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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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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They also told us that 85% of the population will experience low back pain at sometime in their life (including me on occasion!)

For most people, it too shall pass. And, it doesn’t always mean the start of a lifetime of pain.

About 95% of low back pain is non-specific, meaning it is of an unknown cause, isn’t part of something serious, is isolated to the low back and doesn’t spread down the limbs.

If you experience low back pain, there are some ways you can manage it so that you can continue to live your life to its fullest. Thanks to Suzanne Denis, physiotherapist at Sunnybrook, for these tips!

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1. Bed rest is NO good. Pace yourself and stay as active as you are comfortable. Do exercises or activities that do not worsen your back pain and take breaks.  You may find certain activities actually help relieve your back pain.  Some people get relief with the trunk in a forward bend position others find it less uncomfortable to be upright.  Everyone is a bit different, and so not one exercise or activity is best for all.

2. Start low and go slow. When doing an activity you are not sure of, try 5 minutes & see what happens.  If you are not in more pain afterwards, gradually increase the time.

3.  Apply ice and/or heat. Typically, if you have suffered a trauma to the back (for example a fall), you should apply ice during the first 48 hours (For example for 10 to 15 minutes as needed.) Some low back pain sufferers find that applying a heating pad to the area provides more relief. Do not sleep with heat or ice applied.

4. Speak to your pharmacist about anti-inflammatory or other pain medications that you could use.

5. Track it. If your low back pain has not improved over a 2-week period, visit your family doctor or health care provider.

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