“He spent over an hour with me, reviewing healthy lifestyle advice in detail to improve my heart health,” says Abdel. “His care, and advice, has changed my life.”

Abdel has lost approximately 40 pounds in four months by closely following Dr. Moustafa’s tips. The changes, for a self-professed foodie, initially came as a shock. No added sugars, no processed carbs. And the kicker: 30 seconds for each bite or mouthful.

“He patiently listened to my daily eating routine and explained to me the quality of the different types of food, as well as the appropriate healthy quantity and frequency of meals each day. He also detailed the benefits of chewing the food slowly,” explains Abdel.

Aiming for 30 chews per bite improves digestion, nutrient absorption, and most importantly helps you feel full, potentially leading to better weight management. Abdel is now maintaining a good calorie deficit with a sustainable balanced healthy diet and regular exercise.

“I haven’t felt this healthy in more than ten years,” he says. “I’m able to go for daily walks effortlessly, and I’m gaining muscle mass by regularly visiting the gym.”

The patient and doctor have also bonded over their shared experience of being from Egypt. “In Arabic culture, the physician is called “Ḥakīm” which means a wise person. For me, Dr. Moustafa is that person,” says Abdel.

Dr. Moustafa’s impact extends to the students he works with each year at Sunnybrook. He recently received a Peters-Boyd Academy Teaching Award: Foundation Faculty Teaching for Clinical Skills.

The post Heart healthy tips in action: Abdel’s story appeared first on Your Health Matters.

But researchers may have a whole new treatment therapy technique to target and treat hypertension that may be an option in the future.

Newly-published pre-clinical research from scientists at Sunnybrook Research Institute suggests that focused ultrasound – a breakthrough non-invasive surgical technique – when targeted to a specific location in the midbrain, can inhibit neuron activity to reduce blood pressure for potential long-lasting treatment.

When left untreated, hypertension (or high blood pressure) is a fatal condition. Currently, it is treated with diet and lifestyle changes, and systemically-delivered medications that act on the central nervous system to lower the heart rate, relax and open up the blood vessels, help rid the body of excess salt and water, or alter enzyme secretion.

For patients with drug-resistant hypertension, or for those who are pregnant, many treatment options are ineffective and unsafe.

Previous research looked at an alternative approach using deep brain stimulation – an invasive neurosurgical procedure – to stimulate a specific region of the midbrain in a handful of patients. The results were promising, but the procedure has been associated with potential infections and hemorrhage.

That’s where focused ultrasound comes in.

Acclaimed in the medical and scientific world as “scalpel-free brain surgery”, FUS has crossed over from research into successful clinical treatment of some brain conditions, non-invasively.

With its additional ability to safely open the blood-brain barrier (BBB) non-invasively – a world-first research breakthrough – scientists continue to plough forward in their investigations of FUS as a treatment option for other health conditions controlled by the brain, such as is the case in this new study published recently in the journal Brain Stimulation.

“We’ve shown in pre-clinical work that by targeting the periaqueductal grey (PAG) region of the brain we can cause direct neuromodulation of central brain activity, which reduces blood pressure for six hours following a single 10-minute ultrasound sonication,” says Dr. Harriet Lea-Banks, lead author of the study, and junior scientist in the Hurvitz Brain Sciences Program at Sunnybrook Research Institute.

“Lowering high blood pressure into the normal range was extended to nine days with the addition of a second component: introducing nanodroplets – tiny liquid droplets – containing anesthetic medication that are injected into the bloodstream, and triggered with five daily treatments of ultrasound to the brain,” adds Dr. Lea-Banks, also an assistant professor in the Department of Medical Imaging at University of Toronto.

Ultrasound causes the nanodroplets to evaporate, locally releasing the anesthetic drug in a time-controlled fashion, within that specific area of the brain. This approach was shown to extend the time that neuron activity was modified and blood pressure was reduced, and prevent off-target effects, such as general sedation; increasing its reliability.

“This work builds on our previous success with FUS and out of a need for a new alternative strategy for hypertension management,” says Dr. Kullervo Hynynen, senior author of the study, VP of Research at Sunnybrook Research Institute, and a pioneer of focused ultrasound.

This study has shown that transcranial FUS offers a non-invasive tool to stimulate the VLPAG and trigger the delivery of an anesthetic agent; both approaches show the ability to modify central brain activity to achieve sustained reduction of hypertensive blood pressure into the healthy range, while offering the potential for real-time treatment monitoring.”

Based on the results of the research, the authors suggest it may be feasible to develop a FUS device that would allow the control of hypertension initially in a hospital setting, and eventually in the patient’s home for cost-effective, long-lasting treatment.    

“This work has implications for developing a new non-invasive and long-lasting treatment for hypertension that has greater safety and broader applicability than current treatment options for vulnerable patient populations,” adds Dr. Hynynen, also a professor in the Department of Medical Biophysics at University of Toronto.

“We’re looking forward to investigating this option further, and are optimistic the results will add another tool to the clinical toolbox for controlling and reducing hypertension.”

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The professional photographer had been feeling that something wasn’t right for about a year. Typically active, he was feeling out of breath from just a short walk with his dog and was coughing regularly.

Earlier this year, he was diagnosed at Sunnybrook with an advanced case of cardiomyopathy, a disease of the heart muscle that reduces the heart’s ability to pump oxygen-rich blood to the body.

“It was a shock to hear, but I also felt relieved to know exactly what was going on,” says AJ.

After viewing AJ’s EKG and echocardiogram, Dr. Sheldon Singh told AJ he was in atrial fibrillation, meaning his heart was beating irregularly and very rapidly. This abnormal heart beating was likely contributing to his weakened heart. Dr. Singh, Medical Director of Electrophysiology at Sunnybrook, started him on medications and gave him strict orders to alter his lifestyle.

“It meant no work and I couldn’t be stressed,” explains AJ, who began to avoid caffeine, sodium and alcohol. “I came to a point where I really wanted to get off the meds, and Dr. Singh said cardiac ablation was most likely the best course of treatment.”

The day before his 49^th birthday, AJ had an ablation, where Dr. Singh threaded a catheter through a vein in his groin and guided it to his heart. The catheter delivered energy to his heart tissue to create scars blocking his irregular heart rhythms and restoring a typical heartbeat.

“Catheter ablation of atrial fibrillation can improve patient’s quality of life, streamline their medications and decrease visits to the emergency department,” says Dr. Singh. “In some cases, ablation may allow patients with atrial fibrillation to live longer, making it a very important therapy.”

For AJ, the procedure was a game-changer.

“I’m back to my normal self,” reports AJ, who says he is not only back to work, but playing basketball again and hitting the gym. He’s still taking medication, and has a portable EKG machine to test his heart rate every 48 hours.

“I’m loving new challenges, like running up the Harvard University stadium steps when visiting my family in Boston,” AJ told us. “I wouldn’t be in this place without the care I received at Sunnybrook. If you’re feeling off, I would urge you to get it checked out.”

To learn more about cardiac ablation at Sunnybrook’s Schulich Heart Program, please check out our video.

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“This wasn’t the normal, ‘oh, I’m climbing a few staircases’ feeling,” he says, noting he also felt lightheaded when he transitioned from sitting to standing.

A visit to a cardiologist revealed he required a heart valve replacement. Earlier this year, he had a TAVI procedure at Sunnybrook’s Schulich Heart Program. TAVI is a procedure that improves the blood flow in your heart by replacing an aortic valve that doesn’t open fully.

Allan returned to his normal activities, like golfing and driving, within six weeks of having the procedure. His breathlessness improved significantly.

“When our heart valves aren’t working properly, there are often warning signs like breathlessness, dizziness, and fatigue,” explains Dr. Nicolas Bowers, interventional cardiologist with Sunnybrook’s Schulich Heart Program, who performed Allan’s procedure.

Dr. Bowers says one in eight people over the age of 75 are thought to be living with heart valve disease. A simple stethoscope check is the first step to detect heart disease, and urges people to ask their family doctor for this quick test. While untreated and advanced heart valve disease can cause heart failure, stroke, blood clots or death due to sudden cardiac arrest, it’s also very treatable when caught early.

Allan is now back on the golf course, and says his participation in University Health Network’s Cardiovascular Prevention and Rehabilitation Program was greatly beneficial for tailored exercise and nutrition plans after his TAVI.

“I’m now hitting a golf ball further than ever,” he beams, and says he’s looking forward to long walks again while travelling in France.

This week, we mark Heart Valve Awareness Week, an international campaign aimed at improving diagnoses, treatment and management of valve disease. For more information on how to be referred to Sunnybrook’s Schulich Heart Program, please visit us.

The post Listen to your heart: <br>The importance of a simple stethoscope check appeared first on Your Health Matters.

The 87-year-old has since learned that her shortness of breath was due to heart failure. With the help of a few medications, Marilyn is breathing easy now and living independently.

“I clean my house, do errands using my walker and see friends and family a lot,” says Marilyn, an avid piano player and former downhill skier on Canada’s national team. “I’ve always been active, so it’s a relief to have such a simple plan that allows me to do the things I want to.”

Heart failure, which occurs when the heart is damaged or weakened, has no cure, but can be effectively treated with the right medication and lifestyle modifications, says Dr. Stephanie Poon, Director, Sunnybrook’s Heart Function Clinic. Currently over 800,000 Canadians are living with heart failure.

“Our goal is to provide patients like Marilyn, and their families, with strategies to greatly improve their quality of life,” says Dr. Poon.

She notes that some patients are prescribed puffers and antibiotics for months before a correct diagnosis is made. “Those are really missed opportunities, where people aren’t receiving the correct treatment, and the disease progresses. The result is that rates of heart failure are rising. And this is amid the reality that heart failure is deadlier than many common forms of cancer.”

Marilyn Jackson

She urges people experiencing shortness of breath, swelling in their legs or abdomen and fatigue, to seek testing for heart failure. A blood test called natriuretic peptide (NP) levels, also known as BNP or NT-pro BNP, is a reliable diagnostic tool. Elevated NP levels indicate that symptoms may be related to heart failure, prompting further investigation by a physician.

Sunnybrook’s Heart Function Clinic has incorporated the Medly app into their model of care, enabling patients to record daily weight, blood pressure, heart rate, and symptoms. In turn, patients receive instant electronic feedback on how to adjust their medications or alerts based on personalized thresholds and care plans. A nurse practitioner uses a web-based dashboard to assess patients’ health status and respond to alerts generated through the app.

“By enabling early interventions in response to symptom changes, the Medly app can result in dramatic improvements to patients’ health and reductions in hospitalizations,” says Dr. Poon.

For Marilyn, the combination of medication and ensuring she drinks roughly two litres of water a day has made a massive difference. “If I could say anything from my experience, it’s to not delay seeking care if you’re not feeling right,” adds Marilyn. “There are treatment options that can be as simple as taking medication.”

The post Timely diagnosis and right medication lead to improved quality of life for heart failure patients appeared first on Your Health Matters.

A-Fib affects approximately 200,000 Canadians. If treated, most people with atrial fibrillation lead active, normal lives. But left untreated, the disorder can lead to stroke and heart failure, not to mention interfere with your daily quality of life.

Dr. Christopher Cheung is a cardiac electrophysiologist with the Schulich Heart Program at Sunnybrook. At our most recent Speaker Series, he shared his insights on A-Fib and the role of new technologies, smartwatches, and other wearable devices in helping to detect and manage the condition.

What are some common symptoms of atrial fibrillation?

Dr. Cheung: Some common warning signs of atrial fibrillation include a fast, almost fluttering, heartbeat. You may also have chest pain, feel weak, dizzy or tired, lightheaded, and be short of breath.

If atrial fibrillation is suspected, you will have a comprehensive cardiac evaluation, which means we take a medical history, perform a physical examination, and run a series of tests including an electrocardiogram (ECG or EKG) and/or a cardiac ultrasound (echocardiogram).

A critical part of diagnosing an arrhythmia is monitoring the abnormal heart rhythm. We have many ways to formally monitor you, including wearing a Holter or patch monitor for several days, to continuous monitoring devices like implantable loop recorders.

What role can wearables play in detecting hearth rhythm disorders like A-Fib?

Dr. Cheung: With the rise in effective wearables, like smartwatches, patients want to learn more about monitoring their hearts in a non-invasive and convenient way.

Wearable devices will change how we deliver healthcare. While these devices do not provide continuous monitoring at this time, they increase the likelihood of detecting an arrhythmia. If you detect something, you can bring that information to your doctor for interpretation. Wearable devices really give us an opportunity to diagnose and identify more people who may have arrhythmias that would have previously been missed.

What are some other benefits to using a wearable?

Dr. Cheung: In addition to allowing us to potentially detect atrial fibrillation earlier, they allow us to personalize your care, meaning tailoring your treatments and medications based on the symptoms and triggers of your abnormal heart rhythm. How often are you having atrial fibrillation, and how much atrial fibrillation are you having? What are your triggers? Wearable devices may be able to provide us with this information in the future, improving health outcomes for patients.

Wearables may also help us to improve or support healthy behaviors to facilitate lifestyle modification. Many wearables have built-in features like activity trackers which can help improve lifestyle in general.

How do these devices work?

Dr. Cheung: Most use a technology called photoplethysmography. Light from the device is emitted into the skin and reflected back to the detector on the device. It’s similar to technology used in oxygen monitors in the hospital. A lot of these devices also have something called an accelerometer or gyroscope which detect your physical activity and can pair that heart rate data with your activity level. This tells you whether your heart rate may be abnormally high, or low, during a period of physical activity or inactivity.

Any words of caution about using smartwatches or other wearable devices to monitor heart rhythm?

Dr. Cheung: It is still important to be very careful when you are using your wearable for heart monitoring. The accuracy of each device can vary. There is also the phenomenon of a false positive or a false negative finding. A false positive finding is when the device tells you something is going on, such as an alert for an irregular heart rhythm, but you actually don’t have an arrhythmia. On the other hand, a false negative is when the device tells you there is nothing going on, but you do have an arrhythmia. False positives can lead to unnecessary investigations and anxiety, and false negatives can provide false reassurance when treatment may be beneficial.

What is the future of wearables?

Dr. Cheung: As we look forward, wearable devices will have more functions and will come in all shapes and sizes. We already have them in smartwatches, and we are starting to see more devices as chest straps and ECG shirts becoming available.

We will also have studies that will incorporate wearables into your routine care. Wearables will really increase the monitoring options that you have available and ultimately help shape how we deliver cardiac and arrhythmia care.

That being said, it is always important to know that there are limitations and risks with some of these devices, such as incidental findings that may not have any significant meaning. Wearable device users should be aware of these risks when using these technologies.

The post An expert’s take on wearable heart devices appeared first on Your Health Matters.

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

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

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

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

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

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

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

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

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

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

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

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

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

The post Women’s Heart Health: Working towards better understanding and care 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.

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

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

What is a stethoscope check?

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

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

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

What your doctor is listening for

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

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

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

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

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

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

The importance of early detection 

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

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

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

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

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

Who should get a stethoscope check

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

The post What a stethoscope check can tell your doctor about your heart health appeared first on Your Health Matters.

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

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

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

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

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

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

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

There must be some cheat days in there…

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

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

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

Do you sleep well?

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

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

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

The post How to live like the experts: Dr. Maria Terricabras on how she maintains good heart health appeared first on Your Health Matters.