Transcript: Heart Health | Feb 19, 2001

(music plays)
In animation, a title appears inside the shape of a house: “More to money.”

The opening sequence shows a wooden table with a small lit candle as several words fly by: Investments, careers, finances, pensions and money.

Fast clips show different sets of hands performing activities on the table such as drawing a big red heart, tuning a violin, flipping through the pages of a book, cooking, and pouring a glass of red wine.

In animation, the title appears inside the shape of a house: “More to life.”

Maureen appears on screen. She is in her early forties, has straight, shiny, dark brown hair, cut in the shape of a bob with bangs, and wears a pastel green button-down blazer.

Maureen says THE GOOD NEWS IS
FEWER CANADIANS ARE DYING
FROM HEART ATTACKS.
THE BAD NEWS IS HALF THE
SURVIVORS SUFFER SERIOUS
HEART RELATED ILLNESSES.
Dr. ROB MYERS TREATS MATTERS
OF THE HEART.

Dr. Rob appears on his screen in the studio. He is in his late thirties, has short, side-parted, feathery brown hair, and wears thin-rimmed glasses and a beige blazer, white shirt, and dotted black tie.

Maureen continues HE’S A CARDIOLOGIST
AT SUNNYBROOK AND WOMEN’S COLLEGE
HEALTH SCIENCES CENTRE AN THE AUTHOR OF
TAKE IT TO HEART.

The book appears on screen with a title that reads “Take It To Heart, Your Complete Guide to Preventing and Treating Heart Disease by Dr. Rob Myers Cardiologist.”

Maureen continues IF YOU HAVE A QUESTION ABOUT
HEART HEALTH FROM MEDICATION
TO MYOCARDIAL INFARCTION,
GIVE US A CALL IN TORONTO,
THE NUMBER IS:
416 484 2727
AND OUR LONG DISTANCE NUMBER IS FREE.
IT’S 1 888 411 1234
AND YOU CAN E-MAIL YOUR QUESTION
TO DR. MEYERS AT
MORETOLIFE@TVO.ORG
AND Dr. MYERS, WELCOME
BACK.
HI.

Dr. Meyers says THANK YOU VERY MUCH.

Maureen says WHY ARE WE
BETTER AT SAVING HEART
ATTACK PATIENTS IN THE FIRST
PLACE.

Dr. Meyers says WELL THE TECHNOLOGY'S
IMPROVED SO SUBSTANTIALLY.

When Dr. Meyers appears on screen, the caption reads “Dr. Rob Meyers, Cardiologist.”

Dr. Meyers continues I THINK WE'RE MORE FAMILIAR
WITH WHAT NEEDS TO BE DONE
AND WE HAVE THE TOOLS TO DO
IT.
SO IT COMES DOWN TO EVER
IMPROVING TECHNOLOGY.

Maureen says AND BY
TECHNOLOGY ARE WE TALKING
ABOUT DRUGS THAT WE GIVE THE
PATIENT RIGHT AWAY OR
SURGERY --

Dr. Meyers says YOU'VE HIT ON BOTH OF
THEM.
THERE'S NEW MEDICATIONS THAT
ARE AVAILABLE THAT WE'RE
USING.
THERE'S ALWAYS NEW
MEDICATIONS COMING OUT, THAT
AS STUDIES SHOW US THEY'RE
MORE AND MORE EFFECTIVE
WE'RE USING THEM MORE AND
MORE OFTEN AND THEN
PROCEDURES.
WE'RE BETTER AT DOING THINGS
LIKE ANGIOPLASTY THAN WE
ONCE WERE AND BYPASS SURGEVY
MUCH LESS COMPLICATED AND
COMPLEX THAN IT MAY HAVE
BEEN TEN OR 20 YEARS AGO.

Maureen says SOUNDS LIKE
SURVIVING THE HEART ATTACK
IS JUST THE FIRST STEP IN A
LONG JOURNEY.
I MENTIONED THAT PEOPLE WHO
SURVIVE OFTEN HAVE SOME SORT
OF LIMITING ILLNESSES AFTER
THAT TELL ME ABOUT THOSE.

Dr. Meyers says WELL, THE POPULATION, AS
OUR POPULATION AGES, MORE
AND MORE, AND WE'RE KEEPING
PEOPLE ALIVE WHO ARE OLDER
AND OLDER, THAT'S WHY OUR
LIFE EXPECTANCY IS ALWAYS
RISING, SO THOSE PEOPLE HAVE
CO-MORBID CONDITIONS, OTHER
THINGS TROUBLING THEM
BESIDES HEART PROBLEMS, SO
THAT'S NATURALLY GOING TO
INTERFERE WITH THEIR
CONVALESCENCE AND IF WE'RE
BETTER AT KEEPING PEOPLE
ALIVE, THEY'RE GOING TO BE
LEFT WITH RES SUED DULL
PROBLEMS.
SO IF IN THE PAST 20 percent OF
PEOPLE WITH HEART PROBLEMS
DIED AND NOW 10 percent, THAT'S
GIVEN BENEFIT TO PEOPLE WHO
NOW HAVE WORSE HEART
FUNCTION.

Maureen says WHAT HAPPENS
AFTER A HEART ATTACK?
SOMETIMES YOU CAN OPEN SOME
ARTERIES, YOU CAN'T OPEN
OTHERS, WHAT'S THE GENERAL
PICTURE?

Dr. Meyers says THE GENERAL PICTURE IS
YOUR HEART IS LIKE A TREE.
YOU HAVE WATER GOING THROUGH
THE BRANCHES TO THE LEAVES
THE SAME WAY BLOOD IS GOING
THROUGH ARTERIES OF THE
HEART, WHICH ARE CALLED THE CORONARY ARTERIES
AND THE HEART IS LIKE THIS
ROOM.
IT'S GOT PLUMBING, AN
ELECTRICAL SYSTEM, THE WALLS
WHICH MOVE AND DOORS OR
VALVES WHICH ARE LIKE THE
DOORS.
SO IT'S JUST LIKE A ROOM.

A caption reads “Today’s topic: Heart Health.”

Dr. Meyers continues IF YOU CAN -- IF YOU BLOCK
OFF ONE OF THOSE ARTERIES, IF YOU CUT
OFF WATER SUPPLY TO PART OF
THE TREE, THAT PART OF THE
TREE DIES.
WHAT'S IMPORTANT IS WHERE
THE BLOCKAGE IS.
SO YOU CAN HAVE NARROWINGS,
WHICH AREN'T COMPLETELY
BLOCKED SO IT MIGHT CAUSE
YOU TO HAVE CHEST PAN BUT
NOT INTERFERE WITH YOUR
HEART FUNCTION.
IF YOU GET A COMPLETE
BLOCKAGE, THE LEAVES FALL
OFF AND DIE.

The caption changes to “416 484 2727, 1 888 411 1234.”

Dr. Meyers continues IF IT'S AT THE TOP OF THE
TREE, WON'T MATTER.
IT WON'T HAVE MUCH
SIGNIFICANCE TO YOU FOR YOUR
LIFE BUT IF IT'S CLOSER TO
THE BOTTOM AND MORE OF THE
LEAVES ARE GOING TO FALL OFF,
MORE OF YOUR HEART IS GOING
IT DIE THE IMPLICATIONS ARE
MUCH AND MUCH GREATER.
DEAD HEART TISSUE IS DEAD
HEART TISSUE.

The caption changes to “moretolife@tvo.org.”

Maureen says IT DOESN'T COME
BACK.
WHAT IS THE BOTTOM OF THE
TREE, THE HEART IN THIS
ANALOGY?

Dr. Meyers says WELL THE HEART HAS THREE
MAJOR BLOOD VESSELS, TWO OF
WHICH COME FROM ONE ROOT.
SO EACH OF THEM HAVE VARYING
IMPORTANCES TO DIFFERENT
PEOPLE.
IF THE BLOOD VESSEL IS
BLOCKED DOWN AT THE BOTTOM
THEN REALLY ONCE AGAIN IT
WON'T MATTER BUT IF IT'S
BLOCKED AT THE TOP, ONE OF
THE LEFT SYSTEM BLOOD
VESSELS, SOMETHING CALLED
THE LEFT ANTERIOR DESCENDING
ARTERY, IF THAT'S BLOCKED
WAY UP AT THE TOP, THE
IMPLICATIONS ARE MUCH, MUCH
MORE SIGNIFICANT.

Maureen says OKAY, AND WHEN
YOU HAVE A BLOCKAGE, WILL
DRUGS ALONE GET RID OF THE
PLAQUE THAT'S LINING THE
ARTERY?

Dr. Meyers says NOT VERY WELL.
DRUGS ARE PRIMARILY USED TO
ADDRESS PRIMARY AND
SECONDARY PREVENTION -- WHAT
I MEAN BY THAT IS IF YOU'VE
NEVER HAD A HEART ATTACK, A
DRUG LIKE A CHOLESTEROL
LOWERING AGENT MAY HELP
TO -- IT'S A LITTLE
DEBATABLE, MAY HELP TO CAUSE
A BIT OF REGREGS OF THAT
NARROWING WHICH IS CALLED A
PLAQUE BUT MORE RELEVANTLY
PROBABLY STABILIZES IT,
HARDENS IT SO IT'S NOT
LIKELY TO RUPTURE ITS
CONTENTS AND CAUSE A HEART
ATTACK AND THE NUMEROUS
OTHER HEART DRUGS WE USE CAN
CONTROL BLOOD PRESSURE,
WHICH REDUCE THE CHANCES OF
HEART ATTACK AND STROKE, AND
A WHOLE OTHER CATEGORY OF
INFORMATION, WHICH WILL
REDUCE THE SYMPTOMS OF WHAT
YOU HAVE.
YOU WON'T NECESSARILY CHANGE
THE PROCESS.
YOU HAVE NARROWINGS THERE,
BUT IT MAY ALLOW TO YOU
EXERCISE A LITTLE LONGER OR
GO ABOUT YOUR DAY WITHOUT AS
MANY SYMPTOMS.

Maureen says OKAY, LET'S TALK
ABOUT MEDICATION.
THERE'S SO MUCH THERE.
LATELY I'M READING THAT
PEOPLE WHO HAVE HAD A HEART
ATTACK SHOULD PROBABLY BE
PUT ON SOMETHING, AND I WANT
TO GET THIS STRAIGHT, CALLED
A.C.E. INHIBITORS.

Dr. Meyers says ACE INHIBITORS, SURE.

Maureen says ACE INHIBITOR,
WHAT ARE THESE.

Dr. Meyers says THEY ARE DRUGS WHICH WILL
REDUCE -- SEE THE HEART IS
LIKE A FIST, PUMPING AGAINST
RESISTANCE ALL THE TIME.
RESISTANCE IS THE BLOOD.
SO WHAT ACE INHIBITORS DO,
THEY DO A LOT OF DIFFERENT
THINGS BUT DON'T STRENGTHEN
THE HEART.
BUT INSTEAD OF PUMPING
AGAINST A BRICK WALL IT'LL
CHANGE THE WALL SO IT'S LIKE
STYROFOAM OF THE THAT'S
CALLED A RESISTANCE, WHAT WE
THINK OF AS AFTERLOAD WHICH
IS KIND OF A MEDICAL TERM.
BUT ACE INHIBITORS REDUCE
BLOOD PRESSURE BY YOU A
LOUING THE HEART TO PUMP
MORE EASILY, ALLOWING IT TO
FUNCTION IN A HEALTHIER
ENVIRONMENT.

Maureen says GENTLER WAY.

Dr. Meyers says YES, NICE AND GENTLE.
THERE WAS A CANADIAN TRIAL
OUT CALLED THE HOPE TRIAL,
WHICH LOOKED AT 10,000
PEOPLE, SOME OF THEM GOT AN
ACE INHIBITOR, SOME OF THEM
GOT VITAMIN E AND THERE WAS
A SUGGESTION FROM THE HOPE
TRIAL THAT EVERYBODY WITH A
RISK FACTOR, AND EVERYBODY
WITH ANY FORM OF HEART
DISEASE SHOULD BE ON AN ACE
INHIBITOR, AND I THINK IT
DEPENDS HOW YOU SPIN IT.

Maureen says IS THAT RIGHT?

Dr. Meyers says IT'S CONTROVERSIAL.
MY OWN PRACTICE IS NOT TO
PUT ABSOLUTELY EVERYBODY ON
THESE DRUGS.
I PUT PEOPLE THAT HAVE
SPECIFIC KINDS OF CONDITIONS,
SPECIFIC TYPES OF WEAK HEARTS,
FOR EXAMPLE, PEOPLE WITH
DIABETES AND HEART DISEASE
BENEFIT WELL BUT I DON'T
THINK IT SHOULD BE A PANACEA
LIKE WATER THAT'S GIVEN OUT
TO EVERYBODY.

Maureen says AND SOME OF THE
INFORMATION, I READ, SAID
THAT CALCIUM CHANNEL
BLOCKERS WERE MORE READILY
PRESCRIBED AND YET THESE ACE
INHIBITORS WORK BETTER AND
COST LESS.
WHAT'S YOUR HAVE YOU ON
THAT.

Dr. Meyers says WELL, COST LESS, I'M NOT
SURE.
THEY ALWAYS STRIKE ME AS
COSTLY MEDICATIONS.
DRUGS ARE EXTREMELY COSTLY.
SOMETIMES SHOCKS ME WHEN
SOMEBODY COMES TO ME AND
SAYS I SPENT 300 DOLLARS ON THAT
PRE CRIPGS AND IT SHOCKS ME.
BUT CALCIUM BLOCKERS ARE
USEFUL FOR REDUCING BLOOD
PRESSURE, IN TERMS OF ANGINA,
BUT THEY'RE NOT AS GOOD IN
PEOPLE WHO HAVE WEAK HEART
MUSCLES WHEREAS ACE
INHIBITORS OR THE DRUG OF
CHOICE FOR A WEAK HEART
MUSCLE.
SO ALL TOO OFTEN PATIENTS
WITH WEAK HEART MUSCLES ARE
PRESCRIBED CALCIUM BLOCKERS
AND SHOULDN'T BE ON THOSE
DRUGS.

Maureen says HMM,
INTERESTING.
Dr. ROB MYERS, A
CARDIOLOGIST AT SUNNYBROOK
AND WOMEN HEALTH SCIENCES
CENTRE AND THE AUTHOR OF
“TAKE IT TO HEART.”
THIS IS HOW TO AVOID GETTING
HEART DISEASE, BUT WHETHER
YOU WANT TO TALK ABOUT
PREVENTION, YOUR RISKS OR
PERHAPS SOMEONE IN YOUR
FAMILY HAS HAD A HEART
ATTACK AND YOU HAVE
QUESTIONS ABOUT THAT, GIVE
US A CALL.
IN TORONTO,

Maureen says LEONORA IS IN
BRAMPTON.
HI.

Leonara says HI, HOW ARE YOU?

Maureen says GOOD THANK YOU.

Leonara says GOOD.
I HAVE A QUESTION REGARDING
I GUESS PREVENTIVE
MAINTENANCE.
I'M ABOUT 39 YEARS OLD, AND
IN THE LAST FIVE MONTHS I'VE
LOST 40 POUNDS AND I'VE
CHANGED MY EATING HABITS
WITH THE ASSISTANCE OF A
DIETICIAN, JUST BASICALLY
USING THE CANADA FOOD GUIDE.
MY CHOLESTEROL COMBINED
H.D.L. AND L.D.L. AND
TRIGLYCERIDES ARE AT ABOUT
SEVEN.
NOW IN THE LAST FIVE TO SIX
MONTHS, IT'S ONLY DROPPED A
QUARTER OF A POINT.
AND I ALSO INCORPORATED SOME
EXERCISE ON A REGULAR THREE
TO FOUR TIMES A WEEK AS A --
AT A LOCAL GYM, AND I WAS
JUST WONDERING IF THERE WAS
ANYTHING ELSE I COULD DO TO
AVOID HAVING TO TAKE
CHOLESTEROL TABLETS OR
MEDICATION?

Maureen says HMM.
SOUND LIKE SHE'S DOING
THINGS GREAT.

Dr. Meyers says WOW!
YOU COME DOWN HERE, WE'LL DO
A WHOLE HOUR AROUND YOU.
SO IT'S WONDERFUL THAT
YOU'VE LOST SOME WEIGHT, YOU
KNOW WHAT YOUR CHOLESTEROL
PROFILE IS --

Maureen says HOW LOW IS IT BY
THE WAY.

Dr. Meyers says THE SEVEN IS HIGH YET
IT'S IMPOSSIBLE TO COMMENT
ON THE CHOLESTEROL PROFILE
WITHOUT KNOWING EXACTLY WHAT
THE L.D.L. AND H.D.L. IS.
THE L.D.L.'S THE BAD STUFF.
THE L.D.L. IS LIKE A TAXI
CAB THAT TAKES THE TEST ROLL
AND DROPS IT INTO YOUR BLOOD
VESSELS.
THE H.D.L. IS THE GOOD STUFF,
THE TAXI CAB THAT WORKS THE
OTHER WAY.
TAKES THE STUFF OUT OF YOUR
BLOOD VESSELS AND DROPS IT
OFF AT THE LIVER TO GET
CHEWED UP.
SOMEBODY COULD HAVE A REALLY
HIGH H.D.L. AND THAT WILL
MAKE THE TOTALS CHOLESTEROL
LOOK HIGH BUT IN FACT YOU
LOOK AT THE SUB FRACTIONS
YOU SAY WOW, THIS PERSON'S
DOING WELL.
NOW WHAT'S IMPORTANT,
THERE'S A FEW THINGS THAT
COME TO MIND.
FIRST OF ALL YOU'RE A WOMAN
SO YOU'RE LUCKY SO DESPITE A
LOT OF THE BEING POLITICALLY
CORRECT, WOMEN HAVE A MUCH
LOWER INCIDENCE OF HEART
DISEASE THAN MEN DO,
ESPECIALLY AT EARLY AGES
BEFORE MENOPAUSE.
IT'S ACTUALLY QUITE
DRAMATIC.
WOMEN CATCH UP TO MEN IN
THEIR 7, 80s, AT THE AGE OF
39, YOUR LIKELIHOOD OF
HAVING ACTIVE HEART DISEASE
NOW IS NOT THAT HIGH.
THAT'S MIT GAIT AGAINST YOUR
CHOLESTEROL.
YOUR TOTAL CHOLESTEROL IS
SEVEN.
WOMEN TYPICALLY HAVE MUCH
BETTER GOOD STUFF, BUT
YOU'RE SAYING IT HASN'T
CHANGED.
DIETS ARE ACTUALLY SOMETIMES
FRUSTRATING IN TERMS OF
CHOLESTEROL REDUCTION.
THE AVERAGE REDUCTION IS
ABOUT 15 percent IN SOME PEOPLE
IT'LL BE 0 DEGREES.
SOME PEOPLE GO ON A REALLY
TERRIFIC DIET, LOW FAT, HIGH
FISH PRODUCTS AND VEGETABLES
AND STUFF LIKE THAT AND
DESPITE THAT THEIR
CHOLESTEROL WON'T BUDGE.
OTHER PEOPLE RESPOND VERY,
VERY WELL AND THAT'S BECAUSE
THERE'S A BIG GENETIC
COMPONENT TO WHAT YOUR
CHOLESTEROL IS.
YOU'RE EXERCISING VIGOROUSLY,
TERRIFIC.
YOU'VE LOST WEIGHT, IMPLYING
YOUR DIETARY HABITS ARE
LIKELY VERY, VERY GOOD.
THINGS I MIGHT RECOMMEND
WOULD ONCE AGAIN DEPEND ON
WHAT YOUR LDL AND HDL ARE.
HIGH FIBRE DIE YETS, VERY
IMPORTANT.
FIBRE ACTS LIKE A BOWL
BOUNCER.
FIBRE DOES TWO THINGS.
FIRST OF ALL AS IT MOVES
THROUGH YOUR INTESTINES IT
ABSORBS THE CHOLESTEROL,
PREVENTING IT FROM BEING
ABSORBED INTO THED ABOUT
DEEP.
IT TAKES ALL THE STUFF TO GO
OUT THE OTHER END.
THE SECOND THING FIBRE DOES
IS IT'S LIKE A FOOD
REPLACEMENT.
YOU'LL EAT FIBRE, MEANS YOU
WON'T EAT SOME HIGH FAT
FOODS.
YOU COULD GET THE SAME
BENEFIT EATING THE
TELEVISION SET IF YOU WANT
TO, YOU'RE FILLING UP ON
SOMETHING OTHER THAN THE
FOODS THAT ARE GOING TO
RAISE YOUR CHOLESTEROL.
THE OTHER THINGS THAT ARE
SOMETIMES USEFUL WOULD BE
ALCOHOL.
NOBODY PRESCRIBES ALCOHOL
AND I WOULDN'T RECOMMEND WE
TELL EVERYONE TO DOWN A
BOTTLE OF HOME MADE WINE
EVERY NIGHT BUT IN SMALL
AMOUNTS, SMALLER FOR WOMEN
THAN MEN BECAUSE WOMEN WITH
SMALLER LIVERS, TOO MUCH
ALCOHOL CAN INCREASE BREAST
CANCER RISK BUT A SMALL
AMOUNT OF ALCOHOL, HALF
GLASS TO A GLASS OF WINE PER
DAY, NOT MORE.
WILL REDUCE YOUR CARDIAC
MORTALITY RATES.
WILL REDUCE YOUR LIGHTLY --
LIKELIHOOD OF HAVING A HEART
ATTACK, RAISE YOUR --

Maureen says DID YOU SAY HALF
A GLASS A WINE?

Dr. Meyers says HALF A GLASS TO A GLASS.

Maureen says THAT'S NOT VERY
MUCH.
BUT BACK TO THE THING ABOUT
WOMEN AND HEART DISEASE.
THAT'S WHAT'S MAKING THE
HEADLINES LATELY AND MAYBE
IT'S NOT JUST THAT, YOU KNOW,
NO, WOMEN DON'T HAVE AS MANY
HEART AS I TACK AS BUT
RESEARCH SEEMS TO BE AROUND
THE FACT THAT BECAUSE DOCTOR
DOORS DON'T EXPECT WOMEN AT
A YOUNGER AGE TO HAVE HEART
ATTACKS, THEY'RE MISS THE
SYMPTOMS.
WOULD YOU SAY THAT'S TRUE?

Dr. Meyers says I THINK THAT'S VALID,
YET.
WOMEN ARE KNOWN TO PRESENT
WITH THEIR SYMPTOMS IN A
MORE ATYPICAL WAY.
WOMEN MAY NOT HAVE A
CRASHING CHEST PRESSURE
EVERY TIME THEY WALK UP THE
HILL, STABBING PAIN ONS THE
LEFT SIDE, WHAT WHATEVER THE
ATYPICAL -- I THINK IT'S
ACCURATE WOMEN ARE UNDER
DIAGNOSED.

Maureen says THAT BEING SAID,
A LOT MORE MEN ARE GOING TO
DIE OF HEART ATTACKS.

Dr. Meyers says SURE.

Maureen says LEN IN BOB
CAYGEON.
HI LEN.

Len says HI.

Maureen says WHAT'S YOUR
QUESTION?

Len says HOW SERIOUS IS
ATRIAL FIBRILATION?
IT'S NOT HAPPENING
FREQUENTLY WITH ME BUT I DO
HAVE IT AND I'M ON
MEDICATION.
HOW SERIOUS A SITUATION
THIS?

Dr. Meyers says WELL ATRIAL FIBRILOTION
IS PROBABLY THE MOST COMMON
CARDIAC PROBLEM I SEE IN
PRACTICE.
SURPRISINGLY EVEN MORE
COMMON THAN CORONARY
DISEASE.
IT MEANS THAT THERE'S AN
ELECTRICAL GENERATOR AT THE
TOP OF THE HEART WHICH SENDS
OUT IMPULSES, ELECTRICAL
CHARGES AND THEN THE HEART
BEATS.
SORT OF LIKE THE MASTER.
SO WHAT HAPPENS IN ATRIAL
FIBRILATION, THAT GENERATOR
GOES HAYWIRE, SO THAT
ELECTRICAL GENERATION IS
GOING NUTS, AND THE HEART
RESPONDS BY BEATING ERRATICLY.
IT'S COMMON IN PEOPLE WITH
HIGH BLOOD PRESSURE, COMMON
IN PEOPLE THAT AGE, SOME
HAVE NO REASON FOR IT AND
IT'S COMMON IN ALL FORMS OF
HEART DISEASE.
SO IT'S A FINAL COMMON
PATHWAY THAT HAPPENS IN
HEART DISEASE.
IT IS IMPORTANT BECAUSE IT
INCREASES THE RISK OF A
STROKE.
IMAGINE IF YOUR HEART IS NOT
PUMPING IN AN ORGANIZED WAY
LIKE THIS THE BLOOD COEING A
LATES A BIT.
IT HAS A PROPENSITY TO CLOT
A BIT.
EVEN A CLOT THE SIDE OF A
PERIOD AT THE END OF A
SENTENCE CAN BREAK OFF AND
GO INTO THE BRAIN AND CAUSE
A STROKE.
SO ATRIAL FIB LAIGS IS A
COMMON PRE DISPOSITION TO
HAVING A STROKE.
THE RISK WOULD BE 4 percent PER
YEAR FULL.
LOOK AT ONE INDIVIDUAL
PERSON AND THERE ARE OTHER
RISKS, YOU MIGHT CHANGE
THAT.
SO EVEN IN THE PRESENCE OF
PAROXYSMAL ATRIAL
FIBRILATION, EVEN IF IT
COMES AND GOES, CUMADIN
WHICH IS A BLOOD THINNER IS
A VERY IMPORTANT TREATMENT,
PRESUMING THAT A PERSON IS
ONE THE FOLLOWING.
OVER 65, HAS DIABETES, HAS
HAD A PRIOR STROKE, HAS A
VERY WEAK HEART MUSCLE, HAS
HIGH BLOOD PRESSURE, OR
VALVE DISEASE, SIGNIFICANT
VALVE DISEASE SO IF SOMEBODY
FALLS INTO ANYONE OF THOSE
CATEGORIES AND HAS ATRIAL
FIBRILATION THEY DEFINITELY
NEED TO BE ON CUMADIN.
ON THE OTHER HAND, IF I HAD
ONE I WOULDN'T TAKE IT.
BECAUSE THOUGH IT IS A BLOOD
THINNER AND PREVENTS STROKES
FROM HAPPENING THERE IS AN
INCREASED RISK OF HAVING A
BLEED.
ABOUT ONE TO TWO PEOPLE IN A
THOUSAND.

Maureen says WHICH MEANS IF
YOU GOT CUT YOUR BLOOD
WOULDN'T CLOT.

Dr. Meyers says SHAVING WITH A STRAIGHT
EDGED RAISEOR, FOR EXAMPLE,
WHEN PEOPLE GO ON CUMADIN,
YOU TELL THEM NOT TO DO IT
ANYMORE.
IT CAN BE A NUISANCE AND
SERIOUS BLEEDING.
DEFINITELY SERIOUS BLEEDING.

Maureen says AN E-MAIL FROM
DEB BEAT.
I'M A 43-YEAR-OLD FEMALE
WITH HIGH BLOOD PRESSURE AND
WAS ALSO SUFFERING FROM
MAJOR HEADACHES.
I'M TAKING AVIPRO AND HAVE
BEEN FOR THE LAST YEAR.
MY DOCTOR WOULD LIKE FOR ME
TO STOP PILLS BUT I'M AFRAID
TO STOP BECAUSE THESE PILLS
HAVE STOPPED MY HEADACHES.
I HAVEN'T HAD A HEADACHE IN
A YEAR, I WAS GETTING TWO TO
THREE A MONTH.
WHAT'S THE CONNECTION
BETWEEN THIS AND THE HEART?
IT FOR THE HEART?

Dr. Meyers says AVI PRO IS ONE OF THE
VERY -- THERE'S A LONG RAY
OF ANTIHYPERTENSIVE
MEDICATIONS AND
PHARMACEUTICAL COMPANIES
COME OUT WITH THEM ALL THE
TIME.
THERE'S 50 TO CHOOSE FROM.
THIS IS ONE OF THE NEWER
ONES.

Maureen says FOR HIGH BLOOD
PRESSURE.

Dr. Meyers says YES, HYPERTENSION OR HIGH
BLOOD PRESSURE.
HIGH BLOOD PRESSURE IF QUITE
ELEVATED CAN BE ASSOCIATED
WITH HEADACHES BUT HEADACHES
ARE MUCH LIKE FATIGUE.
IT'S A VERY COMMON SYMPTOM
DUE TO A NUMBER OF
CONDITIONS AND HOW DO YOU
KNOW THERE'S A RELATIONSHIP.
SO I WOULDN'T THINK OF THE
AVI PRO AS TREATING THE
HEADACHE.
SO WHEN YOU'RE SAYING THAT
YOU DON'T WANT TO COME OFF
OF IT BECAUSE YOUR HEADACHES
ARE GONE, I THINK THAT'S A
VERY SEPARATE ISSUE TO WHAT
THE EFFECT OF THE AVI PRO IS
ON THE BLOOD PRESSURE.
THE QUESTION IS, IS YOUR
BLOOD PRESSURE CONTROLLED?
AND WHAT I OFTEN ADVISE
PEOPLE -- I COULD PROBABLY
BE A MARKETER FOR HOME BLOOD
PRESSURE KIDS BUT -- KITS,
BUT I OFTEN TELL PEOPLE IT'S
IMPORTANT TO GO HOME GO, TO
A PHARMACY, SPEND $100 OR
$150, IT MIGHT BE THAT MUCH
ON A BLOOD PRESSURE KIT THAT
GOES ON THE ARM HERE, NOT ON
THE FOREARM OR FINGERS AND
TAKE YOUR BLOOD PRESSURE,
YOU DOAN NEED TO TAKE IT
TWICE A DAY, TAKE IT FIVE
TIMES A WEEK, TWICE A WEEK,
FIVE TIMES A DAY, DOESN'T
MATTER WHEN, HOW OFTEN, BUT
TAKE IT ENOUGH THAT WHEN YOU
COME TO SEE ME OR YOUR
FAMILY DOCTOR, YOU'VE GOT A
LIST OF YOUR HOME BLOOD
PRESSURES.
BECAUSE IN MY OFFICE, I
MIGHT MAKE YOU REALLY
NERVOUS.
YOUR BLOOD PRESSURE MIGHT BE
THROUGH THE ROOF AND NEXT
THING YOU KNOW I'M
COMMITTING YOU TO A
MEDICATION SO I'M COMMITTING
TO YOU A MEDICATION BASED ON
PROBABLY INSUFFICIENT
INFORMATION.
SO I LIKE PEOPLE TO BRING IN
THEIR OWN BLOOD PRESSURE
MEASUREMENTS.
SO THE QUESTION ONCE AGAIN
IS HOW IS YOUR BLOOD
PRESSURE?
IS IT CONTROLLED?
IF IT'S REALLY WELL
CONTROLLED AND YOU'RE 43 AND
YOUR DOCTOR WANTS TO TAKE
YOU OFF THE MEDICATION TO
SEE IF IT NORMLIZES AND
STAYS NORMAL, THAT SOUNDS
REASONABLE.

Maureen says WHAT'S A GOOD
BLOOD PRESSURE?

Dr. Meyers says DEPENDS ON WHETHER A
PERSON HAS DIABETES OR NOT.
IN THE ABSENCE OF DIABETES,
AN ACCEPTABLE OFFICE BLOOD
PRESSURE IS A SYSTOLLIC
BLOOD PRESSURE OF LESS THAN
140 AND THE BOTTOM NUMBER,
DIASTOLIC 190.
IF YOU HAVE DIABETES IT'S
GOT TO BE LESS THAN 130 TO
LESS THAN 85 OR SO.

Maureen says IS ONE OF THOSE
NUMBERS MEASURING YOUR
PULSE?

Dr. Meyers says NO, IT'S MEASURING THE
PRESSURE IN THE ARTERIES
WHEN THE HEART IS PUMPING
AND WHEN IT'S RELAXING.
SO WHEN IT'S PUMPING THERE'S
HIGHER BLOOD PRESSURE,
THAT'S THE TOP NUMBER.
WHEN IT'S RELAXING THERE'S
STILL A PRESSURE INSIDE THE
ARTERIES STILL EXISTS, AND
IT'S LOWER AND THAT'S THE
LOWER NUMBER.

Maureen says GOT IT.
FELICE IS IN SPRUCEDALE.
HI FELICE?

Felice says HI, I HAVE A
QUESTION REGARDING MY MOTHER,
SHE'S 47 YEARS OLD, A
DIABETIC AND SHE'S BEEN
TREATED FOR A WHILE FOR
CONGESTIVE HEART FAILURE.
MY QUESTION IS REGARDING
CHRONIC DIZZINESS FOR ABOUT
A YEAR TO A YEAR AND A HALF,
SHE'S BEEN COMPLAINING OF
BEING CHRONICALLY DIZZY, AND
IT'S SO BAD, WHEN SHE'S
SITTING DOWN SHE DOESN'T
NOTICE IT AS MUCH BUT THE
MOMENT SHE GETS UP SHE KIND
OF TIPS OVER AND SHE'S
ALWAYS OFF BALANCE.
SHE MENTIONED IT TO THE
DOCTORS BUT THEY DON'T SEEM
TO KNOW WHAT COULD BE
CAUSING IT.
AND I JUST WONDER IF YOU
MIGHT HAVE A SUGGESTION.

Dr. Meyers says WELL, DIZZINESS IS
EXTREMELY COMMON.
SO I'LL PREFACE MY COMMENT
BY SAYING DIZZINESS CAN BE
DUE TO PROBLEMS IN ALL SORTS
OF DIFFERENT SYSTEMS.
YOU COULD HAVE DIZZINESS
BECAUSE THERE'S AN INNER EAR
PROBLEM.
BUT WE'LL LEAVE THAT ASIDE
AND PRESUME FOR A MOMENT
THAT THE DIZZINESS IS IN
SOME WAY HEART ELT READY.
WHAT YOU'RE DESCRIBING IS
WHEN SHE STANDS UP HER
SYMPTOMS ARE EXACERBATED AND
THAT'S CALLED POSTUREAL
LIGHT HEADEDNESS, MORE
COMMON IN ELDERLY PEOPLE,
THOUGH I'M NOT CERTAIN I
WOULD CALL 74 ELDERLY.
AS WE AGE.
IT'S MORE COMMON FOR THE
REFLEXES THAT AS WE STAND UP,
AND I'M NOT GOING TO DO IT
IN THE STUDIO BECAUSE YOU'LL
GET A SHOT OF MY CHEST HERE,
BUT AS WE STAND UP THE BLOOD
IS SUPPOSED TO GO CENTRALLY
INTO MY HEART AND THE WAY IT
DOES THAT IS WE HAVE
REFLEXES THAT CLAMP DOWN AND
PUSH THE BLOOD.
WELL OLDER PEOPLE THOSE
REFLEXES DON'T WORK AS WELL
SO YOU STAND UP QUICKLY AND
GET LIGHTHEADED.
BUT BECAUSE OF THE DIABETES,
THE REFLEX MECHANISMS THAT
CENTRALIZE YOUR BLOOD VOLUME
ARE EVEN WORSE.
AND THAT'S SOMETHING CALLED
AUTONOMIC DYSFUNCTION.
DIABETIC PEOPLE ARE MUCH
MORE LIKELY TO HAVE
AUTONOMIC DISFUNCTION.
EVEN PEOPLE WITH NO HEART
DYSFUNCTION AT ALL CAN GET
THAT.
BUT IN THE PRESENCE OF HEART
FAILURE, SHE'S LIKELY ON A
NUMBER OF CARDIAC
MEDICATIONS.
HEART FAILURE IS SOMETHING
THAT IS TREATED IN A VERY
STANDARD WAY.
THERE'S PROBABLY A HALF
DOZEN PILLS THAT IF
EVERYBODY ISN'T ON THEY
SHOULD AT LEAST BE TRIED ON.
THOSE MEDICATIONS LOWER
BLOOD PRESSURE.
THAT'S HOW THEY WORK.
THEY HELP PEOPLE WITH HEART
FAILURE, THEY HELP THEM
TREMENDOUSLY, THEY KEEP THEM
OUT OF HOSPITAL, KEEP THEM
ALIVE.
BUT BECAUSE THEY LOWER BLOOD
PRESSURE IN ESSENCE YOUR
MOTHER'S LIKELY ON
ANTIHYPERTENSIVE DRUGS.
THOSE ARE ONLY GOING TO
WORSEN ANY SYMPTOMS WHEN SHE
STANDS UP SUDDENLY.
EACH ONE OF THOSE THREE
POSSIBILITIES, THE MOST
LIKELY IS THE
ANTIHYPERTENSIVE MEDICATION
AS WELL AS THE DIABETES.
IN TERMS OF DOING SOMETHING
ABOUT IT IT'S A VERY
DIFFICULT THING TO CORRECT
AND THE REASON I SAY IT, IS
IF SOMEONE DID NOT HAVE
HEART DISEASE, THE WAY YOU
CORRECT IT IS YOU GIVE THEM
SALT AND WATER TO TAKE.
AND THERE ARE EVEN SOME
MEDICATIONS THAT WILL
INCREASE YOUR CENTRAL BLOOD
VOLUME LIKE THAT.
IN SOMEBODY WITH HEART
FAILURE YOU DON'T WANT TO
GIVE THEM SALT WATER SO YOU
HAVE TO -- SO I DON'T HAVE A
QUICK ANSWER FOR YOU.
I THINK THAT IT WOULD BE
USEFUL TO HAVE A MORE THROW
ASSESSMENT --

Maureen says SOUNDS LIKE
SOMEBODY NEEDS TO NAIL DOWN
WHY SHE'S DIZZY.
SPEAKING OF SALT AND WATER,
I DIDN'T CLIP THIS ARTICLE
BUT SOMEWHERE AROUND
KITCHENER I BELIEVE THEY'VE
NOTICED A HIGH IODINE
CONTENT IN THE WATER AND
HEART PATIENTS HAVE ACTUALLY
BEEN TOLD THEY SHOULD BE
CAREFUL ABOUT THAT.
SO SALT IS A BAD THING IF
YOU HAVE HYPERTENSION, IS
THAT IT?

Dr. Meyers says YES, DEFINITELY.
THE IODINE, I WUBD DER IF
THAT'S GOING TO MAKE THEM
HYPERTHYROID OR SOMETHING.
BUT SALT IS A BIT
CONTROVERSIAL, WHETHER IT
REALLY CONTRIBUTES OR NOT.
SOME PEOPLE SAY IT
DEFINITELY DOES AND SOME
PEOPLE SEEM IT DEFINITELY
DOESN'T AND THEY BOTH SEEM
VERY SMART TO ME.

Maureen says COULD YOU GUYS
GET THIS STRAIGHTENED OUT
FOR US?

Dr. Meyers says I'M GOING TO TRY.

Maureen says THANKS FELICE FOR YOUR CALL.
MARSHA IS IN WATERLOO.
HELLO?

Marsha says HELLO, MAUREEN.
I LIKE YOUR PROGRAMME VERY,
VERY MUCH.

Maureen says THANK YOU.

Marsha says AND I WOULD LIKE
TO ASK Dr. MYERS IF HE COULD
SAY ANYTHING ON HEART VALVE,
IN PARTICULAR I HAVE HAD MY
AORTIC VALVE CHANGED.
I'M 71 BUT APPARENTLY I WAS
BORN WITH A VALVE THAT WAS
NOT FUNCTIONING WELL OR NOT
WORKING WELL BUT IT TOOK A
LONG TIME TO FIGURE THIS
OUT.
I DON'T HAVE HIGH BLOOD
PRESSURE, BUT YOU HARDLY
EVER SEE ANYTHING OF IT OR
ANY PROGRAMMES ON HEART
VALVES THEMSELVES, AND WHAT
IT DOES.
FOR INSTANCE I WAS VERY
DIZZY, AND MY DOCTOR DID
FIGURE OUT WHAT IT WAS.
I FINALLY FELL DOWN AND
REALLY QUITE INJURED MYSELF,
AND THEN THEY FOUND OUT THAT
IN THE END MY HEART VALVE
WAS 90 TO 95 percent CLOSED,
ACCORDING TO THE SURGEON.
SOME THIS HAS GONE QUITE
FAR.
AND I'D LIKE TO KNOW HOW ONE
LIVES NOW.
I HAVE AN ARTIFICIAL VALVE.

Maureen says OH, I'VE HEARD
OF THIS.
SO YOU WANT TO KNOW YOUR
QUALITY OF LIFE AND THINGS
YOU COULD BE DOING NOW TO
MAKE SURE.
TALK A BIT ABOUT THE VALVE
WE'VE BEEN TALKING ABOUT,
BLOCKED ARTERIES.

Dr. Meyers says THAT'S WHAT MAKES
CARDIOLOGY SO INTERESTING,
THE ASPECTS TO THE HEART AND
IT'S FUNCTION.
THE HEART HAS FOUR VALVES,
TWO ON THE LEFT SIDE CALLED
THE AORTIC AND MITRAL, AND
ON THE RIGHT SIDE, PULMONARY
AND TRICUSPID.
SO 90 percent OF THE TIME WHEN
WE'RE TALKING ABOUT REPAIR
WE'RE TALKING ABOUT THE LEFT
SIDE, AORTIC VALVE AND
MITRAL.
BUT THE AOR THE PARTICULAR
VALVE SITS ON LIKE AN
ELEPHANT TRUNK SO THE AORTA
COMES OFF FROM THE HEART AND
IT'S SEPARATED BY THE VALVE
AND THE VALVE IS SUPPOSED TO
ONLY LET BLOOD FLOW IN ONE
DIRECTION, IT'S INTERESTING
TO ME, YOU SAID YOU WERE
BORN WITH A PROBLEM.
THE AORTIC VALVE IS SUPPOSED
TO HAVE THREE CUSPS LIKE
LEAFLETS.
IF YOU LOOKED DOWN IT WOULD
LIKE LIKE A MERCEDES BENZ
SIDE.
SOME PEOPLE ARE BORN WITH
TWO CUSPS AND THAT'S CALLED
A BY CUSS PID AORTIC VALVE.
IT'S USUALLY IDENTIFIED MUCH
EARLIER THAN A PERSON IN THE
70s.
WHAT HAPPENS IS BECAUSE
THERE'S ONLY TWO OF THEM,
THERE'S TURBULENCE ACROSS
THE VALVE SO WITH ALL OF
THAT TURBULENCE IT STARTS TO
THICKEN AND OVER DECADES AND
DECADES IT THICKENS AND
DOESN'T OPEN UP AS WELL.
SO INSTEAD OF OPENING UP
LIKE THIS IT'LL OPEN UP LIKE
THAT, SO IT'LL BE VERY VERY
NARROW AND THAT'LL CAUSE
SYMPTOMS SUCH AS WHAT YOU
DESCRIBED.
IT CAN CAUSE BREATHING
DIFFICULTY, CHEST PAIN,
LIGHT HEADEDNESS AND
COLLAPSE.
AND THAT'S CALLED AORTIC
STINOSIS, OR VERY, VERY
LEAKY, AND THAT WOULD BE
CALLED AORTIC REGURGITATION.

Maureen says SHE'S GOT AN
ARTIFICIAL ONE NOW.

Dr. Meyers says ARTIFICIAL VALVES ARE A
WHOLE DIFFERENT TYPE OF
HEART SURGERY WHERE YOU NAT
A VALVE.
THEY'RE EITHER MECHANICAL
ARTIFICIAL VALVES WHICH ARE
MADE OF DIFFERENT TYPES OF
SYNTHETIC MATERIALS OR
THEY'RE BIOPROSTHETIC VALVES,
MEANING MIGHT COME FROM
ANOTHER ANIMAL, SOMETIMES
THE AREA AROUND THE HEART
CALLED THE PERI CARDCARDIUM
CAN BE USED TO CONSTRUCT IT.
THOSE ARE THE TWO MAIN ONES.
THE MECHANICAL VALVES ARE
EXTREMELY DO YOU
REMEMBERABLE, VERY, VERY
DURABLE BUT THEY REQUIRE A
PERSON BE ON THE BLOOD
THINNER WE SPOKE ABOUT,
CUMADIN BECAUSE WITH THIS
ARTIFICIAL MATERIAL IN
THERE'S A PROPENSITY TO CLOT
AROUND THE VALVE AND THEN IF
THOSE CLOTS BREAK OFF, AGAIN
YOU COULD HAVE A STROKE SO
IT'S VERY IMPORTANT SOMEBODY
IS ON CUMADIN WITH
MECHANICAL VALVE.
ON THE OTHER HAND, WITH THE
BIOPROSTHETIC VALVE, THE ONE
MADE OUT OF ANIMAL TISSUE
TYPICALLY, YOU DON'T NEED TO
BE ON CUMADIN FOR THAT
HOWEVER IT'S NOT AS DURABLE.
IT'S EIGHTH OF A TRADE OFF.
IN TERMS OF LIVING WITH A
VALVE AT AGE 71, THERE IS AN
ATTRITION RATE SO, WE DO
KNOW FOR EVERY 100 VALVES
THAT GO IN, THERE'S A SMALL
NUMBER OF VALVES THAT WILL
FAIL YEAR TO YEAR.
SO TO RECOGNIZE THAT THAT
CAN HAPPEN, HOWEVER IT WOULD
BE USUAL THAT A PERSON WOULD
HAVE SYMPTOMS LEADING UP TO
THAT AND AS LONG AS YOU'RE
HAVING AN APPOINTMENT WITH
YOUR CARDIOLOGIST OR
ULTRASOUND OF YOUR HEART
ONCE A YO, OR YOU SEE
SOMEBODY EARLIER IF YOU
DEVELOP NEW BREATHING
SYMPTOMS THERE REALLY
SHOULDN'T BE ANY LIMITATIONS
WITH THE VALVE AT ALL.

Maureen says LET ME THROW A
TERM AT YOU, WHAT IS
ESCHEMIA.

Dr. Meyers says ESCHEMIA MEANS REDUCED
BLOOD FLOW IT.
CAN APPLY NOT ONLY TO THE
HEART BUT YOUR LIMB, TO
ANYWHERE.
'EM SCHEMIA MEANS THERE'S
NOT ENOUGH BLOOD GETTING
THROUGH.
WHEN WE USED OUR ANALOGY
WITH THE TREE AND WATER
GOING THROUGH THE BRANCHES,
IF ONE OF THE BRANCHES IS
NARROWED YOU'RE GOING TO
HAVE -- LET'S GO BACK TO THE
HEART.
IF ONE OF THE CORONARY
ARTERIES IS NARROWED 70 percent,
THAT WILL PRODUCE ESCHEMIA
MEANS NOT NF ENOUGH BLOOD IS
GETTING TO THE MUSCLE ITSELF
WHERE IT'S NEEDED.

Maureen says THAT'S WHEN YOU
MIGHT HAVE TO GO IN THERE
AND OPEN UP THAT ARTERY SO
CAN WE TALK ABOUT ANGLE YO
LAST SEE AND BY PASS SURGE
SFLEE WHEN DO YOU DO ONE
OVER THE OTHER?
HOW DO YOU MAKE THAT
DECISION?

Dr. Meyers says THAT'S A VERY
CONTROVERSIAL SUBJECT.
FOR STARTERS, BYPASS
SURGERY'S BEEN AROUND
PROBABLY ABOUT 40 YEARS OR
MORE.
IT WAS FIRST STARTED BY SOME
ARGENTINIAN FELLOW WHO
INITIATED THE WHOLE CONCEPT
OF DOING BYPASS.
ANGIOPLASTY'S ONLY BEEN
AROUND 25 YEARS AND IT'S
MUCH LESS INVASIVE.
BECAUSE IT'S PUTTING IN A
CATHETER, ACCESSING A BLOOD
VESSEL, THE FEMERAL ARTERY,
AN ARTERY IN YOUR LEG, AND
PASSING A CATHETER, SORT OF
LIKE A HOLLOW PIECE OF
SPAGHETTI, A FLEXIBLE
CATHETER INTO THE HEART AND
YOU CAN DEPLOY DEVICES.
IT'S HOLLOW, SO YOU CAN PUT
IN A LITTLE BALLOON AND FIND
THAT NARROWING AND OPEN IT
UP.
IF IT'S TECHNICALLY
POSSIBLE.
SEE, ANGIOPLASTY ISN'T
ALWAYS POSSIBLE.

Maureen says WHY NOT?
WHAT WOULD BE THE REASONS
WHY YOU COULDN'T OPEN IT?

Dr. Meyers says WELL WHAT IF A NARROWING
IS PARTICULARLY LONG?
IT MIGHT NOT BE AM MEN I
BELIEVE.
IF IT'S AT A BEND IN A BLOOD
VESSEL.
IF IT'S NICE AND STRAIGHT
ALONG THE STRAIGHT HIGHWAY,
THAT'S TERRIFIC.
YOU CAN OPEN THAT UP
RELATIVELY EASY.
I DON'T DO ANGIOPLASTY BUT
DOCTORS WILL DO THAT.
IF IT'S AT A BEND OR A CURVE
IT MIGHT BE TECHNICALLY
DIFFICULT TO GET SOMETHING
AROUND IT, LIKE A STENT, A
METAL COIL TO KEEP OPEN THE
VESSEL OR A BALLOON.
IF THERE'S MULT TELL BLOOD
VESSELS NARROWED, IT'S OFTEN
THOUGHT BY PASS IS A BETTER
OPTION.
ONE OF THE REASONS FOR THAT
IS THE LIKELIHOOD AFTER
RENARROWING IS ABOUT 10 percent PER
VESSEL WITHIN SIX MONTHS.
SO IF YOU HAVE ONE, YOU'VE
GOT A ONE IN TEN CHANCE IN
SIX MONTHS YOU'RE GOING TO
GET MORE AN 199NA, MEANING
TEST PAIN, BECAUSE NOT
ENOUGH BLOOD IS GETTING TO
THE HEART.
BY PASS IS VERY DURABLE.
THERE ARE SOME LIMITATIONS
FOR BYPASS, BUT IN
HEAD-TO-HEAD COMPARISONS
THERE ARE CERTAIN SITUATION,
MULTIPLE BLOOD VESSELS IN
PATIENTS WHO HAVE DIABETES,
CERTAIN SITUATIONS WHERE BY
PASS LEADS TO A BETTER OUTCOME,
EVEN THOUGH IT'S DIFFICULT
SURGERY, MAKES A PERSON FEEL
UNWELL FOR WEEKS.
THEY MAY NOT GET BACK ON
THEIR FEET FOR A COUPLE OF
MONTHS.
SO BY PASS IS MUCH LESS
INVASIVE.
IF I HAD MY CHOICE I HAD
MUCH PREFER TO HAVE
ANGIOPLASTY HOWEVER THERE
ARE CLINICAL SITUATIONS IN
WHICH MY SURVIVORAL WOULD BE
BETTER WITH BY PASS SURGERY.

Maureen says SO NO ONE EASY
ANSWER.
DEPENDS ON THE PATIENT.

Dr. Meyers says USUALLY SINGULAR VESSEL
DISEASE.
THAT'S THE EASY ANSWER.
TYPICALLY THEY END UP WITH
ANGIOPLASTY.

Maureen says WE'RE TALKING
ABOUT THE HEART THIS
AFTERNOON WITH Dr. ROB
MYERS, A CARDIOLOGIST AT
SUNNYBROOK AND WOMEN'S
COLLEGE HEMT SCIENCES CENTRE,
THE AUTHOR OF A BOOK CALLED
“TAKE IT TO HEART” YOUR
COMPLETE GUIDE TO PREVENTING
AND TREATING HEART DISEASE.
THAT'S AT TOPIC THIS
AFTERNOON.
IF YOU HAVE A QUESTION:

Maureen says DEAN THAT IS IN
THORNHILL.
HELLO, DEAN IN A?

Dina says YES, I'M CALLING
ABOUT MY BROTHER.

Maureen says SORRY, CAN YOU
REPEAT THAT?

Dina says MY BROTHER, TWO
MONTHS AGO HE HAD A HEART
ATTACK AND HE HAD QUADRUPLE
BY PASS IN DECEMBER.
AND WHEN THEY OPENED UP HIS
CHEST THEY REALIZED THAT AT
THE AGE OF 12 HIS HEART
STOPPED GROWING.
SO HE'S 50 YEARS OLD WITH
THE HEART OF A 12-YEAR-OLD.
COULD YOU TELL ME WHAT
CAUSES THAT AND IF IT'S
HEREDITARY?

Dr. Meyers says I'M ACTUALLY UNFAMILIAR
WITH THE CONCEPT.
THE IDEA THAT THEY OPENED UP
THE CHEST AND SAID HE HAS
THE HEART OF A 12-YEAR-OLD.

Maureen says DOES OUR HEART
CONTINUE GROWING BEYOND THE
AGE OF TWELVE?

Dr. Meyers says IT SHOULD.
IT SHOULD GROW LIKE ANY
OTHER PART OF OUR BODY.
SO I'VE NEVER HEARD OF --

Maureen says JUST SORT OF A
STUNTED --

Dr. Meyers says NO, I'VE NEVER HEARD OF
AN ISOLATED FAILURE TO GROW.
I SUSPECT THERE'S PROBABLY
SOMETHING ELSE GOING ON BUT
NO, I'VE NEVER HEARD OF
THAT.

Maureen says IN GENERAL
THOUGH -- SO HE HAD A HEART
ATTACK, THEN HE HAD A BY
PASS.
DO YOU WANT TO TALK IN
GENERAL ABOUT WHAT HIS SORT
OF OUTLOOK IS AFTER A BY
PASS?
DID SHE SAY QUADRUPLE?
I THINK SHE SAID QUADRUPLE.

Dr. Meyers says THE NUMBER OF BY PASSES
OFTEN IS --.

Maureen says MEANINGLESS?

Dr. Meyers says MEANINGLESS.
YEAH, IT'S SORT OF A NICE
CONVERSATION PIECE BUT IT'S
UNDER GOING THE SURGERY
THAT'S REALLY IMPORTANT.
I GUESS FROM A PURIST
PERSPECTIVE, THE MORE BLOOD
VESSELS THAT NEED TO BE BY
PASSED THE NUMBER OF -- THE
LONGER THE SURGERY, MORE THE
RISK.
NONETHELESS BY PASS SURGEVY
QUITE SUCCESSFUL.
THE COMPLICATION RATE IS
MAYBE TWO OR THREE OR MAYBE
4 percent, COMPLICATION RATE OF
DYING, HAVING A HEART ATTACK
OR STROKE.
SERIOUS COMPLICATIONS.
BY PASS SURGEVY DONE USUALLY
WITH THE HEART ON A BYPASS
MACHINE.
THE SURGEONS WILL OPERATE ON
A MOTIONLESS HEART.
SO THERE ARE NEW TECHNIQUES,
BEATING HEART SURGERIES
WHERE IF IT'S A TYPICAL
REQUIREMENT FOR THE BY PASS
YOU CAN ACTUALLY OPERATE ON
A BEATING HEART AND THAT
MIGHT REDUCE THE
COMPLICATION RATE.
THE RAMIFICATIONS OF HAVING
BY PASS ONCE YOU GET THROUGH
IT SUCCESSFUL USUALLY DEPEND
ON A NUMBER OF THINGS.
ONE OF WHICH IS WAS IT
COMPLETE.
SOME BLOOD VESSELS ARE TOO
SMALL TO BY PASS.
IF YOU HAVE SOMETHING --
IT'S LIKE A FIVE-LANE
HIGHWAY.
IF THERE'S ONLY TWO -- ONLY
TWO LANES AT THE BOTTOM IT'S
GOING TO BE HARD TO BY PASS
THAT ACCIDENT AROUND THE
IT'S HARD.
YOU CAN'T ALWAYS BE
COMPLETELY FIXED.
SOME PEOPLE STILL HAVE RES
SUED DUEL PROBLEMS WITH
NARROWNESS.
THE OTHER ISSUE WITH BY PASS
SURGEVY WHAT'S HEART
FUNCTION?
AND THAT'S ONE OF THE SINGLE
MOST IMPORTANT DETERMINATES
IN TERMS OF PROGNOSIS OF
HEART DISEASE.
HOW WELL DOES THE HEART
WORK?

Maureen says BEFORE THE BYPASS?

Dr. Meyers says BEFORE AND AFTER.
BEFORE RELATES TO THE
COMPLICATION OF THE BY PASS
ITSELF.
AFTER RELATES TO HOW WELL A
PERSON'S GOING TO DO.
WE USE A SCALE, A SYSTEM --
WE USE A LOT OF DIFFERENT
SYSTEM, BUT ONE SYSTEM THAT
IS ULTRASOUND BASED IS ONE
TO FOUR.
IF YOU HAVE A GRADE ONE
VENTRICAL, GRADE ONE OUT OF
FOUR, THAT'S NORMAL.
IF YOU HAVE A GRADE FOUR
VENTRICAL, THAT'S SEVERELY
WEAKENED.
THREE OUT OF FOUR IS ALSO
NOT VERY GOOD BUT IT'S A
SOMEWHAT SUBJECTIVE SCALE.
WE HAVE OTHER TECHNIQUES WE
CAN ALSO USE.
PERSON WHO HAS A GRADE FOUR
VENTRICAL HAS A BAD
PROGNOSIS FOR DEVELOPING
FURTHER CARDIAC PROBLEMS.
A PERSON WITH A GRADE ONE,
SAILING.

Maureen says DOES THAT MEAN
IN A PERSON WITH THE GRADE
FOUR THAT YOU DON'T GO AHEAD
AND TRY THE BY PASS OR --
THERE'S THIS NOTION OF
SHOULD YOU BE AGGRESSIVE
WITH EVERYBODY?

Dr. Meyers says THAT'S A VERY GOOD
QUESTION.
THERE ARE SOME PEOPLE WHO
MAY HAVE MULTIPLE CONDITIONS,
AND EACH ONE OF THEM
CONTRIBUTES TO A DECISION
THAT SAYS LET'S NOT DO
ANYTHING.
SO A PERSON COULD BE VERY
ELDERLY, THEY COULD HAVE
KIDNEY FAILURE, THEY COULD
HAVE HAD A PREVIOUS STROKE
AND THEY'VE GOT A VERY WEAK
HEART.
WELL PUTTING ALL THOSE
THINGS TOGETHER, YOU'RE NOT
LIKELY GOING TO DO AN
OPERATION.
IF ON THE OTHER HAND YOU'VE
GOT A 50-YEAR-OLD WOMAN WHO
HAS ISOLATED WEAKNESS OF
PRESIDENT HEART AND
NARROWINGS, THEN EVEN IF THE
HEART IS SEVERELY WEAKENED,
BECAUSE OF THE AGE AND
BECAUSE THERE'S NOT OTHER
CONDITIONS THAT WOULD MAKE
THE PROGNOSIS WORSE, YOU'RE
GOING TO GO AHEAD AND DO
THAT SURGERY.
AND THERE'S SO MANY PEOPLE
THAT FALL IN THE MIDDLE.
DIFFICULT DECISIONS.
SOME PATIENTS DON'T WANT
THINGS DONE, ALSO.

Maureen says OBVIOUSLY.
DINA, THANKS FOR YOUR CALL.
“I'M A 38-YEAR-OLD WOMAN.
LAST YEAR I DEVELOPED
EURYTHMIA, AFTER TESTING
FOUND THE HEARTEN LARGED,
PUT ON 50 MILLIGRAMS OF
MET --
METHALOL, DIDN'T CORRECT
EURITHMIA.
I HAVE NATURALLY BLOOD
PRESSURE AND MEDS FURTHER
LOWER MY BLED PRESSURE I'M
TIRED AND COLD ALL THE TIME.
ALSO, CAN YOU EXPLAIN WHAT
AN ENLARGED LEFT ATRIUM
MEANS?”
SHE'S GOT A CARDIOLOGIST AND
SHE'S GOT TO PHONE IN TO YOU
TO ASK WHAT THAT MEANS.
ARE THEY NOT ANSWERING THESE
QUESTIONS FOR THESE PEOPLE?

Dr. Meyers says DO I GIVE YOU THE
POLITICALLY CORRECT
STATEMENT?

Maureen says I WON'T MAKE YOU,
IT WAS RHETORICAL.
WHAT DOES THAT MEAN?

Dr. Meyers says WE SPOKE ABOUT THE HEART
BEING LIKE A ROOM, THERE
HAPPEN TO BE FOUR CHAMBERS.
THE TWO PUMPING CHAIMERS
THAT ARE REALLY IMPORTANT,
LEFT VENTRICAL PUMPS TO THE
BODY, RIGHT VENTRICAL PUMPS
TO THE LUNGS AND IT'S A BIG
CIRCUIT.
WHEN THE BLOOD RERNS TO THE
HEART IT RETURNS TO THE
ATRIUM, THE LEFT AND RIGHT
ATRIUM.
SO YOU'VE GOT -- IT'S A FOUR
ROOM HOUSE WITH A DIFFERENT
CIRCUIT.
YOU'VE GOT THE LEFT ATRIUM
WHICH IS A SMALL RESERVOIR,
THE BLOOD GOES THROUGH THE
MITRAL VALVE, INTO THE LEFT
VENTRICAL, PUMPED INTO THE
BODY AND IT HAPPENS ON THE
RIGHT SIDE.
SO THE LEFT ATRIUM IS THE
SITE -- IF IT IS DILATED
THAT WILL INCREASE THE
PROPENSITY FOR WHAT YOU
TERMED AN EAR RIT MA.
THAT IS NOT SPECIFIC ENOUGH.
I HAVE ERYTHMIAS.
EVERY TIME YOU HAVE A
SKIPPED BEAT YOU HAVE ONE SO
IT'S KIND OF LIKE SAYING GO
BUY ME SOME FRUIT.
YOU WANT TO BE SPECIFIC
ABOUT WHAT KIND IT IS.
THERE ARE ERYTHMIA'S THAT
ARE DEADLY SERIOUS AND NEED
EMERGENCY TREATMENT AND MORE
THAN LIKELY THERE ARE MORE
THAT ARE NOTHING BUT A
NUISANCE AND MANY THAT SIT
IN TEEN.
THERE'S 50 TIVET KINDS,
THERE'S MORE.
SO YOU WENT ON METOPEROL
THREE TIMES A DAY, I WOULD
SHARE YOUR PHARMACIST'S
CONCERN.
IT'S USUALLY A TWICE A DAY
DRUG, THOUGH THERE'S A NEW
LONG ACTING PREPARATION
AVAILABLE IN THE U.S., ONCE
A DAY.
THAT'S NEITHER HERE NOR
THERE.
IT'S VERY HARD FOR ME TO
ANSWER YOUR QUESTION ONLY
BECAUSE I DON'T KNOW WHAT
KIND OF ERRYTHMIA YOU HAD.
THERE ARE SOME KINDS, THE
SENSATION THAT YOUR HEART IS
SKIPPING BEATS.
BUT WHEN YOU CONSIDER A
RHYTHM LIKE ATRIAL
FIBRULATION, THOUGH IT MAY
SLOW DOWN THE HEARTRATE, THE
DRUG, AND MAKE SOMEBODY FEEL
REALLY GOOD IT WON'T CHANGE
THE RHYTHM SO THERE ARE
DRUGS WHICH JUST SLOW THE
HEART BEAT AND DRUGS WHICH
ACTUALLY CONVERT YOUR RHYTHM
TO THE BETTER ONE.
I DON'T KNOW WHAT KIND WE
HAVE HERE.

Maureen says WHICH IS MORE OF
A CONCERN?
AN ERRYTHMIA, AND WE DON'T
KNOW WHAT KIND OR LOW BLOOD
PRESSURE?

Dr. Meyers says LOW BLOOD PRESSURE IS
COMMON.
THE FACT THAT YOU'RE ON THE
MED KAIG, YOU'RE BLOOD
PRESSURE'S ONLY GOING TO BE
LOWERED FURTHER THAT'S A
CONCERN IF YOU HAVE
SYMPTOMS.
LOW BLOOD PRESSURE IS ONLY
AS RELEVANT AS THE SYMPTOMS
IT PRODUCES.

Maureen says TIRED AND COLD.

Dr. Meyers says WELL, BLOOD PRESSURE
COULD DEFINITELY BE A FACTOR
THERE.
THYROID COMES TO MIND.
YOU SHOULD MAKE SURE YOUR
THYROID COMES TO MIND IF
YOU'RE TIRED AND COLD.

Maureen says ALL RIGHT, WE'LL
GO TO DOUG ON THE LINE.
DOUG?

Doug says HI THERE.
I'M CALLING, I HAD A
QUESTION ALSO ABOUT
METTROPALOL.
YOU PRETTY WELL ANSWERED IT.
ONE THING, OVERTIME, CAN
YOU -- SHOULD YOU INCREASE
THE DOSAGE OF METROPALOL,
NOT THE FREQUENCY BUT FROM
THE 50 MILLIGRAM TO THE 100
MILLIGRAM?
AND ALSO I FIND AFTER HAVING
HAD A BY PASS 12 YEARS AGO,
NOW THE LAST TWO YEARS THE
COLD REALLY SEEMS TO BOTHER
MY CHEST, AND I MEAN, I JUST
HAVE TO GET OUT OF THE COLD.
AND I'M FINE.
AND THIRDLY, IS YOUR SISTER
A SURGE ZON THERE WAS A
DOCTOR MARY LOU MYERS THAT
DID MY BY PASSES AND I WAS
JUST WONDERING IF IT WAS A
FAMILY AFFAIR.

Dr. Meyers says NO, SHE'S NOT A SURGEON.
I WAS GOING TO JOKE WITH YOU
AND SAY NO, SHE IS BUT NOT
VERY GOOD.
NO, SHE'S NOT A SURGEON.
WHERE ARE YOU ON THE
METROPALL?

Doug says TO REGULATE MY
HEART BEAT.

Dr. Meyers says SO ANGINA OR --

Doug says IT'S NOT BLOOD
PRESSURE, IT'S JUST TO
REGULATE -- LIKE YOU SAY.
IT SEEMS TO SKIP A BEAT
EVERY ONCE IN A WHILE --

Maureen says YOU'VE HAD A
HEART ATTACK.

Doug says I'VE HAD A HEART ATTACK
AND TRIPLE BY PASS 12 YEARS
AGO.

Dr. Meyers says SO MORE THAN LIKELY WE
KNOW FROM STUDIES THAT ARE
PROBABLY 20, 25 YEARS AGO,
EVERYBODY WITH A HEART
ATTACK IF THEY CAN TOLERATE
THE DRUG SHOULD BE ON A DRUG
CALLED A BETA BLOCKER OF
WHICH METOPALOL IS ONE TYPE.
MORE THAN REGULATING THE
HEART BEAT, I SUSPECT YOU'RE
PROBABLY ON IT BECAUSE
YOU'VE HAD A HEART ATTACK.
THE METOPALOL, ONE THING
THAT CONCERNED ME A BIT, YOU
SAID YOU'RE FEELING IN THE
CHEST YOU GOT TO GET OUT OF
THE COLD.
I WOULD JUST WONDER OUT LOUD
WHETHER IT'S -- IT'S WHAT
OUR PERCEIVING IT TO BE, A
SENSITIVITY RELATED TO THE
SURGERY OR WHETHER THIS
COULD PROBABLY BE AN
199NACHLT AND I THINK THAT
WE'RE NOT GOING TO CLARIFY
THAT HERE, BUT IT IS
SOMETHING THAT NEEDS TO BE
ADDRESSED --

Doug says I DON'T THINK IT'S ANGINA,
I THINK IT'S JUST THE COLD
AIR.
I CAN JUST WALK LIKE HALF A
BLOCK, BUT IF I TAKE A FEW
STEPS WITH THE COLD AIR IT
STARTS TO HURT AND GO DOWN
TO THE COFFEE SHOT, AFTER
BEING THERE, JUST IN THE
WARM AIR A COUPLE OF BREATHS
AND THE PAIN IS GOING AWAY.

Maureen says YEAH BUT PAIN IN
MY CHEST.

Dr. Meyers says I THINK MY MEDICAL
PROTECTION COVERS PHONE
ADVICE, BUT I WANT TO TELL
YOU THAT THAT CONCERNS ME,
NOT TO THE POINT OF ASKING
YOU TO BE WORRIED ABOUT THIS
BUT THAT CONCERNS ME.
IT'S NATURAL TO TRY AND
ATTRIBUTE SYMPTOMS TO
SOMETHING OTHER THAN WHAT
COULD BE A HEART ISSUE,
ESPECIALLY WITH YOUR HISTORY,
BUT I WOULD STRONGLY
RECOMMEND, IF YOU WERE
SITTING OPPOSITE ME RIGHT
NOW, I WOULD TALK TO YOU A
LITTLE BIT MORE ABOUT IT AND
PROBABLY ARRANGE SOME KIND
OF TESTING TO MAKE SURE
YOU'RE RIGHT.
I WOULDN'T TO WANT SPECULATE
AND ASSUME THAT IT IS ONLY
COLD WEATHER THAT'S
IRRITATING YOUR CHEST.
I THINK THAT'S A CONCERN,
AND I WOULD IMPLORE YOU TO
LOOK INTO THAT WITH YOUR
DOCTOR.
THE METOPEROL -- I FORGET
THE OTHER PART OF THE
QUESTION.

Maureen says I THINK HE
WANTED TO KNOW WHETHER OR
NOT THAT WAS RESPONSIBLE FOR
HIM FEELING THE COLDNESS OR
NOT BUT PROBABLY NOT.

Dr. Meyers says NO.

Maureen says GET THAT CHECKED
OUT.
THANKS VERY MUCH, DOUG.
MARY IS IN TORONTO.
HI MARY.

Mary says HI.
MY HUSBAND IS A VERY FIT
59-YEAR-OLD AND ON A ROUTINE
STRESS TEST THEY FOUND OUT
HE HAD BLOCKAGES, AND HE HAD
A TRIPLE BY PASS FIVE MONTHS
AGO.
AS A RESULT HE NOW HAS A
RAPID HEART BEAT.
IT WAS ABOUT -- HIS PULSE
WAS ABOUT 107 AFTERWARDS FOR
A WHILE, AND IT'S NOW DOWN
TO BETWEEN 90 AND 100
RESTING HEARTRATE.
THE -- HE EXERCISES AN HOUR
VIGOROUSLY EVERYDAY.
IS THIS SOMETHING TO WORRY
ABOUT LONG-TERM?
THE CARDIAC SURGEON SAYS OH,
WELL IT'LL GO DOWN ONCE
YOU'RE FIT.
WELL HE REALLY WAS VERY FIT
AND SLIM AND THE
CARDIOLOGIST DOESN'T SEEM TO
KNOW.

Dr. Meyers says INTERESTING.
ONCE AGAIN, THE FIRST THING
I'D WANT TO KNOW IS I'D WANT
TO HAVE THAT CARDIOGRAM IN
FRONT OF ME TO MAKE SURE
THAT IT'S THE NORMAL RHYTHM.
SO IT'S FAST, BUT EVERYBODY
HOPEFULLY, IF YOU DON'T HAVE
A RHYTHM DISTURBANCE YOU'RE
IN SOMETHING CALLED SINUS
RHYTHM.
THAT'S THE NAME OF THE
GENERATOR.
TELLS YOU WHERE THE RHYTHM'S
STARTING FROM.
SO YOU'RE DESCRIBING A SINUS
TACHYCARDIA.
WHICH IF I GO UP A FLIGHT
OF STAIRS I'M GOING TO
DEVELOP A FAST HEART BEAT.
THAT'S WHAT YOU'RE
DESCRIBING.
SO I'D TO WANT MAKE SURE
FIRST OF ALL THAT WE'RE
TALKING ABOUT THE SAME
RHYTHM ISSUE.
AND WE'LL SPECULATE FOR A
MOMENT AND ATHAT WE ARE.
IF IT'S SINUS TACHYCARDIA,
IT'S INTERESTING, IT'S NOT
COMMON.
SOMETIMES AFTER SURGERY, YOU
CAN DAMAGE SOME OF THE
NERVES THAT REGULATE THE
HEARTBEAT SO, SOMEBODY'S
HEARTRATE CAN BE FIXED AT A
HIGHER LEVEL SO,TA THAT CAN
EXIST AFTER SURGERY.
I'VE ONLY SEEN THAT MAYBE
ONCE OR TWICE IT.
WOULD BE INTERESTINGTOR ME
TO KNOW WHETHER HE HAD ANY
ISSUE RELATED TO THIS BEFORE
HIS SURGERY.
DID HE HAVE ANY FAST HEART
BEATS BEFORE HIS SURGERY?

Mary says NO.

Dr. Meyers says NOT AT ALL?

Mary says NO, AND THAT'S WHY THE
CARDIOLOGIST SAID IT'S
RATHER UNIQUE AS WELL.

Dr. Meyers says YEAH, BUT DESPITE BEING
UNIQUE, THERE'S STILL AN
EXPLANATION FOR IT.
NOW I HAVE BEEN TOLD BY
SURGEON, AS A NON-SURGEON
THAT THIS IS SOMETHING THAT
DOES TEND TO IMPROVE.
AND THE ONE PATIENT I'VE
SEEN WITH IT, IT DEFINITELY
IMPROVED.
FAST HEARTRATES ARE ONCE
AGAIN AS IMPORTANT AS THE
SYMPTOM, THOUGH AT SOME
LEVEL I'VE SEEN MANY PEOPLE
COME INTO MY OFFICE HAVE
HEARTRATES OF 140 AND NOT
EVEN KNOW IT.
SO WHEN I SAY AS IMPORTANT
AS THE SYMPTOMS, IF HE'S GOT
A HEART RATE OF 90 AND IT'S
NOT TROUBLING HIM, THEN I
THINK THAT'S ACCEPTABLE.
WHAT I THINK HE NEEDS IS
SOMETHING CALLED A HOLTER
MONITOR.
Y PROBABLY HAD IT.
HAS HE HAD IT?

Mary says NO, HE HASN'T.

Dr. Meyers says SO WHAT THAT DOES, IT'S
LITTLE DEVICE YOU WEAR.
IT'S PRETTY CHEAP.
IT MEASURES EVERY SINGLE
HEARTBEAT OVER A 24 OR 48
HOUR PERIOD AND THEN GIVES
YOU THE AVERAGE AS WELL ANY
THE HEART BEATS YOU WANT SO
IF HE HAD IT AND HIS AVERAGE
HEARTBEAT WAS 70 OVER 24
HOUR, I WOULD SAY WAIT A
MINUTE, MAYBE MUCH LIKE
BLOOD PRESSURE BEING TOO
HIGH IN MY OFFICE,
SOMEBODY'S NERVOUS AND THEIR
HEARTRATE GOES UP IN MY
OFFICE.
HOLTER MONITOR WOULD BE
IMPORTANT TO CONFIRM THAT
HIS AVERAGE HEARTRATE OVER A
24 HOUR PERIOD OF TIME IS
TRULY ELEVATED.
IF IT IS, THEN TREATMENT
WOULD DEPENDS ON HOW HIGH
THAT HEARTRATE IS AND HOW
TROUBLING IT IS AND THE BEST
TREATMENT IS TYPICALLY A
BETA BLOCKER, ONCE AGAIN
SUCH AS METOPEROL.
YOU ALWAYS HAVE TO BE AWARE.
I KNOW SO MANY PEOPLE ARE
WATCHING THIS PROBABLY, OF
BETA BLOCKERS, ASSOCIATED
WITH THOSE DRUGS IT CAN
CAUSE DEPRESSION, IMPOTENCE,
FATIGUE AND BAD DREAMS.
IT CAN DO THOSE THINGS.
I DON'T THINK I'VE EVER MET
ANYBODY OPPOSITE MY DESK IN
MY OFFICE WHO DIDN'T TELL ME
THEY WERE FATIGUESED.
SO ONCE AGAIN WE'RE DEALING
WITH COMMON SYMPTOMS THAT
MAY OR MAY NOT BE du TO THE
DRUG THOUGH I'VE SEEN PEOPLE
COME IN WHO CANNOT TOLERATE
THE DRUG NO MATTER HOW
IMPORTANT IT IS, BECAUSE
THEY'RE TOO DARNED TIRED.

Maureen says I GUESS MARY'S
HUSBAND WILL NOW BE
CONSIDERED TO HAVE HEART
DISEASE AND THEREFORE
CHILDREN THAT THEY HAVE MAY
BE CONSIDERED AT HIGHER
RISK?
AND WHAT I WANT TO KNOW IS,
FOR MY HUSBAND'S SAKE, CAN
YOU BEAT YOUR GENETIC
HERITAGE WHEN IT COMES TO
HEART DISEASE?
IF YOUR DAD HAS HAD HEART
DISEASE, AND YOU EXERCISE,
AND YOU, YOU KNOW, EAT RIGHT,
CAN YOU BEAT THAT?

Dr. Meyers says UH, I WISH IT WAS MORE --
I WISH IT WAS AS DOGMATIC AS
WE CAN BE AND SAY YES, YOU
CAN BEAT IT.
I THINK YOU CAN CONTROL IT.
I THINK YOU CAN MAKE THE
FINISH LINE FURTHER AHEAD.
I DON'T THINK YOU CAN BOAT
YOUR GENETICS AT THIS POINT
IN THE YEAR 2001.
I THINK IN MY LIFETIME WE'LL
PROBABLY BE ABLE TO -- WHAT
YOU CAN DO IS DELAY IT.
A PERSON WHO EXERCISES, EATS
PROPERLY, DOES NOT SMOKE,
CONTROLS BLOOD PRESSURE,
KNOWS THEIR CHOLESTEROL AND
CONTROLS IT IS FAR MORE
LIKELY TO NOT HAVE HEART
PROBLEMS THAN THE PERSON WHO
DOES ANYONE OF THOSE THINGS.
BUT TO THIS POINT, WE CAN
MOTT NOT MODIFY GENETICS.
NOT WELL.

Maureen says ARE WE STUDYING
THAT THOUGH?

Dr. Meyers says SURE.
SURE, THERE'S A LOT OF STUDY
AND RESEARCH THAT GOES INTO
WHETHER WE CAN ACTUALLY
ALTER THE GENES SO THAT
INSTEAD OF EXPRESSING SOME
GENE THAT MAKES YOUR CLOSE
ROLL HIGH YOU WENT EXPRESS
THAT ANYMORE.
THAT'S TOOLLY BEEN DONE, I
BELIEVE IN QUEBEC.
WHERE A WOMAN WHO HAD --
IT'S PROBABLY BEEN DONE MORE
THAN THIS NOW.
IT WAS A FAMILIAL, A VERY
SEVERE CHOLESTEROL ELEVATION
SUCH THAT YOU MANIFEST HEART
DISEASE IN YOUR TEENS.
GENETICALLY THE LIVER CELLS
WERE MODIFIED TO NO LONGER
PRODUCE THE SAME -- I
BELIEVE IT WAS SUCCESSFULFUL.
IT'S CERTAINLY NOT
MAINSTREAM.

Maureen says GENE THERAPY.
IN THE LAST COUPLE MINUTES,
I WANT TO ASK YOU, WHO
SHOULD BE YOU ON AN ASPIRIN
A DAY?

Dr. Meyers says YOU ASK ALL THE GOOD
QUESTIONS.

Maureen says OH, GOOD.

Dr. Meyers says THAT'S A LITTLE
CONTROVERSIAL.
THERE ARE A NUMBER OF
STUDIES THAT INVOLVE
HUNDREDS OF THOUSANDS OF
PEOPLE.
A NURSE'S HEALTH STUDY AND
DOCTOR'S STUDY THAT SAY
YOU'RE OLD TAN 50 AND HAVE
ANY RISK FACTOR FOR HEART
DISEASE WHATSOEVER,
CHOLESTEROL, SMOKE, BLOOD
PRESSURE, DIABETES, FAMILY
HISTORY, YOU SHOULD BE ON
ASPIRIN.
THERE'S ANOTHER RECENT
REVIEW OF THOSE STUDIES --
THE REASON NOT EVERYBODY
GOES ON ASPIRIN IS ONLY
BECAUSE IT INCREASES YOUR
RISK OF BLEEDING.
WHEREAS I USED TO COUNCIL MY
PATIENTS THAT A BABY ASPIRIN
WAS LESS LIKE LOW TO CAUSE
BLEEDING THAN A FULL
STRENGTH ONE, A RECENT STUDY
SUGGESTED THAT MIGHT NOT BE
TRUE.
HOWEVER KNOWING A BABY
ASPIRIN IS AS EFFECTIVE AS A
FULL STRENGTH ASPIRIN IN
HEART DISEASE, I STILL TELL
PEOPLE TO TAKE A BABY
ASPIRIN.
THE DOWN SIDE IS YOU CAN GET
ULCERS AND BLEEDING.
IT SLIGHTLY INCREASES YOUR
RISK OF SERIOUS INTRACRANIAL
LEADINGS, MEANING STROKES
AND STOMACH BLEEDINGS.
THE DILEMMA IS HOW DO YOU
WEIGH THOSE TWO TOGETHER?
AND THAT'S HOW THIS
CONCLUSION OF ANYBODY OVER
50 WITH A RISK FACTOR SHOULD
BE ON IT.

Maureen says YOU HAVE IT LOOK
AT THE OTHER THINGS LIKE THE
RISK OF BLEEDING.
I'M AFRAID WE'RE OUT OF TIME
BUT THANK YOU VERY MUCH.
THAT WAS GREAT.

Dr. Meyers says A PLEASURE.

Maureen says COME BACK AGAIN.
Dr. ROB MYERS IS A
CARDIOLOGIST AT SUNNYBROOK
AND WOMEN'S COLLEGE HEALTH
SCIENCES CENTRE AND THE
AUTHOR OF “TAKE IT TO
HEART.”
FOR MORE INFORMATION ON
HEART HEALTH TRY:

A slide appears on screen and Maureen reads “Heart and Stroke Foundation, 416 489 7100, 1 888 HSF IFO (473 4636) www.hsf.on.ca.”

Maureen says SO WE'VE BEEN
TALKING MOSTLY ABOUT
CONVENTIONAL TREATMENTS FOR
HEART DISEASE BUT ONE DAY
Dr. MYERS WILL PROBABLY BE
HERE TALKING ABOUT AN
UNCONVENTIONAL TREATMENT.
HERE IN CANADA, RESEARCHERS
ARE RUNNING CLINICAL TRIALS
ON GENE THERAPY FOR THE
HEART AND THE RESULTS SO FAR
ARE PROMISING.
JACK FINN BELIEVES THE
EXTREMES SAVED HIS LIFE.

A video clip plays. Jack appears on screen throwing a mini bowling ball down the lane. He is in his 60s, has short, dark, side-parted gray hair, wears thin glasses, has a white moustache, and wears a green t-shirt and khaki pants.

Maureen narrates and says JACK FINN LOOKS PRETTY
HEALTHY FOR A MAN IN HIS
60s.
HE'S ACTIVE, FIT AND SLIM
BUT JACK'S LUCKY TO BE
ALIVE.
HE FELT HIS FIRST SYMPTOM OF
HEART DISEASE 27 YEARS AGO
AT A HOUSE WARMING PARTY FOR
A FRIEND.

Jack says I STARTED GETTING PAINS
IN MY CHEST, EVEN IN THE TOP
OF THE STOMACH AREA, WHICH I
THOUGHT WAS INDIGESTION.

A caption reads “Jack Finn.”

Jack continues I FINALLY LEFT THE HOUSE
WARMING PARTY AND DROVE
MYSELF TO THE HOSPITAL.
I WAS HAVING A HEART ATTACK.
SO THAT WAS MY FIRST HEART
ATTACK AT 40 YEARS OLD.

Maureen says AFTER 25 YEARS OF HEAVY
SMOKING AND A SEDENTERY
LIFESTYLE, JACK KNEW HE HAD
TO MAKE SOME DRAMATIC
CHANGES, AND HE DID.

Jack says I STARTED GETTING INTO A
REGIMENTS EXERCISE PROGRAMME,
WHERE I STARTED WALKING AND
EVENTUALLY JOGGING.
AND GOT INTO SOME LONG
DISTANCE RUNNING.

Maureen says WITHIN A FEW YEARS, JACK
WAS RUNNING MARATHONS.
INCLUDING THE GRANDDADDY OF
THEM ALL, THE BOSTON
MARATHON.
BUT IT DIDN'T HELP HIS
HEART.
THREE SHORT MONTHS LATER, HE
NEEDED QUADRUPLE BY PASS
SURGERY.

Pictures of Jack finishing the Boston Marathon appear on screen. Then a picture of him with short messy black hair, his same glasses, and a dark moustache lying in a hospital bed appear.

Maureen continues HE WAS 50 YEARS OLD.
THINGS WERE GOOD FOR THE
NEXT FIVE YEARS.

Jack says I SUDDENLY STARTED HAVING
ANGINA AGAIN, AND IT WAS
FAIRLY SUDDEN, SO I THINK
WHAT HAPPENED WAS THAT ONE
OF THE GRAPHS, ONE OF THE
BYBASSES JUST GAVE UP.
CLOSED UP.

Maureen says HE WAS BACK IN HOSPITAL
FOR ANOTHER BY PASS
OPERATION.
THE FACT THAT HE SURVIVED IT
IS ALMOST A MIRACLE.

Jack says THAT ONE WAS A LITTLE
TOUGHER BECAUSE I SPENT A
COUPLE WEEKS IN HOSPITAL
BEFORE THE BY PASS, IN THE
HOSPITAL IN BURLINGTON.
AND I HAD AT LEAST ONE OR
TWO HEART ATTACKS THERE.
THEY TRANSPORTED ME TO
TORONTO FOR THE BY PASS AND
I HAD ANOTHER HEART ATTACK
ON THE TABLE.

Maureen says BUT NOW JACK WAS PUSHING
60, IN AND OUT OF HOSPITAL
WITH UNSTABLE ANGINA AND
LIVING WITH SEVERE CHEST
PAIN.

Jack says I WAS GETTING ANGINA
PROBABLY UP TO 20 TIMES A
DAY.
SOMETIMES JUST SITTING DOING
NOTHING.
THERE WERE OTHER TIMES WHEN
IT ALMOST FELT LIKE I WAS
HAVING ANOTHER HEART ATTACK,
BECAUSE IT WOULD BE WHAT
MIGHT BE DESCRIBED AS A VERY
TIGHT PAIN, HEAVINESS IN MY
CHEST, COMING FROM THE BACK
RATE THROUGH TO MY CHEST,
DOWN MY ARMS.
VERY DEBILITATING.

Maureen says JACK THOUGHT HE
WAS GOING TO DIE OF A HEART
ATTACK, BUT THERE WAS LITTLE
DOCTORS COULD DO.
WITH SO MUCH SCAR TISSUE, HE
WAS TOLD HE COULDN'T UNDERGO
ANOTHER BY PASS OPERATION.

Jack says IT IS FRIGHTENING.
THERE HAVE BEEN A LOT OF
TIMES WHERE HE HAD AN ANGINA
SESSION THAT WE WERE READY
TO CALL 911 AND GO BACK INTO
THE HOSPITAL AGAIN, NOT
REALLY KNOWING WHAT THEY
COULD DO FOR ME.
BECAUSE THEY TOLD ME I
COULDN'T HAVE SURGERY.

Maureen says THEN IN 1999,
JACK WAS GIVEN HOPE.
HE WAS OFFERED THE CHANCE TO
BE PART OF AN EXPERIMENT.
JACK WOULD BE ONLY THE
SECOND PERSON IN CANADA TO
RECEIVE A CONTROVERSIAL
TREATMENT.
GENE THERAPY INJECTED
STRAIGHT INTO THE HEART.
THE IDEA BEHIND GENE THERAPY
IS INSTEAD OF USING DRUGS OR
SURGERY TO TREAT A PROBLEM,
YOU GIVE THE BODY THE
BUILDING BLOCKS.
THE GENES IT NEEDS TO REPAIR
ITSELF.

Dr. Duncan Stewart says THE POTENTIAL IS HUGE.

Dr. Duncan Stewart is in his fifties, has thin, straight, dark gray hair, has a thick gray moustache with gray stubble, and wears a white lab coat, white shirt and dark tie.

Dr. Duncan Stewart continues I MEAN, I THINK IF IT
WORKS -- IF IT EVEN WORKS
SLIGHTLY IN THESE EARLY
TRIALS, I THINK THIS WOULD
BE UNBELIEVABLY EXCITING.

Maureen says Dr. DUNCAN
STEWART IS HEAD OF
CARDIOLOGY AT St. MIKE KL'S
HOSPITAL AND UNIVERSITY IN
TORONTO.
Dr. STEWART AND HIS TEAM
WERE THE FIRST IN CANADA TO
INJECT A GENE DIRECTLY INTO
THE OPEN HEART OF A PATIENT.

Just out of surgery, Dr. Duncan Stewart says WE'RE USING A GENE WHICH
INDUCES THE GROWTH OF NEW
BLOOD VESSELS SO IT
STIMULATES BLOOD VESSEL
PRODUCTION TAI PEERS TO
TRIGGER A NATURAL RESPONSE
IN THE BODY -- THIS IS
IMPORTANT WHEN YOU HAVE
HEALING OF A WOUND FOR
INSTANCE, ANYTHING OF THAT
NATURE, YOU NEED TO -- THIS
IS A NORMAL FUNCTION OF THE
BODY SO WHAT WE'RE DOING IS
AUGMENTS THAT AND --
AUGMENTING THAT AND
STIMULATING IT.
TRIGGERING HOPEFULLY A
ROBUST STRONG BLOOD VESSEL
GROWTH EXPANSION INTO AN
AREA WHERE WE KNOW THERE'S A
NEED FOR MORE BLOOD VESSELS.

Maureen says THE TRIALS ARE
STILL AT A VERY EARLY STAGE
AND BEING DONE ONLY ON A
SELECT GROUP OF PATIENTS.
BUT IF THIS THERAPY IS
SUCCESSFUL, MANY COULD
BENEFIT.

Dr. Duncan Stewart says THERE ARE A LOT OF PEOPLE
THAT HAVE SUCH SEVERE
BLOCKAGES OR SO MANY
BLOCKAGES THAT THEY CAN'T BE
OPENED BY BALLOON ANGIE YO
LAST SEE, HAVE SURGERY DONE,
AND THESE PEOPLE OFTEN HAVE
VERY SEVERE SYMPTOMS SO
THESE ARE THE SO CALLED NO
OPTION PATIENTS THAT WE
DON'T HAVE ANYTHING TO OFFER
THEM AND THESE ARE THE
PEOPLE WHO ARE THE ONES THAT
WE ARE HOPING TO BENEFIT
WITH THIS NEW APPROACH.

Maureen says BUT EVEN FOR NO
OPTION PATIENTS THERE ARE
CONSIDERABLE RISKS.
BECAUSE THE GENE ENCOURAGES
BLOOD VESSELS TO GO, THERE'S
A CHANCE THAT IT COULD DO
JUST THAT IN AREAS OTHER
THAN THE HEART, AND THAT
COULD BE DANGEROUS.

Dr. Duncan Stewart says FOR INSTANCE IN DIABETICS
THAT HAVE EYE PROBLEMS, VERY
OF THIS IS DUE TO NEW BLOOD
VESSEL GROWTH IN THE BACK OF
THE EYE AND THAT COULD CAUSE
BLINDNESS.

Maureen says BUT Dr. STEWART SAYS THE
BIGGEST CONCERN IS CANCER.

Dr. Duncan Stewart says BECAUSE CANCERS ARE
DEPENDENT ON BLOOD SUPPLY
FOR GROWTH AND IT'S RECENTLY
RECOGNIZED THEY NEED TO
DEVELOP NEW BLOOD VESSELS TO
GROW.
SO THERE'S A CONCERN THAT IF
SOMEBODY HAD A CANCER, AND
YOU WERE TO GIVE THEM THAT
GENE, YOU COULD INCREASE THE
RATE OF GROWTH OF THE
CANCER.
IT'S IMPORTANT TO KNOW IT
WON'T CAUSE CANCER.
THERE'S NO REASON TO THINK
THAT THESE GENES WOULD
ACTUALLY PRODUCE A CANCER
BUT IF THE CANCER WAS THERE
IT COULD ACCELERATE THE
GROWTH.

Jack looks through a photo album and says OH, AUGUST '78.
THIS IS THE MET TREE POLICE
MARATHON.

Maureen says JACK WAS CAREFULLY
SCREENED TO QUALIFY FOR THIS
TRIAL AND WAS WARNED OF THE
RISKS.

Jack says THEY TESTED MY BLOOD FOR
CANCER MARKERS.
I HAD AN ULTRASOUND ON MY
PROSTATE, I HAD A BIOPSY ON
MY PROSTATE.
I HAD MY EYES EXAMINED AND
FLASH PICTURES TAKEN IN
THEM.
AID DERMATOLOGIST GO OVER MY
WHOLE BODY FOR ANY SIGNS OF
UNUSUAL MOLES.

Maureen says JACK HAD ONE MORE HEART
BY PASS, BUT THIS TIME
DOCTORS INJECTED A GENE INTO
THOSE ARTERIES THAT WERE TOO
BLOCKED TO BY PASS.
Dr. STEWART HAS HIGH HOPES
FOR THIS AS A TREATMENT FOR
HEART DISEASE.

Dr. Duncan Stewart says THEORETICALLY, WE WOULD
ONLY NEED TO GIVE THE GENE
ONCE AND YOU COULD
THEORETICALLY HAVE THAT GENE
PRODUCED BY THE CELLS FOR
THE REST OF THE PATIENT'S
LIFE AND THEREFORE ONE
THERAPY COULD FIX THE
PROBLEM, IF YOU WILL.
AND GIVE YOU A THERAPEUTIC
EFFECT THAT COULD BE LONG
LASTING.

Maureen says THREE MONTHS
AFTER SURGERY, JACK HAD AN
ANGLE ANGIOGRAM TO SEE IF
THERE'D BEEN ANY CHANGE.

Dr. Duncan Stewart points at an X-ray and says YOU CAN SEE THE BY PASS
GRAFT, A VERY SMALL BRANCH
HERE AND THESE LITTLE
VESSELS HERE WERE NOT THERE
PREVIOUSLY, THEY'RE NEW,
QUITE LONG, EXTEND ALL THE
WAY THROUGH HERE AND
RECONSTITUTE AT THIS BRANCH
RIGHT HERE, SUPPLYING BLOOD
TO THE INFERIOR PART OF THE
WALL WHERE HE DIDN'T HAVE
ANY BLOOD SUPPLY BEFORE.

Jack says THEY WERE VERY EXCITED
ABOUT THIS, BECAUSE THEY
DIDN'T EXPECT TO SEE IT.
BECAUSE IT -- THEY HAD TOLD
ME BEFORE THE ANGIOGRAM THAT
THEY DIDN'T EXPECT THE ANGIOGRAM
WOULD MAGNIFY ENOUGH TO SHOW
THESE LITTLE ARTERIES, SO
THEY WERE EXCITED ABOUT IT
AND I IN TURN WAS VERY
EXCITED MYSELF.
I THINK BEFORE THIS LAST
SURGERY, I WAS BEGINNING TO
FEEL LIKE AN OLD MAN.
BECAUSE THERE WAS SO MANY
THINGS THAT I COULDN'T DO.
I COULDN'T SHOVEL SNOW, I
COULDN'T CUT THE LAWN.
NOW I FEEL -- I ACTUALLY
FEEL YOUNGER.
I FEEL YOUNGER.

Maureen says THAT’S IT FOR THIS EDITION
OF MORE TO LIFE. I’M
MAUREEN TAYLOR INVITING YOU TO JOIN US
MONDAY THROUGH FRIDAY FOR
GREAT TOPICS AND GUESTS AT ONE O’CLOCK.

A disclaimer slide appears on screen with a female narrator that reads “The advice given in the preceding program is of a general nature only. Viewers should consult their own medical professional for medical advice specific to their circumstances.

Watch: Heart Health