“We were very worried about sending him home,” says Brian Grant, social worker at Sunnybrook’s Reactivation Care Centre. “We discussed long-term care at length, but his wish was to get back home. We wanted to respect that, but we wanted it to be a successful return home.”

The health-care team, aware of his concerns, held regular meetings to discuss his progress and needs. They recognized that John didn’t just want to leave the hospital; he wanted to reclaim his independence and maintain a quality of life in the home that he loved.

It was during this time that Sunnybrook and its community partners launched the Sunnybrook-to-Home program. This program was designed specifically to help patients transition safely back to their homes with the wrap-around support they needed from the day they got home.

“With Sunnybrook-to-Home, there was no need to even consider long-term care anymore,” admits Brian.

After careful planning and coordination with community health providers, John was finally ready to go home. Within 24 hours of arriving, he received comprehensive in-home care services that filled gaps and strengthened the supports he already had in place through primary and community care. His care now encompassed nursing, personal care, meal support, social work, physiotherapy and occupational therapy – all tailored to his specific needs.

“When I came home, I needed more help than I realized,” says John. “I don’t like asking people for help. Before I’d say I don’t need that, but now I’ll take all the help I can get!”

John realized that accepting support didn’t mean losing independence; rather, it could enhance his ability to live at home safely and comfortably.

Grateful to be receiving care at home, and reflecting on his time in hospital, he admits, “I do not want to go back to those places.”

Through regular check-ins, the Sunnybrook-to-Home team and its community partners ensures John is thriving. He learned to appreciate the community of support around him—neighbours and friends who check-in, and the health-care team that remained invested in his well-being.

The post A path back to independence appeared first on Your Health Matters.

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.

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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.

The post Behind the Research: Do women still get the ‘short end of the stick’ when it comes to heart attack care? appeared first on Your Health Matters.

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 that 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 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. Mina 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. 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.

The post ‘I never, ever thought I was having a heart attack’: 46-year-old Ines’ story appeared first on Your Health Matters.

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.

The post An alternative to blood thinners appeared first on Your Health Matters.

Julian was talking to his wife on their family room couch before taking on an afternoon of housework. When he stood up, he felt a strange sensation in his left eye and sat back down. Then, all his strength drained from his body. Thinking little of it, he dragged himself to the bedroom to sleep it off. It wasn’t until hours later that he called 911 and was rushed to the emergency room at Sunnybrook Health Sciences Centre.

“Life suddenly changed. Everything changed,” says Julian.

Julian suffered a stroke that weakened the entire left side of his body so much so that he was virtually bedridden for more than a month. He couldn’t sit up or even raise his arm. Doctors said his stroke was likely caused by high blood pressure and his 30-year history of heavy smoking.

“I didn’t pay much attention to my blood pressure. Sometimes I didn’t take my medicine. I didn’t eat right. I smoked one-and-a-half packs every day,” he admits. “Now, all of my mind is on exercise, getting back my health and my capability of daily life.”

Julian rebuilds his strength and balance with physiotherapist Chaya Plonka at Sunnybrook’s St. John’s Rehab.

Since April, Julian has been working with a multidisciplinary team at St. John’s Rehab, including nurses, physicians, physiotherapists and occupational therapists, to regain his strength, balance and mobility.

“After a month, something in me changed. I tried to adjust my psychology to think in a positive way,” he says. Soon after, he made the decision to quit smoking and became determined to get moving.

“Every day I exercised,” he says proudly. “Eventually, I was able to stand up by the side of my bed. Then, I took a couple of steps. Gradually, a couple more. Then I pushed the wheelchair outside the room and walked down the corridor.”

Julian was still dependent on a wheelchair when he was discharged as an inpatient but continued his rehabilitation through the hospital’s outpatient program.

“About a week after discharge, I got rid of my wheelchair,” he says. “Now I barely use a cane. I’m almost back to normal.”

Back at home, Julian insists on going for walks in his neighbourhood every day and is determined to prevent a second stroke.

“The stroke was very bad for me and in a way it’s good for me,” he says. “After the stroke, I quit smoking and a lot of bad habits. On the whole, my body and health is much better.”

The post Julian says his stroke was a ‘wake-up call’ appeared first on Your Health Matters.

“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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In a room at the Odette Cancer Centre, shelves of neatly arranged wigs and head coverings line the walls. They’re free for patients who’ve lost their hair from chemotherapy or other cancer-related treatment. Many of the wigs sit atop expertly handcrafted wooden wig stands, which are also available free of charge to patients.

Woodturner Allan Cooper says his wife lost her hair due to chemotherapy nine years ago. In an attempt to add something beautiful to her life, the retired lawyer made her a wig stand. Although she has since passed away, he’s been making and donating them to the hospital ever since. 

“I decided the hospital could use something more attractive than the Styrofoam heads,” he says.  

In addition to creating his own wig stands, Allan Cooper also collects stands from other woodturners across the province.

Allan also collects stands from other woodturners across the province. In the last two years, he’s collected more than 150 wig stands for donation, with no two being identical. “Wigs are very important to patients going through chemotherapy. Having a stand to place it on gives it the respect it deserves,” says Erin Di Lella, volunteer coordinator at the Odette Cancer Centre. “And these stands are beautiful works of art made with love.” 

Each stand varies in finish, from a clear lacquer that showcases the wood grain to colourful paint.  

Volunteers at the cancer centre say patients are comforted knowing that somebody took the time and energy to make such striking showpieces. 

“The object of life is to try to improve life for other people,” Allan says. “When somebody has an illness, it’s not difficult to make their life just a little bit better, [to] add something unique, make them feel special. So, if I can make them even a little bit happier, then I’m satisfied.”

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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.

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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.

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