Our Million Dollar Man

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Kathlyn Jefferson
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2 Our Million Dollar Man Paul Myers = $25M LGH Foundation = $75M Province/VCH = $100M Total Project Cost = $200M Paul Myers

3 Acute Care Tower

4 New Medical & Surgical Centre

5 Single Patient Rooms

6 New State-of-the-Art OR s

New Medical & Surgical Centre Highlights:

7 New Medical & Surgical Centre Highlights: 108 medical and surgical beds State-of-the-art surgical services Restorative healing environment New technology Virtual care in the home Benefits: Shorter length of hospital stays Improved infection control Improved privacy

8 Medical & Surgical Centre Campaign Total Raised to Date $65,014,947 Total # Donors = 2,735

10 Dr. Annie Chou Honours Physiology 2004 Medical Degree 2009 Internal Med Residency 2012 Cardiology Fellowship 2015 Extensive Research & Publications

11 Annie Chou, MD, FRCPC Cardiologist North Shore Heart Centre Lions Gate Hospital

12 Women are less frequently diagnosed with heart attacks compared with men

13 Heart disease is #1 killer of women After age 75, more women are diagnosed with heart attack and blocked arteries

14 Women develop heart disease a decade later than men

15 Vascular protection by female sex hormones Hormone replacement does not protect postmenopausal women from heart disease

16 Outline Sex differences in the Heart Women and Heart Disease, including signs and symptoms Prevention

18 How does estrogen protect the heart vessels?

19 Estrogen causes arteries to relax Increases blood flow to supply the heart

20 The Other Side of the Story Structurally, women s arteries are Smaller Stiffer Exposed to unique conditions Fluctuating hormonal states Pregnancy Migraines Lupus Under-diagnosed

21 Genetic Anatomic Neurohormonal Heart vessel instability Decreased blood flow

23 Case 1 76F with high blood pressure and diabetes Sudden stomach pain while walking her dog Associated with nausea Thought it was just gas

24 Diagnosis: Myocardial Infarction (heart attack) Received a stent to blocked artery Holte. Cardiovasc Ultrasound 2007;5:33

25 What Causes a heart attack? Heart is supplied by coronary arteries When an artery is blocked, blood flow decreases

26 Starts with plaque formation Progression Normal vessel Minimal disease Moderate disease Severe disease Glagov et al, N Engl J Med, 1987.

27 Ends with plaque rupture Vulnerable Plaque Healed Fissure Blood clot in Lumen

28 Women with heart blockages Less likely to have typical chest pressure Chest pain can be Burning Sharp No chest pain Fatigue Shortness of breath Stomach or throat pain Induced by mental stress or at rest Mackay MH, Ratner PA, Buller CE, et al. Gender differences in reported symptoms of acute coronary syndromes. Can J Cardiol 2009; 25 (suppl B):115b.

29 When in Doubt, go to ER or! Symptoms: Exertional chest pain radiating down the arm, stomach pain, shortness of breath Nausea Not self Shortness of breath laying down

30 Case 2 68F with high cholesterol Chest discomfort after hearing news of injured son Associated with shortness of breath Thought it was a heart attack

31 Angiogram: Normal coronary arteries Diagnosis: Takotsubo Cardiomyopathy (weak heart) Heart Function improved with meds Merchant et al. West J Emerg Med 2008;9:104

prevalent in postmenopausal women Temporary decrease in

32 Takotsubo/Broken Heart Syndrome First described: 1990 in Japan Induced by mental or physical stress Highly prevalent in postmenopausal women Temporary decrease in heart function Recovery 1-4 weeks Kurisu et al. Am Heart J 2002;143:448

33 What Causes a Broken Heart? Unclear mechanism Excess stress hormones, causing Heart stunning Artery spasm

34 Why are Women More Affected? The Evolution Theory Men are exposed to more physical stress Protection from stress hormone surges The Hormone Theory Estrogen deficiency + mental stress = small vessel dysfunction

36 When in Doubt, go to ER or! Symptoms: Same as heart attack Treatment Medications to improve heart function

37 Case 3 44F healthy Worsening exertional CP since 2012, radiation to left arm, relieved with rest Positive stress test 2010 Angiogram 2010: no blockages, normal heart function Thought it was all in her head

38 Diagnosis: Microvascular Coronary Dysfunction (Cardiac Syndrome X) Chest Pain MCD (+) Stress Test Normal Angiogram Dysfunction of small heart vessels Prevalent in pregnant and post-menopausal women Resolved with amlodipine

39 When in Doubt, go to ER or! Symptoms: Same as heart attack Treatment Medications to reduce vessel constriction

40 Case 4 37F healthy 3 weeks after pregnancy and delivery Sudden sharp chest pain at rest, no response to NTG Radiated to both arms Thought it was cramps

41 Maeder et al. Int J Cardiol 2005;101:363 Diagnosis: Spontaneous Coronary Artery Dissection Repeat angiogram: healed dissection Conservative treatment with meds

42 Spontaneous Coronary Artery Dissection (SCAD) Heart attack caused by a tear in the coronary arteries Often occurs in young women (85%) Recurs in about 15% of patients

43 Saw. CJC 2013;29: Spontaneous Separation of Arterial Wall Subsequent clot causes obstruction to blood flow

44 What Causes SCAD? Predisposing arteriopathy Precipitating stressor SCAD Atherosclerosis Other Sheer stress Connective tissue disease Inflammatory disease Fibromuscular dysplasia Peripartum Hormonal changes Intense exercise Emotional distress Stimulant use

45 Pregnancy as an example Hormonal changes Emotional stress SCAD J Cardiovasc Med (Hagerstown) 2011;12:448

46 When in Doubt, go to ER or! Symptoms: Same as heart attack Beta-blocker Decrease stress on heart Prevent recurrence Aspirin Prevent occlusion +/- stents or bypass surgery Stress / mood management

47 Prevention: How to Decrease Risk?

fluctuations Psychological stress Heart wall dysfunction Small

49 Take-Home Messages Women are special Like men, can also have vessel blockages Prone to other heart conditions due to: Hormonal fluctuations Psychological stress Heart wall dysfunction Small vessel disease Artery dissection Lifestyle optimization for heart health

50 Thank you

Multimodality Imaging in Spontaneous Coronary Artery Dissection in the Peripartum Period

Multimodality Imaging in Spontaneous Coronary Artery Dissection in the Peripartum Period Marysia Tweet, MD NASCI Annual Meeting October 18 th, 2016 2016 MFMER slide-1 DISCLOSURE No relevant financial relationship(s)