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.

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

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

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

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

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

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

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

There must be some cheat days in there…

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

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

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

Do you sleep well?

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

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

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

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

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

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

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

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

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

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

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Why did you look at this issue?

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

What did you find?

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

Can you explain why this happened?

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

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

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

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

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

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

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Along with these dietary changes, many also wonder if they should choose lower fat milk, avoid fried foods or opt for margarine over butter. While choosing foods containing lower levels of fats won’t directly improve blood sugar levels, this can help protect and improve heart health. That’s important because people living with diabetes may be at risk of developing heart disease up to 15 years earlier compared to people who don’t have this condition. Here are some of the reasons why:

Gender
In Canada, women with diabetes are 4 times more likely to develop heart disease due to its connection with hormonal levels during menopause, as diabetes cancels out the protective effect that estrogen provided.

Insulin resistance
Insulin resistance plays a role in the development of diabetes and prediabetes. Insulin is the hormone in our bodies that regulates energy or glucose, and resistance happens when the cells in your muscles, fat and liver don’t respond properly. Over time, your blood sugar levels go up because your body isn’t able to use glucose from your body for energy. Insulin resistance plays a role in the development of plaque in the arteries. If plaque builds up too much, it can lead to blocking the blood vessel, significantly increasing the risk of heart attack or stroke.

Unhealthy cholesterol levels
Diabetes can increase the risk of “bad” cholesterol in the body, and lower the “good” cholesterol, which in turn can increase the risk of stroke and heart disease.

High blood pressure
Many people with type 2 diabetes also have high blood pressure, also known as hypertension. There are likely many factors contributing to both conditions including obesity, a diet rich in fat and salt as well as inactivity.

Inactivity
Physical activity is important for overall general health, and may be especially important if you have diabetes. It can help maintain a healthy weight, keep the heart strong and reduce insulin resistance.

Increased body weight
Insulin therapy can lead to weight gain, as insulin promotes fat storage in the body. In turn, being overweight or obese means your heart has to work harder to do its job, increasing the risk of heart disease and other cardiac complications.

Ways to protect your heart

When it comes to diabetes there are many ways to protect your heart, such as having regular check ups with your doctor or endocrinologist to monitor your blood pressure, cholesterol and blood sugar A1C to get these levels into health ranges. The target ranges for blood pressure and cholesterol are much lower for people with diabetes, and similar to targets for someone who has already has had a heart attack or stroke. It’s also important to not smoke, and to take any medications as directed.

Coming back to diet, it plays a critical role. Worldwide, diets low in fruits and vegetable are major contributors to the risk of developing diabetes and heart disease, and nutrition therapy is an integral part of managing both conditions together. Generally, avoid processed foods as they are normally high in salt, sugar and saturated fat. Opt for fresh fruits, vegetables, legumes, beans, lentils, nuts, whole grains and lean proteins, while limiting alcohol intake. Be sure to reach out to your diabetes care team for more information and direction.

View the full Speaker Series event here:

The post Managing your heart health with diabetes appeared first on Your Health Matters.

They are right. But why? To answer that question, Dr. Chris Idestrup, Anesthesia Site Chief at Sunnybrook’s Holland Orthopaedic and Arthritic Centre, directed me to StopSmokingforSaferSurgery.ca, a site maintained by Ontario’s Anesthesiologists. This site has some great info and five reasons about why it might be a good idea to quit smoking before going in for surgery.

Your lungs.

Smoking damages your lungs and that can put you at a higher risk of breathing issues from the anesthetic you need for surgery.

Being smoke-free for even just a few weeks before your surgery can help your lungs heal.

Your heart.

According to StopSmokingforSaferSurgery.ca, the carbon monoxide in cigarette smoke reduces the amount of oxygen that your blood can carry to your heart. Nicotine makes your heart beat faster. Together, that puts you at a higher risk of a heart attack.

Your recovery.

If you smoke after surgery, this can slow down your healing and increase your chance of getting an infection. This is because of the reduced oxygen getting to your surgery site, slowing the normal healing process. Staying smoke-free after surgery can help your healing.

Your success at quitting for the long-term.

Changing your routine can help you quit smoking – so preparing for and undergoing surgery is a good time to switch things up. Plus, hospitals are smoke-free zones, so even a short stay in the hospital will limit your actual ability to light up. And, hospitals are full of people who can give you the necessary resources and support for quitting. Tell your doctor or another health-care provider that you have recently quit smoking or if you are in the process of quitting; they can help.

The rest of your life.

If you stay smoke-free, it’ll reduce your risk of returning to the hospital, both due to infection from this surgery and for further health issues.

From the Heart and Stroke Foundation:

• Within one year of quitting smoking, your added risk of coronary heart disease is cut in half than that of a smoker.
• Within five years, your risk of having a stroke will be nearly the same as a non-smoker.
• Within 10 years, the risk of dying from lung cancer is cut in half.
• Within 15 years, your risk of coronary heart disease will be similar to that of a non-smoker.

Check out StopSmokingforSaferSurgery.ca and Ontario Anesthesiologist’s site for more information.

The Smoker’s Helpline has quitting support and info.

Or check out quick tips on quitting from a Sunnybrook social worker.

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