity.

“Athletes who have this condition would not be allowed to participate in their sport,” says Myers. “Because of that, people may not come forward with their symptoms.”

Myers says anybody who wants to partake in vigorous sporting activities should look out for the symptoms, speak up if symptoms appear, and talk to their doctor about being screened.

The post What causes the sudden death of young athletes? appeared first on Your Health Matters.

Blood pressure measurement is considered a cornerstone for the diagnosis and treatment of hypertension, but experts are questioning the accuracy of blood pressure testing conducted in doctors’ offices.

Traditionally, blood pressure tests have been conducted manually: a doctor or nurse would wrap a cuff around your upper arm, pump the cuff full of air, and release the air while listening through a stethoscope and reading the measurement on a gauge. But research over the past several decades has noted many problems with this form of testing:

“Talking with the patient, not allowing periods of rest before the readings, rapid deflation of the cuff and rounding off readings to the nearest zero have resulted in readings that are both inaccurate and inappropriately high,” says Dr. Martin Myers, a cardiologist at Sunnybrook Health Sciences Centre and a leading scientist in hypertension and blood pressure measurement.

Now, a new study published in JAMA Network and led by Myers, confirms manual measurement should be replaced with what’s known as fully automated office blood pressure (AOBP) measurement.

AOBP requires a patient to sit alone for several minutes as a computer records several blood pressure readings. These devices are similar to what you’d use for home monitoring, but are more advanced and have a built-in delay that allows a nurse or physician to initiate readings, and then leave the patient alone before any measurements are taken.

“The common cause of inaccuracy with any blood pressure measurement testing is human interaction or human error,” says Myers, “If we can remove or restrict human interaction with the test, we can improve its accuracy.”

The study also suggests AOBP measurement may effectively be taken in a community pharmacy or in physicians’ waiting rooms, as long as the patient is sitting alone and is not disturbed by medical staff.

When it comes to diagnosing hypertension, Myers says even using blood pressure monitoring devices at home can be better than testing exclusively in a medical office, provided the testing is done properly.

“If you’re at home, take your blood pressure readings twice in the morning and again in the evening for at least four days, and preferably a week,” says Myers. “These readings should be taken at about the same times each day, and not when you think your blood pressure may be particularly high or low.”

Myers adds that after a week of readings, you should take the device to your family doctor who could verify the measurements and give you a proper diagnosis.

The post How accurate is your doctor’s blood pressure test? appeared first on Your Health Matters.

Many of us know the link between heart disease and stroke, but did you know heart disease is also related to arthritis?

Studies show that having arthritis, especially rheumatoid arthritis, doubles your risk of developing a heart condition, says Dr. Jessica Widdifield, a scientist in the Holland Bone and Joint Research Program at Sunnybrook Research Institute. She leads population-based studies to improve the evaluation, care and outcomes for patients with musculoskeletal conditions.

Cardiovascular disease is also the leading cause of death in patients with rheumatoid arthritis. Researchers believe the increased risk may be due to rheumatoid arthritis as an autoimmune condition where there is ongoing inflammation. The immune system attacks the body’s own tissues and affects the synovium or lining of the joints. This causes swelling which leads to damaged bones and joints.

Inflammation in rheumatoid arthritis can then also lead to damage in other areas of the body. It contributes to hypertension (high pressure of blood against artery walls) a well-established risk factor for developing heart disease resulting in overall reduced elasticity in blood vessels and increased stiffness, specifically in arteries.

Most individuals with arthritis are unaware that they are at an increased risk of developing cardiovascular disease in relation to their condition. If you didn’t know of these connections you are not alone, adds Dr. Widdifield who is also an assistant professor at the University of Toronto’s Institute of Health Policy, Management and Evaluation. Her research team has also identified that patients are not often adequately screened for cardiovascular risk factors by their physicians. “So it’s very important that patients take a proactive role in their health,” she adds.

If you have rheumatoid arthritis or have been newly diagnosed, what can you do to be proactive about heart disease risk? Rheumatologist Dr. Shirley Lake, also a member of Sunnybrook’s Holland Bone and Joint Program, offers information that may be helpful in your discussions with your doctor:

How much exercise should I be getting?

“The Canadian Physical Activity Guidelines for adults recommends getting at least 150 minutes of moderate to vigorous-intensity aerobic physical activity weekly, in bouts of 10 minutes or more. However, if there are other existing medical conditions or if there is difficulty with weight bearing, talk to your doctor or a health care provider such as a physiotherapist who can help you tailor a plan that works. It is also beneficial to add muscle and bone strengthening activity using major muscle groups at least two days a week.”

What is a moderate weight for me to aim for?

“Some people aim for an average body-mass index of 18.5-25 kg /m2. But there are exceptions based on the amount of muscle someone may have, so it is best to use this average only as a general guideline.”

What can I do to quit smoking?

“Just asking about options is the first step. There are so many resources to help people quit – from books, helplines, counsellors, and medications. Talk to your health care provider and check out smokershelpline.ca”

How do I manage inflammation? Are their dietary or other things I can do?

“The not-so-good news is that diets don’t cure arthritis. The good news is that switching some foods may help you manage your arthritis better. By maintaining a healthy weight, there’s less strain on your joints and this gives you more energy. A good rule is to try to minimize calories and maximize nutrients like whole grains, fruits and vegetables, lean proteins and lower-fat dairy products. For certain arthritis conditions like gout, eating less red meat, shellfish and alcohol help prevent attacks. More vegetables and low fat dairy are beneficial. In general, talk to a dietitian about what would be beneficial.

Am I at risk for diabetes? If yes, what can I do reduce my risk?

“The prevalence of insulin resistance and type 2 diabetes is increased in patients with rheumatoid arthritis. The increased insulin resistance in rheumatoid arthritis is related to systemic inflammation. Some of the drugs used to treat arthritis, such as steroids, can increase your risk of diabetes. Early introduction of effective disease-modifying anti-rheumatic drugs such as methotrexate, hydroxychloroquine, and TNF alpha antagonists control inflammation, which may decrease insulin resistance. Other things you can do to reduce your risk of diabetes is be active, keep a healthy weight, and make healthy food choices.”

Might my medications for rheumatoid arthritis, work, or not, for helping reduce risk for a heart condition?

“Certain medications such as methotrexate that treat rheumatoid arthritis have been shown to reduce risk of heart disease^**. Other medications such as NSAIDs (non-steroidal anti-inflammatory drugs), especially in the long term, can increase your risk of certain heart diseases. Certain biologics have been associated with worsening heart conditions such as heart failure. However, if these medications decrease pain and improve quality of life so that an individual can now function and exercise, they may improve their overall health. Every medication needs to be decided upon based on each person’s individual cardiac risk factors and the benefits and risk of the medication, and in consultation with your doctor.”

**A study led by Dr. Widdifield recently published in the Journal of Rheumatology evaluated the associations between use of methotrexate and risk of cardiovascular events in a cohort of 23,994 patients diagnosed with rheumatoid arthritis after age 65. The study observed a 20 percent decrease in cardiovascular events associated with these patients’ recent continuous use of methotrexate.

The post Heart disease and arthritis: what you need to know appeared first on Your Health Matters.

People living with heart disease, diabetes or other health issues can be at risk for ulcers, often hard to heal lesions that can be painful and increase the risk of infection and amputation. At the latest Speaker Series event, An Evening Discussion on the Heart, Dr. Ahmed Kayssi, a vascular surgeon with the Schulich Heart Program, cleared up some common misconceptions about wound healing.

It’s a simple question, but generally, how do wounds heal?

There are four stages to wound healing, which include:

1. Hemostasis: When the skin is cut, or the integrity of the skin is disrupted, you likely bleed. Hemostasis causes a blood clot to form and stop this bleeding.
2. Inflammation: This is the red hot, painful stage where the body is reacting to the wound. There can be swelling at the site of the wound, and it’s tender to the touch. I treat a lot of patients who are stuck at this stage.
3. Proliferation: This stage happens when the body is actively repairing the wound and replacing it with other products, a process that can take several weeks.
4. Remodeling: This refers to your body forming a scar, a process that can take up to two years. Keep in mind that even with optimal healing, the damaged skin will never be as strong as it was before the wound happened.

Should you expose ulcers exposed to air?

No! The most important thing to keep in mind when healing an ulcer wound is maintaining proper moisture balance. If you are drying a wound out by exposing it to air, or putting iodine or other substances on it, you are essentially forming a scab. And just because you scab over a wound doesn’t mean you’ve healed it. Scabs actually get in the way of your skin bridging over a wound and forming a new cover.

Here is the take away: just because your wound is dried out doesn’t mean you’ve healed it. In fact, the ulcer might sometimes still be there underneath the scab. This is a really important concept for people to understand.

So moisture is key?

Moist wound healing is by far the better approach, and something you should talk to your doctor about. Generally, to heal an ulcer properly, it needs the proper balance of moisture and oxygen, meaning it needs to have the right blood supply. To check for that, your doctor may arrange for you to have an ultrasound or other tests.

If your blood supply is the problem, there are some surgical solutions. With angioplasty, we can open up the blood vessel in the leg with a tiny balloon to improve blood flow.  Bypass is another option, where we create an alternate route for the blood to flow by implanting a vein or a prosthetic graft around the blocked blood vessel.

How quickly should wounds heal?

Most wounds should reduce in size by 40% or more after four weeks of a given therapy. If a wound is older than three months, or not responding to wound care after four weeks of therapy, a biopsy should be considered. And if a wound bed is worsening despite treatment, or is excessively painful, it could be infected. Make sure you talk to your health care team to determine the best treatment path for you.

Any other things to consider?

Think about the big picture, your overall health. By the time you have a wound, there are other health issues that got you there. So if you are diabetic, you need to optimize your blood sugars. Also, have your feet inspected regularly by a specialist.

Moisturizing your skin daily is also important. A very effective and affordable option is petroleum jelly. It doesn’t cost a lot and works wonders!

If you are on your feet a lot, wear compression socks. They are available in stores, and can also be prescribed by your doctor. Also, wear the proper footwear. Certain manufacturers make shoes that are specifically made to cater to those at high risk for ulcers.

Watch the whole Speaker Series event:

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Patient and Family Advisors offer important viewpoints on services we provide to patients. They volunteer their time as part of the Schulich Surgery Patient and Family Advisory Council and work with our health-care teams to further improve the patient and family experience. Learn more and apply »

The post Clearing up common misconceptions about wound healing appeared first on Your Health Matters.

Drones have long been used for recreation, but in a Canadian first, Sunnybrook is leading research to evaluate their use in responding to cardiac arrests. It’s a medical emergency where minutes matter, and there is promise that drones could help life-saving treatment begin up to 80 per cent faster.

The post How drones could help deliver life-saving treatment in rural areas appeared first on Your Health Matters.

Cardiac electrophysiologist Dr. Ben Glover. (Photo by Kevin Van Paassen)

Millions of Canadians experience irregular heart rhythms, known as arrhythmias; and, while many types of arrhythmias have no symptoms or warning signs, others may be life-threatening. In the more severe cases where lifestyle changes and medications aren’t enough to treat the irregularity, patients may undergo cardiac ablation to restore a normal heart rhythm.

Cardiac ablation is a procedure in which abnormal heart tissue is burned to create scar tissue that blocks stray electrical signals. Traditionally, during the non-surgical procedure, cardiac electrophysiologists use real-time, continuous X-rays (known as fluoroscopy) to guide their instruments into and around the heart; but a new technique is helping patients and medical staff avoid prolonged exposure to radiation during the procedure.

Sunnybrook Health Sciences Centre is one of few hospitals in Canada to adopt the new way of doing ablations using a three-dimensional mapping system called EnSite Precision cardiac mapping, which uses sensors, not X-rays, to provide highly detailed models of the heart.

How it works

During the ablation procedure, thin, flexible tubes with wires – called catheters – are inserted into the heart through small incisions in the skin. Diagnostic catheters record electrical information from the heart and display it on a screen in a three-dimensional model. The heart’s electrical pulses twinkle throughout the three-dimensional image, allowing the cardiologist to see any abnormalities. Abnormal tissue is then targeted using another catheter that has a specialized tip. The tip emits heat using high-frequency energy and creates a tiny scar that blocks the electrical signals causing the arrhythmia.

“When we move the catheters around the inside chamber of the heart, we build a map that allows us to see precisely – within a millimeter – what tissue we need to treat,” says Dr. Ben Glover, cardiac electrophysiologist at Sunnybrook’s Schulich Heart Program. “And because we are eliminating the need for fluoroscopy with this technology, we are eliminating the radiation that goes along with it.”

Dr. Glover uses 3D mapping technology to avoid prolonged exposure to radiation during catheter cardiac ablation procedures. (Photo by Kevin Van Paassen)

Not only does the new approach reduce radiation exposure to the patient, it also helps protect the medical staff who may be doing three of these multi-hour procedures in a single day.

“Conventional ablations have an immense effect on our health in the long-term. While there are strategies in place to ensure exposure is minimal, we – the physicians, the nurses, the anesthetists, the technologists – are all being exposed to X-rays to some extent during these procedures,” says Dr. Glover.

Studies show that during a 30-year career, cardiologists and other staff who work in catheterization laboratories have a cumulative radiation exposure of 50 mSv to 200 mSv, which is the equivalent of 2,500 to 10,000 chest X-rays. The impact is an increased risk of cataracts, cancer and other conditions linked to radiation.

It’s not just the radiation itself that affects the health of the medical team. Using traditional fluoroscopy, the staff within the catheterization lab need to wear heavy lead aprons for protection. These aprons can weigh up to 5 kg (11 lbs) and may be a contributor to orthopedic issues, like chronic back pain.

“There is considerable evidence that many electrophysiologists or cardiologists who perform these procedures report serious back problems and other musculoskeletal concerns that end up forcing them off work,” says Dr. Glover, adding that with the new approach, lead aprons would no longer be required.

Dr. Glover hopes more centres across Canada will use the fluoroscopy-free approach for the good of the patients and the staff.

This story also appeared in the July 2019 issue of Hospital News.

The post New cardiac ablation technique reduces radiation appeared first on Your Health Matters.

Former investment banking analyst Michelle Jennett switched careers to pursue her passion for medicine. Now, she’s developing RescuBeat, a potentially life-saving CPR device born and nurtured at Sunnybrook

Photography by Doug Nicholson

Michelle Jennett went from helping people save money to working on a device that could save lives.

In 2015, she was an investment banking analyst at a leading firm in New York. But she found herself drawn to another part of the city once she left the office.

“I was always volunteering Saturday nights in the emergency room,” she says. “So in the back of my mind, there was this passion for [medicine].”

Those evenings of cleaning hospital beds and giving out warm blankets to patients were fulfilling in a way the financial realm wasn’t. Jennett decided to move back to her home province of Ontario to pursue pre-medical school, a move that ultimately led her to Sunnybrook’s Medventions program.

Medventions was founded through the Schulich Heart Program in 2016 as a way to put technological innovations on the path to commercialization. The program connects aspiring medtech entrepreneurs with scientists, clinicians and engineers to develop medical devices that address very specific problems in the hospital environment.

Jennett went through the Medventions program as a fellow in 2018, and subsequently co-invented one of the program’s most promising innovations – a commercially viable medical device called RescuBeat, designed to improve life-saving measures in critical care environments.

RescuBeat has the potential to overcome a number of challenges associated with administering cardiopulmonary resuscitation (CPR) to patients in cardiac arrest in the catheterization (cath) lab.

Cath labs are specialized examination and treatment rooms equipped with diagnostic imaging equipment.

While most patients brought to the cardiac cath lab have a relatively low risk of complications, some patients, emergent cases in particular, are at a higher risk of cardiac arrest, says  Dr. Brian Courtney, an interventional cardiologist at Sunnybrook and co-inventor of RescuBeat.

CPR compresses the chest and pumps blood from the heart to the rest of the body to prevent irreparable damage to critical organs. With the right amount of pressure and consistency, compressions can save a patient on the verge of dying, but CPR is difficult and exhausting to administer by hand, even for trained health professionals.

And while mechanical CPR devices already exist, which can help eliminate human error and fatigue, “their use is unfavourable in situations like the catheterization lab for heart attack patients,” Jennett says.

“The problem in the lab is  you do not want to have a person standing in the path of X-rays while administering manual CPR because they will get exposed to unwanted radiation,”  Dr. Courtney says.

The X-ray exposure may be necessary for a patient who may die without the help of an angiogram. During an angiogram, a hollow, thin tube called a catheter is inserted into the cardiac blood vessel through the skin, allowing doctors to examine how well the heart is working. And while one-time exposure is unlikely to lead to lasting harm, health-care providers would inevitably be exposed multiple times during the course of a career performing CPR in the lab on several occasions.

Mechanical CPR devices prevent this kind of exposure. But devices currently on the market can block X-rays that allow cardiologists from viewing the vessels of the heart during an angiogram, a necessity during a heart attack.

Jennett witnessed this problem first-hand while shadowing Dr. Courtney as part of her Medventions learning experience.

“One of the existing [CPR] devices was placed on the patient and it blocked views of the arteries during the angiogram, making it very difficult to proceed with the procedure,” she says. “That’s when we realized there must be a better way.”

The moment served as a critical juncture in the development of RescuBeat. Jennett and the team – which consisted of herself, Dr. Courtney and engineers Reniel Engelbrecht and Miles Montgomery – had identified a major problem worth solving. And that’s a key part of the Medventions process, says Ahmed Nasef, Medventions program manager.

“We immerse multi-disciplinary teams of clinicians, engineers and people from a business background in the clinical environment at Sunnybrook where they spend a substantial amount of time trying to identify challenges that impose a significant medical burden,” Nasef says.

The Medventions Internship Program gives participants the chance to find these sorts of problems by letting them shadow health-care professionals at Sunnybrook for the first half of the four-month program.

“This really is the most important phase,” Nasef says. “Because if you get this stage right, chances are you will likely develop a solution that has high commercialization potential.”

Dr. Courtney points out that medical devices comprise a multi-billion-dollar industry, yet Canada accounts for a small fraction of this economy. 

“We import $8 billion in medical devices and export $3 billion in medical devices,” he says. “We know we have great engineering talent, research infrastructure and clinicians, so why is it we don’t develop a lot of good medical technology?”

Dr. Courtney came to Sunnybrook to be part of the answer. He was driven by his experience at Stanford University as an early student in the pilot phase of the Biodesign Program, which was instrumental in building the booming medical device industry in the U.S.

Now, Medventions is becoming a blueprint for other medical centres. Sunnybrook recently received a $49 million investment from the federal government to help spearhead medical technology commercialization across Canada.

While the potential economic spinoffs are massive, even more important is the potential to solve health-care challenges and improve the lives of patients.

With a provisional patent filed earlier this year, RescuBeat is well on its way to commercialization. It’s also the first Medventions device accepted by MaRS Innovation, which provides seed funding and other supports to fledgling medical startups.

Although a work in progress, the device may one day not just save lives in the cath lab. It could be used anywhere cardiac arrest occurs.

“Our hope is to bring a device to market that will ultimately save many, many lives,” Jennett says.

The post Michelle went from an investment banker, to inventing a device that could save lives appeared first on Your Health Matters.

Imagine being faced with two difficult choices: let your malfunctioning heart continue to deteriorate or face high-risk surgery. That has long been the reality for many people with valve disorders. But advances in valve replacement technology and novel thinking by Sunnybrook health-care experts are providing patients with new ways to get their lives back.

Photography by Kevin Van Paassen

Marilyn Ostrander feels like she’s been given a third chance at life.

In 2010, doctors operated to give her a replacement heart valve. But eight years later, it was failing her. She was on the brink of palliative care.

“Surviving day-to-day was the biggest challenge of my life,” the 86-year-old recalls.

Marilyn’s daughters remember talking her through bouts of severe shortness of breath – a sensation so intense it felt like suffocating. Leg cramps at night made her restless, and she suffered extreme fatigue during the day. Her diet was so strictly regimented that she had to weigh and measure all her food and didn’t dream of ever eating out.

Because of Marilyn’s age and fragile condition, another open-heart surgery – like the one she’d had in 2010 for her first replacement valve – was out of the question. The risks were too great.

In June 2018, Marilyn got that third chance in the form of a replacement valve delivered to the heart through a tube inserted into her leg vein. The procedure was lower-risk and took around 60 minutes.

Describing Marilyn’s post-procedure improvement as dramatic is an understatement.

“When I first saw her in the clinic, she was essentially bed-bound. She couldn’t move, she couldn’t do anything,” recalls Dr. Andrew Czarnecki, a cardiologist at Sunnybrook and a member of Marilyn’s care team. “And then when I saw her again, she was out shopping with her daughters.” She’s now back to living independently at her home in Prince Edward County, Ont., where she cooks for herself, gardens, eats out and travels with her daughters.

Marilyn’s success story is thanks to monumental advances in heart valve repair and replacement technology. It’s also due to the innovative thinking of Sunnybrook health-care experts who have joined forces to apply the technology in creative ways – often funded by donors. In the past, she and 900,000 other Canadians with her condition typically faced a choice between inaction and high-risk surgery. Today, they have a range of options and more chances to get their lives back.

A revolutionary approach

Valve disorders affect the thin, strong flaps of tissue that separate the chambers of the heart. The flaps open to let blood flow forward through the heart when it beats and close again to stop blood flowing backwards. When the valves aren’t functioning properly, sometimes due to an infection or because calcium buildup makes the valve stiff, they begin to leak. Blood flows in the wrong direction and the heart has to work harder to provide enough oxygen-carrying blood to the body. A person can feel tired, breathless, have swollen ankles or find it hard to breathe when lying down in bed at night.

As recently as 10 years ago, the only options for patients were to do nothing, take medication or have open-heart surgery. Surgery to repair or replace the valve requires a 15-to-20-centimetre incision in the chest, stopping the heart and placing the person on a heart-lung machine.

“The challenge was not so much that the surgical treatment didn’t work. People would often have good results,” says Dr. Eric Cohen, deputy head of the cardiology division of the Schulich Heart Program at Sunnybrook. “The challenge was that it was uncertain whether a patient who was sick or elderly would get through the surgery.”

Dr. Eric Cohen (left), Dr. Gideon Cohen and Dr. Andrew Czarnecki perform a mitral valve replacement

Now those replacements and repairs can be performed by feeding a catheter up an artery or vein through a small incision in the patient’s leg. These procedures are called percutaneous implantations, or implantations through the skin. The heart remains beating and the patient can be sitting up within a few hours and go home in a few days. (One of the more well-known percutaneous implantations is TAVI, or transcatheter aortic valve implantation, which is used to treat aortic valve problems.)

“When that happened, it revolutionized our approach to valve pathology in that it opened up the realm of treatment possibilities for patients who we previously deemed inoperable,” says Dr. Gideon Cohen, division head of cardiac surgery at Sunnybrook and medical director of the Schulich Heart Program. “It’s rare now that we turn down a patient.”

Marilyn’s recent procedure was a tricuspid valve-in-valve replacement, meaning she had a new artificial valve implanted on top of her existing failing one. The old valve acts as an anchor for the new one.

New techniques like this do more than broaden the types of patients who can receive treatment. They’ve prompted the creation of a new specialty in cardiac medicine – structural heart intervention – where surgeons and cardiologists join forces to treat disease. That team approach makes Sunnybrook one of the largest and most successful intervention groups in Canada.

“We are the gold standard in this approach. Nobody really matches the collaborative program that we have between surgeons and cardiologists,” says Dr. Gideon Cohen.

Marilyn felt supported by her team throughout her treatment. “Their confidence made me confident,” she says.

Her daughter, Kim Bouma, says her mother was looked after with dignity and respect not just by the physicians but by the entire health-care team. “The environment there was so supportive,” she says. “It truly was patient-centred care.”

Changing the storyline

Now that Sunnybrook doctors have performed many valve repairs with percutaneous implantations, tackling more than 200 each year, they’re developing exciting ways to expand the use of the technology they have at their disposal.

One option for repairing the mitral valve, which separates the left heart chambers, is to secure its two leaflets together using a staple-like device called the MitraClip. This device has been in use at Sunnybrook since 2011, but Dr. Gideon Cohen and Dr. Eric Cohen recently pioneered its use as an emergency procedure, stabilizing patients until they’re well enough for surgery.

Marilyn Ostrander (Photography by Kevin Van Paassen)

In one case, a patient came in with a burst mitral valve after a heart attack. He was close to death, but his heart couldn’t tolerate the stress of an operation. The risks were extremely high, with an 80 per cent chance that he wouldn’t make it.

“We used to operate because there was no other option. A 20-per-cent chance of living was better than nothing,” says Dr. Gideon Cohen. “With the clip procedure, we’ve changed the storyline here.”

The patient underwent the minimally invasive and far less risky MitraClip procedure. A few months later, after recovering from his heart attack, he received a repair operation. In a different case, a patient avoided surgery altogether because the clip worked well enough on its own.

Because the MitraClip is being utilized in ways not originally intended, its usage isn’t funded by OHIP, but rather through donations to Sunnybrook Foundation.

Dramatic change on the way

While the ingenuity of Sunnybrook surgeons and cardiologists continue to move the field forward, Dr. Gideon Cohen explains that some challenges still remain. Mitral valve replacement (not repair) through a catheter in the leg, rather than open heart, is still in its infancy.

“The mitral space is a lot more complex,” he says. In comparison to other valves, the mitral is more difficult to anchor to and also bigger, making delivery of a new valve through a tiny catheter difficult.

Sunnybrook is testing a new technology called the Caisson device, which has been successful in two patients already. What sets the Caisson apart from the many others under development is that it can be fed up through a vein along the same path as the MitraClip. Other devices require making an incision in the chest and piercing the tip of the heart to deliver the replacement valve. While this procedure is not quite as invasive as open-heart surgery, Dr. Gideon Cohen explains, it’s still a surgery with significant risks. In contrast, the Caisson valve is a lot more delicate, he says. The Caisson is currently undergoing a redesign to make it even more effective in the long term before a new clinical trial begins.

Another challenge is replacing a tricuspid valve non-surgically in first-time patients, says Dr. Czarnecki. The valve-in-valve replacement that Marilyn had works well because the existing valve acts as an anchor. Clinical trials are underway at Sunnybrook investigating whether a form of the MitraClip can be used to repair the tricuspid valve. Elsewhere, trials of new replacement devices are ongoing.

“There’s no doubt that over the next five to 10 years, this is going to be a huge area of growth because of a very clear recognition that this is the most under-serviced population in the valve space,” says Dr. Czarnecki.

The team is optimistic that the technology in the valve space will improve even further in the next decade. When Dr. Gideon Cohen first replaced Marilyn’s tricuspid valve through open heart surgery 10 years ago, he knew there was a possibility that it would need replacing again.

But he never dreamed of the options that would be available when that time came.

“It just goes to show you how things change dramatically in a short period of time and can really change people’s lives,” he says.

Marilyn’s three daughters are still overwhelmed by the improvement they’ve seen in their mother, thanks to the procedure.

“We’re still pinching ourselves….Did this really happen?” says Kathryn Ostrander, Marilyn’s oldest daughter. They’ve gone from being caregivers to spending quality time with their mom. The four plan on many more adventures in the future, including a trip to the Okanagan
in B.C.

“I’m just so overjoyed to be home and [to be] able to do things,” says Marilyn. “It’s worth a million dollars.”

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Transcatheter aortic valve implantation (TAVI) – also known as transcatheter aortic valve replacement (TAVR) – has quickly become the treatment of choice for elderly patients with severe aortic stenosis (narrowing of the aortic valve). The minimally-invasive procedure offers a treatment option to individuals who are at a higher risk with open-heart surgery. Patients who are offered and consented for the procedure may be put on a waitlist.

Being on a waitlist is never easy, especially if you’re waiting for medical treatment. If you have severe aortic stenosis and are waiting for TAVI, the amount of time you are on a waitlist will vary depending on the number of people waiting and your symptoms.

Below are six general tips to help you maintain your heart while you are waiting, and when you should seek help. Please consult your TAVI team for recommendations specific to your condition.

Limit your fluid intake

Drink less than 2 litres (8 cups) of liquid per day. If you have kidney issues, follow your nephrologist’s advice on how much liquid you can drink per day. Liquid includes water, tea, coffee, juice, shakes, smoothies, soup and Jell-O.

Take a walk

Walk every day, slowly and rest often. If you have difficulty breathing or feel tired, stop and rest.

Limit sodium (salt)

Eat foods low in salt and don’t add salt to your food. Your maximum total salt intake in one day should be 2 grams.

Do not lift, push or pull heavy objects

Lifting, pushing or pulling objects more than 5 kilograms (10 pounds) could increase your heart rate and put strain on your heart. This includes holding children, carrying groceries or a basket of laundry, shovelling snow, using a snow blower and cutting grass.

Take your medications

Take all your medications as prescribed. If you feel your medications need to be changed, please see your family doctor, cardiologist or other specialist before stopping or adjusting medications.

Do not smoke

Smoking makes your heart work harder. It increases your heart rate, narrows blood vessels, raises blood pressure, and reduces the amount of blood, oxygen and nutrients that get to your heart. Second hand smoke can cause the same effects. Ask your doctor or pharmacist for ways of helping you stop or reduce smoking. You may also visit smokershelpline.ca.

When should I seek medical care?

If you experience swelling in your legs, speak with your cardiologist or family doctor. If you experience any of the following symptoms, call 9-1-1 or seek urgent medical care:

• Fainting
• Shortness of breath that does not improve after 10 minutes of rest.

Notify the urgent care provider that you are on the waitlist for TAVI.

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We hear somewhere almost every day: “Eat well!” and “Add more vegetables to your diet”. But how can we keep up our vegetable intake – or add more! – when prices of fresh vegetables can be quite high?

Daphna Steinberg, registered dietitian, shares these tips to help you fill up on veggies but not empty your wallet:

Talk to the produce manager at the grocery store

The manager can help guide you to what’s freshest and tastiest, and can even give you ideas on how to cook them best.

What’s on sale?

Check flyers and coupons for what’s on sale and plan your menu accordingly. I am never excited to see a cauliflower until I see a fine-looking bunch on sale for $3.99! Sweet potatoes on sale? Add baked sweet potato fries to a dinner this week. And if something is on sale…

…Buy lots and freeze it!

It’s best for nutritional value for you to freeze while it’s fresh. So, buy double, and chop and freeze half right away. Be sure to store in airtight containers.

Frozen and canned vegetables count

Choose low sodium canned goods. And choose plain frozen vegetables (not with sauces already added) or freeze your own.

Shop local

Try to buy produce that’s grown locally (think greenhouse tomatoes and cucumbers, winter squashes). Keep track of what’s in season.

Think outside the {fill in your go-to vegetable here}

We all have favourites we reach for in the produce aisle – whether for taste, habit or convenience. Try to shake it up a little and give some other vegetables that you usually skip over a try. Hate boiled brussel sprouts? (need I even ask?) Try tossing brussel sprouts in olive oil, garlic and salt and pepper and roasting them (about 20-25 minutes at 375 C). Daphna says her eight-year-old son gobbles these up. Or, try roasting beets (cheap and delicious).

Skip the organic

If you are looking to save on vegetables, don’t purchase organic, which are more expensive and typically travel longer distances so don’t last as long once in your fridge.

Make the most of  ’em

Make the most out of the vegetables you purchase by using them all up! Leave the skin on those cucumbers, carrots and potatoes, just give them a good wash. That’ll help avoid peeling the bulk of them away – and leaves on good fibre. Finely chop up the broccoli stalks and use them for coleslaw. Or, include the stalks in a soup.

Soup’s on

Instead of tossing out that wilted cauliflower that cost you $5.99, or those carrots that have lost their crispness, throw them all into a stock pot with some low sodium broth and make a nice warm soup.

(This post was reviewed and updated Feb. 7, 2020)

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Patients who have certain implantable medical devices, like pacemakers and defibrillators, may benefit from remote device monitoring. This allows your heart specialist to get important information from your device and about your health, even when you are not physically present for a check up. Dr. Ben Glover, an electrophysiologist in Sunnybrook’s Schulich Heart Program, talked about this advance at the latest Speaker Series event, Rhythm Of My Heart.

All patients who live with devices, like pacemakers or defibrillators to control their heart function, should be monitored regularly, says Dr. Glover. Typically, monitoring is done during your in-clinic appointments. The doctor will place a special programming tool on your chest to check on your heart rhythms and to monitor how the device is functioning overall.

Increasingly, Dr. Glover says some patients may benefit from remote device monitoring. Depending on the type of device you have, the manufacturer of your device and what your doctor decides is the best approach for you is, there may be an opportunity to have your clinical team access information about your health and device no matter where you are. Information may be securely shared over the phone or wirelessly over the internet, depending on your device. Your doctor will discuss the specifics with you.

If you are eligible for remote device monitoring, Dr. Glover says there are many potential benefits, including:

• close monitoring that can lead to earlier interventions
• quicker access to patient health information
• real-time information about heart rate
• increased convenience for patients, especially for those living in remote communities or travelling
• fewer visits to the clinic or emergency department

Dr. Glover says remote device monitoring won’t eliminate all contact with your heart specialist. Importantly, they should always be contacted if you are experiencing unusual symptoms or need to have your device settings updated or changed. If you are experiencing a medical emergency, always call 911 or go directly to your nearest emergency department.

View the full Speaker Series event here:

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Mary Mandel has heart disease. She is considered one of the high-risk and vulnerable people during the COVID-19 pandemic.

“My 86-year-old husband is in a nursing home…one long-time friend has died of the virus, and another was diagnosed and recovered,” she says. “It hits very close to home. I know I’m vulnerable and I’m taking it very seriously.”

A former nurse and clinical researcher, Mary remembers the “old days” when she was caring for a patient with tuberculosis.

“I still remember him saying, ‘If I’ve got it, you’re going to have it too,’ then he coughed right in my face,” says Mary, who is now retired. “You get some takeaway memories. I’ve become overly critical of the techniques being used to keep people safe.”

Mary admits she was worried she’d be disappointed at the hospital when she had to go to Sunnybrook Health Sciences Centre for an echocardiogram and visit with her cardiologist.

“It was a very anxious thing, and that made me even more impressed with how well they did,” she says. “You couldn’t get in without being screened – there was no way around it. It was very reassuring.”

Toronto-area hospitals have been taking extra precautions to reduce the risk of the novel coronavirus being spread from person-to-person, from entrance screening to personal protective equipment in clinical and high-traffic common areas.

Robert Kates, a seventy-seven-year-old grandfather of six (soon to be seven), says he too is “a little paranoid” about contracting COVID-19.

“At my age and with my prior history of infections, I’m overly cautious,” he says. “I wear a mask. I carry sanitizer in both my pockets. The only time I leave my house is to go out for groceries, and that’s about twice a week. I even sanitize my own car inside.”

Over the past three months, Robert has been to Sunnybrook three times to undergo tests to evaluate possible heart problems. On visiting the hospital, he says he wasn’t overly concerned: “I wondered what they were going to do. I knew they’d be taking precautions, and I was very relaxed and calm going in there.”

If you are going to hospital or out in public, infection control experts at Sunnybrook recommend you wash or sanitize your hands frequently, keep your hands away from your face, practice physical distancing, and make sure to wear your mask properly.

“Take precautions and trust in the hospital and the doctors,” advises Robert. “If you need to visit the hospital, do it. Don’t wait. It’s your life.”

Heart attacks don’t stop during a pandemic

Don’t ignore the signs of serious heart problems, especially if you have a heart condition. Call 911 if you think you are having a heart attack. Symptoms include:

• Chest pain
• Difficulty breathing
• Discomfort in your chest, arms, back, neck, shoulder or jaw

If you have questions about COVID-19 and your heart condition, or need a health visit, speak to your cardiologist or other health-care provider.

Source: Canadian Cardiovascular Society

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Dr. Harindra Wijeysundera’s work involves the tiniest details. As an interventional cardiologist, he diagnoses and treats structural heart diseases using novel devices small enough to fit inside a heart valve.

But he never loses sight of the big picture.

“Each aspect of my work informs the other,” says Dr. Wijeysundera.

In Sunnybrook’s Schulich Heart Program, Dr. Wijeysundera is part of a team that leads the country in minimally invasive treatments for patients, many of whom cannot withstand open-heart surgery. Among his specialties is the transcatheter aortic valve implant (TAVI) procedure, which involves repairing the aortic valve, responsible for pumping blood to the heart. Dr. Wijeysundera threads a catheter through a small incision in the leg up to the heart, then deploys a mesh replacement valve in the narrowed aortic valve, relieving shortness of breath and chest pain often immediately.

When Dr. Wijeysundera isn’t treating patients in the catheterization lab, he leads an impressive research program that evaluates how health technologies like TAVI can be used to treat even more patients.

“As physicians, we have responsibilities to the patient in front of us, but we also have bigger responsibilities as caretakers of the health-care system,” he says.

Dr. Wijeysundera and his team analyze large amounts of data involving patients who have received devices like TAVIs in order to put forward policy recommendations to key provincial decision-making groups about how such life-saving technologies can be optimized for more patients across the health system. His efforts have been recognized with multiple awards, including his most recent honour, the Distinguished Clinician Scientist Award from the Heart and Stroke Foundation of Canada.

Profile text by Ishani Nath. Photo by Kevin Van Paassen.

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In March 2020, cardiac electrophysiologist Dr. Benedict Glover, director of arrhythmia services in Sunnybrook’s Schulich Heart Program, implanted a medical device into a patient to help control his heart function. But instead of asking the man to return for a three- or six-month checkup, Dr. Glover signed him up for a new service: remote device monitoring.

This method of community-based care allows heart specialists to keep tabs on implantable medical devices like pacemakers and defibrillators – no physical clinic appointment required.

For the patient, that decision was a godsend. He had just driven almost three days with a friend from his home outside Thunder Bay, Ont. Returning for frequent follow-ups would have been a challenge.

“We forget sometimes how massive Ontario is and that we get referrals from all over the province,” says Dr. Glover. “A lot of follow-ups can be done remotely.”

Even heart patients in Toronto can benefit. With remote monitoring, patients connect their pacemaker or defibrillator via Bluetooth to a small receiver in their home that downloads real-time, encrypted data and transmits it to Dr. Glover’s clinic. Staff check that information each morning, looking for abnormalities.

This ongoing diagnostic monitoring is more likely to lead to earlier interventions, Dr. Glover says. It can also mean fewer visits to the emergency department.

“The world is changing, and we are all moving to more remote systems for patients,” he says. “The more data we can get, the better.”

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Julie Atkinson was diagnosed with preeclampsia, a pregnancy complication often characterized by high blood pressure, during labour with her first child.

All of a sudden, the swelling she experienced during her pregnancy made sense.

“I had not thought about my blood pressure because I was so young, only 27, with my first pregnancy,” says Julie, a mother of four from St. Thomas, Ontario, who adds she wishes she knew that preeclampsia can happen at any age.

Learn more about symptoms, risk factors and treatment for preeclampsia

Julie experienced preeclampsia with all four of her pregnancies and was surprised to hear the condition affects roughly seven per cent of pregnancies in Canada. The condition can impair liver and kidney function, cause blood clotting problems, seizures and, in some severe and untreated cases, even maternal and infant death. Recently, celebrities like Beyonce and Kim Kardashian have been public about their experiences with the condition.

Dr. Lisa Dubrofsky, nephrologist at Sunnybrook, is working with a team of clinicians to better understand the best way to reach women to raise awareness around preeclampsia and the health impact it can have later on in a woman’s life.

“Many women with preeclampsia think ‘that’s it, my risk has ended’ after they have their baby,” says Dr. Dubrofsky, noting that the condition increases risk of long-term cardiovascular conditions, as well as diabetes, high blood pressure and kidney disorders. “Easy-to-access postpartum education is critical to keep women healthy.”

The Sunnybrook team have launched the Her-HEART study to better understand the best approach to boosting awareness of the condition’s long-lasting impact. The study will assess how to best educate women, like Julie, to reduce the long-term risk of heart disease.

“We’re really keen to know whether women are open to an online web-based education session or a personalized telemedicine consult,” says Dr. Dubrofsky, who adds the study will only take about two hours of time in total.

Julie says she will participate in the Her-HEART study and encourages other women who have had preeclampsia to join.

“Taking an active interest in preeclampsia, and the lifestyle changes I can make, has made a huge difference in my subsequent pregnancies and my ongoing health.”

Learn more about the Her-HEART study and how to participate

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Heart disease remains the number one killer of both men and women worldwide, edging out cancer for the past few years.

Here’s the good news: there are some things we can do to help prevent heart disease and, if heart disease or attack is recognized and treated early, there are some great outcomes for patients.

I spoke with Dr. Mina Madan, cardiologist at Sunnybrook, to answer some FAQs about the heart and how we can keep ours healthy.

Q. A real easy one, to get us started: What is the heart? (Because it’s been awhile since we’ve sat in a Science Class)

The heart is a muscle pump in the left part of the chest that pumps blood carrying oxygen to the rest of the body. It has its own blood supply that delivers oxygen and nutrients to the heart.

Q. What is coronary artery disease?

The heart’s blood supply is kind of like a plumbing system. Coronary artery disease is build up in those pipes. When there’s a blockage – made up of cholesterol plaque – oxygen and nutrients can’t get to the heart, and so it starts starving. The build-up can happen over time or abruptly.

After about 30-40 minutes of a complete (100%) blockage, you may start to feel some or all of the classic symptoms of a heart attack.

Q. What are the symptoms of a heart attack – or what doctors would call a myocardial infarction?

The classic symptoms are: central heaviness in the chest, burning in the chest that radiates up the neck and into the jaw, pain in the back, difficulty breathing, sweating, pain in your left arm, nausea or vomiting. If you experience these symptoms, call 911.

Q. What are some of the not-so-typical symptoms?

There are other atypical symptoms that both men and women may have. Those might be just jaw pain, just back pain, or burning in the stomach area (kind of like acid reflux). This explains why sometimes the diagnosis of heart attack can be missed.

Q. I’ve heard women experience heart attack differently than men and many don’t realize they are having a heart attack at all?

It’s true. Many women have other atypical symptoms or report just feeling breathless, or really fatigued in the days leading up to a heart attack; some women experience the so-called classic symptoms, but less intense. These symptoms could be a sign of trouble in your heart. You should talk to your doctor.

It’s not really known why these differences exist – just differences in how men and women are wired.

Heart attacks are more common in men. Post-menopausal women have heart attacks more often than pre-menopausal women due to the reduced levels of estrogen associated with menopause (estrogen has a protective effect on the heart).

Q. What are heart disease risk factors?

It’s important that people know the risk factors. Diabetes, high blood pressure, high cholesterol, smoking and a family history of heart disease are all risk factors. As you approach middle age it’s important you are aware of your family history. Talk to your doctor about your risk factors and take measures to keep your heart healthy.

Q. What can we all do to stay on the heart-healthy track?

If you smoke, consider quitting.

Get your blood pressure checked – you can actually do it yourself at most pharmacies.

Have an annual appointment with your family doctor.

Maintain a healthy body weight through a healthy diet and by staying active. You should exercise three to five times per week. Obesity itself is not a risk factor – but being overweight often goes hand in hand with high blood pressure, high cholesterol and diabetes.

If you have risk factors, feel out of breath more than usual or have any of the other lead-up symptoms mentioned above, talk to your doctor about taking a stress test. If heart disease is diagnosed, there are treatments and the outcomes are usually very good.

This column was also published in 2017 the Town Crier Group of Newspapers in Toronto, Ont. It has been reviewed and updated for 2021.

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Atrial fibrillation (also known as “AF” or “A-Fib”) is a type of irregular heart rhythm or arrhythmia that affects over 30 million people worldwide and is a leading cause of deadly strokes, particularly in the elderly.

With atrial fibrillation, the heart may not be able to pump blood normally. This can cause blood to pool in a small pouch that sits off the left side of the heart, known as the left atrial appendage (LAA), and form a clot. If left untreated, the clot can enter the bloodstream, travel to the brain and cause a stroke.

To reduce the risk of stroke, physicians often prescribe a blood-thinning medication, or anticoagulant. These medications slow down or prevent blood cells from clumping together to form a clot. But they may not be appropriate for everyone.

“Despite their effectiveness, taking blood thinners may be difficult for some patients,” says Dr. Sheldon Singh, a cardiac electrophysiologist at Sunnybrook’s Schulich Heart Centre. “These medications are not always well-tolerated and they present a risk for bleeding complications.”

How a unique heart device can help prevent stroke

A treatment called the Watchman implant is an alternative to blood thinners. It is designed to permanently seal off the appendage in the heart where blood clots can form.

“This procedure can protect those who are at a high risk of stroke from atrial fibrillation but who either cannot take blood thinners, or cannot take them consistently for a long period of time,” says Dr. Singh. “Studies have shown that, on average, people who got the implant lived longer than those on some blood thinners, likely caused by life-threatening bleeding.”

In the minimally-invasive procedure, a specialized device is guided by a catheter through a vein in the upper leg and into the left side of the heart. Once in position, the implant is released and seals off the left atrial appendage. Over time, heart tissue grows over the device to create a permanent barrier. The procedure typically takes an hour, with only a 24-hour recovery time.

More procedures, more lives

In the five years since Sunnybrook first introduced the minimally invasive treatment, approximately 40 patients have received the device, with the help of donor support.

During that time, a new iteration of the device first used in Ontario by Sunnybrook has made it easier to implant, says Dr. Singh, “which makes the procedure quicker and safer.”

In March 2020, the Ministry of Health announced its decision to fund 20 Watchman cases annually at Sunnybrook, along with five other centres in Ontario, making the life-saving procedure more accessible for patients who need it. After completing all 20 cases within just five months, the Schulich Heart Centre will be resuming the treatment in April 2021.

“With provincial funding and growing capacity, the procedure is gradually becoming a valuable and more commonly accepted alternative,” says Dr. Singh. “This means we have more opportunities to reduce the risk of stroke in people with atrial fibrillation who previously had very few options.”

Global studies are underway

The Schulich Heart Program was recently selected as one of three Canadian centres, and the only Ontario program, to participate in a clinical trial evaluating the Watchman technology. It is also one of only two Canadian centres chosen to participate in a pivotal global trial evaluating the Watchman against blood thinners in the general population with atrial fibrillation. Set to launch in 2021, the U.S.-run trial will involve patients who have received ablation to treat atrial fibrillation. Researchers will compare the outcomes of those who take blood thinners to those who receive the Watchman device.

“If you have atrial fibrillation and you’re looking for an alternative to blood thinners, speak to your cardiologist about your options,” says Dr. Singh.

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