The Cardiovascular System MICHAEL McCANN Your Worship Mayor Marianne Matichuk and members of City Council, it is a pleasure to present to you this a progress report on Health Sciences North / Horizon Santé-Nord. The Cardiovascular System How your Heart and Blood Vessels Work

Learning Points Overview of the heart and the circulatory system Coronary artery disease (CAD) and peripheral arterial disease (PAD) Atrial Fib and Heart Failure Treatment Options The redefining process included an extensive consultation phase. Over 1,600 touchpoints were achieved through a variety of input vehicles including one-on-one interviews, group sessions, walkabouts, online surveys and telephone polls. The Steering Group was also designed to ensure a broad representation of input from key stakeholders. Members from the education, business, municipal sectors as well as employee and physician representation were included. It should be noted that Sudbury Regional Hospital was a name chosen by a group of consultants acting on behalf of the provincial government under the Hospital Restructuring initiative. There was no consultation, no community input. Health Sciences North is a name selected by our entire community.

The Heart is a muscle the size of your fist located between the breastbone and the spine just to the left of the midline inside your rib cage A women’s heart is smaller in size than a man’s Some of the questions that were asked during the consultations included: What are our opportunities? What should our promise be to our community? What are you most proud of? The consultations confirmed support for our academic mandate. But while people were excited about the new direction, there was not a full understanding of the academic mission. We recognize the need to engage our internal and external audiences in a dialogue about what it means to be an academic health sciences centre and the opportunities it brings for our patients and community. The launch of Health Sciences North will serve as an excellent platform for that dialogue to occur. It is perhaps the strongest message we will send about our new and evolving role in health care. The November 8 public forum at Science North will also afford us with an opportunity to continue that dialogue. What is important to remember is that we are not rebranding or renaming our institution. Health Sciences North is a new direction, a new mandate, a vision that will see us transform and redefine who we are and what we do.

The Heart Our bodies need oxygen to survive Blood carries oxygen to the whole body The heart pumps the blood (oxygen) through the arteries to the body tissues The redefining process considered not only our organizational name, but also all of the facilities, services, programs and affiliates that make up our institution. There were three main questions that we considered: What is the best name for the organization? What is the best name for all our other sites and programs? and How do these various sites and programs relate back to the organization? There have been several amalgamations and consolidations that have occurred over the past decade which have resulted in many programs becoming part of our institution. The result has been a multitude of “add-ons” with no clear structure to ensure an appropriate and consistent approach to how these new services are reflected in the overall organization. This has led to some confusion on the part of our clients and also a feeling of being disenfranchised by some “off-site” employees.

The Heart Has four chambers two upper chambers called Atria two lower chambers called Ventricles The left ventricular wall is thicker to be able to pump with more force This slide is a good depiction of our current situation. Our organization name is the same name as the acute care site. This creates the “other sites” and “off-sites” scenario that I just described. The various facilities we have carry names that are either historical in nature – for example former hospitals – or based on where they are situated geographically such as Cedar Street or Kirkwood. There is no uniforming element amongst all of these facilities and programs. Nor is there any clear demonstration as to how these various elements relate back to the overall organization. 5

The Heart The grade of the left ventricle indicates the amount of damage to the heart muscle: Grade 1 - normal Grade 2 - some damage Grade 3 - more damage Grade 4 - weakened heart This slide displays our new name architecture. The organization’s name of Health Sciences North serves as an umbrella to the overall architecture. Our acute care site will be named Ramsey Lake Health Centre. This name was selected for its flexibility and breadth of scope to be inclusive of the various programs and facilities situated at this site such as the CTC, Cancer Centre, Learner Space, Research Institute and, in the future, the Pediatric Centre. The Memorial Site will be named Sudbury Outpatient Centre to reflect the new mandate of that facility. The RCP will be called the Northeast Cancer Centre and Cedar Street and Kirkwood will be called the Sudbury Mental Health and Addictions Centre. All of the facilities are named “centres” as a unifying element. It also serves to denote a place as opposed to an organization or program. In addition, all facilities and programs will be endorsed as being part of Health Sciences North. 6

There are four valves: Tricuspid Pulmonic Mitral - Bicuspid Aortic valves are strong and flexible allow blood to flow in one direction may be injured or diseased requiring repair or replacement

Circulation of Blood to the Heart Muscle Through the Coronary Arteries right coronary artery left coronary artery circumflex left anterior descending artery

Collateral Circulation develops in later age arteries grow to make a natural bypass towards an area of reduced blood flow

Heart’s Electrical Conduction The Sinoatrial node or pacemaker beats 60-100 times per minute Atrioventricular node can beat 40-60 times per minute as a backup Bundle of His and Ventricles can beat 20-40 times per minute as a further backup

Artery disease = Atherosclerosis Process can start before birth Gradual buildup of plaque in the arteries Narrows the inside diameter of the arteries Causes the artery walls to become less elastic

Where can blockages occur? Any artery in the body Occurs more often in areas where arteries branch Most common in arteries to the: head - carotid artery disease heart - coronary artery disease legs - peripheral artery disease organs - eg. kidneys, male sex organs

Angina -reduced blood flow to the heart muscle Temporary lack of oxygen to the heart muscle is caused by a narrowing in one or more of the coronary arteries Treated with Nitrospray and rest

Angina Symptoms Men and Women: chest pain pain into throat and jaw pain down one or both arms shortness of breath More common in women: fatigue pain in back between shoulder blades nausea and vomiting

Claudication -reduced blood flow to the muscles in the lower extremities Temporary lack of oxygen to one or both of your legs is caused by a narrowing in one or more of the arteries Treated with rest

Reduced blood flow to the brain: signs and symptoms TIA and Stroke Headache Blurred vision Slurred speech Dizziness Difficulty swallowing Weakness on one side Difficulty with balance

How does a Heart Attack occur? A sudden severe blockage in a coronary artery caused by plaque rupture and blood clotting Coronary artery spasm An involuntary closing of the walls of the artery. Usually occurs for a short period of time but can cause severe blockage Coronary artery spasm and blood clot occurring together

Heart Attack Occurs

Other Medical Conditions Atrial Fibrillation Heart Failure

Atrial Fibrillation A rapid and irregular heart beat Most common causes are Damage to the heart’s structure Diseases affecting the heart’s valves or pumping system Long term high blood pressure Undetermined cause

Atrial Fibrillation Signs and symptoms Fast, irregular heart beat Weak, lightheaded, confused Shortness of breath, chest pain Treatment Medication – slow down the heart rate Pacemaker – to control the heart rate Surgical – ablation/maze procedure to change the electrical pathway Blood thinner medication - to prevent blood clots

Heart failure The heart is not strong enough to pump enough blood through the body to meet the demands Causes – most common Heart attack Long term high blood pressure Heart valve problems

Heart failure Symptoms Shortness of breath Difficulty sleeping laying flat Cough Fluid retention causing swelling Sudden weight gain Fatigue, confusion, impaired memory

Heart failure Treatment goal is to manage the problem Medications Exercise Heart devices eg. Pacemaker, ICD Surgery - transplant

Diagnostic Tests

Diagnostic Testing – for the heart Resting ECG - looking at the heart’s electrical system from 12 different views Holter Monitor/Loop recorders - longer term ECG monitoring Exercise stress test - checking ECG changes while increasing the work of the heart Echocardiogram - heart ultrasound Stress Thallium - nuclear dye test with or without a stress test Angiogram - dye test of the heart’s arteries

Diagnostic testing – for the legs and head Doppler studies Angiograms

Treatments

Interventions Angioplasty Stent

Stent – Coronary Artery A wire mesh tube used to prop open an artery after angioplasty The stent is placed over the angioplasty balloon catheter When the balloon is inflated the stent expands

Drug Eluting Stent The stent slowly releases a drug to reduce the chance of a clot forming Used at doctors’ discretion

Angioplasty and stent

Surgical Procedures

Surgical Procedures Pacemakers Implantable Defibrillators Endarterectomy Artery Bypass Grafting (coronary, carotid, leg arteries) Valve Replacement or repair Heart Transplantation

Pacemaker Stimulates the heart to beat regularly The generator is the size of a silver dollar and is implanted just beneath the skin. The leads are threaded into position through veins leading back to the heart.

Pacemaker Battery life is up to 10 years depending on the usage Has the ability to slow down or speed up the heart rate In some models, the heart rate can be increased with activity Indications: heart rate too slow heart rate too fast

Implantable defibrillators (ICD) A pacemaker with the ability to deliver an electrical shock to correct a life threatening heart rhythm Indications: life threatening irregular heart rhythm heart failure

Endarterectomy Surgical removal of plaque from the inner lining of an artery

Coronary Artery Bypass Graft (CABG) Provides a new supply of blood beyond the site(s) of the blockage Indications unstable angina that does not respond to medical treatment stable angina with severe left-main or significant three-vessel coronary artery disease

Leg Artery Bypass Vein from leg or arm, or synthetic graft is used to bypass a blockage in legs For severe blockage when there is a risk of losing your limb

Valve Replacement and Repair Valves must flex, stretch, and hold back pressure to function normally Aortic and Mitral valves are the most commonly repaired or replaced valves 2 types of valves used tissue valves from pigs; do not need to take blood thinners mechanical valves; need to take blood thinners for life

Heart Transplantation People who require heart transplants suffer from severe heart failure 2 major causes of heart failure are coronary artery disease (CAD) and cardiomyopathy

Any Questions?