LECTURES

Ottawa Heart Institute Alumni Fall Lecture
October 21, 2002

"What's Hot in Cardiac Research at the Heart Institute"
Dr. Lyall Higginson

Over 110 people gathered on Monday evening, October 21, 2002 to hear Dr. Lyall Higginson describe the exciting research advances in cardiology, many of them a part of research at the University of Ottawa Heart Institute.

President Jim Phillips welcomed the Members present and, before introducing Dr. Higginson, reported on some of the activities of the Alumni. This year over $195,000 has been committed to the work of the Institute. We have supported the acquisition of a dialysis machine, 10 more high tech patient beds, operating room equipment, and nurse training. Jim thanked Dennis Doucette for his leadership in setting up the fine new Association Web Site that can be found at www.ottawaheartalumni.ca. He urged members to get on their computers and check out this news-filled site.

President Jim Phillips asked Members to note the date of the next Annual General Meeting of the Association to be held on June 10, 2003. This meeting is always a sell-out popular event and will be even more so with the announcement that the speaker will be Rod Bryden, President of both World Heart and the Ottawa Senators. Bryden has assured Jim that he will be at our AGM even if the Senators are playing in the Stanley Cup that evening.

Heather Campbell introduced Dr. Higginson who commenced by thanking the members of the Association for their strong support over the years. One of the strengths of the Institute, he said, was its strong contact with the local community.

Dr. Higginson began by reminding the audience of some interesting figures. The Institute has an annual operating budget of $70 million, has a catchment area population (from Eastern Ontario and Western Quebec) of 1.8 million people, and spends $18 million annually on research.

Acute Myocardial Infarction

Dr. Higginson first spoke about Acute Myocardial Infarction (AMI), a heart attack, the most common cause of death, and what should be the response. There are two options: a clot busting medication, or a balloon and stent. The most important issue is the promptness of therapy.

The number of lives saved is dramatically increased by prompt (less than 45 minutes) use of a clot buster. Thus, the use of a clot buster right in the ambulance is being studied. Even with all of these advances, Dr. Higginson reminded the audience that aspirin is still an important first response to the onset of a heart attack.

Interventional Cardiology

A major problem with stents in the past has been that up to 25% renarrow. Fortunately, a new stent that is coated with a medication that inhibits renarrowing is beginning to become available. It represents a huge advance in cardiac treatment. That's the good news. The bad news is that these new stents cost $3000 and, so far, are not eligible for government funding.

Atrial Septal Defect (A congenital hole between cardiac chambers)

There is a great new technique for closing holes that exists from birth between chambers in the heart. It's an umbrella! Cardiologists at the Heart Institute are employing a technique of inserting two miniature umbrellas into the fermoral vein at the groin and guiding it up and into the heart. There, an umbrella is opened over the hole on one side of the wall, and another umbrella opened on the other side of the wall over the same hole. The catheter, that got the whole assembly into the heart, is disconnected and withdrawn, and soon the two umbrellas are merged right into the atrial wall sealing the defect.

Positron Emission Tomography - PET

A dedicated Cardiac PET unit is another Heart Institute first for Canada. Cardiologists inject a nuclear chemical (guaranteed not to go off in a mushroom cloud) into the heart in order to be able to get a very detailed look at the heart. The resulting image is sufficiently detailed to determine, more precisely, whether the heart would benefit from by-pass surgery or whether a transplant is necessary.

Cardiac Resynchronization

Cardiac Heart Failure (CHF) is sometimes aggravated by the heart's electrical system going awry. The electrical signals that cause the two sides of the heart to work together in a traditional rhythm get out of synchronization, and the heart muscles become a jumbled dysfunction. The Institute cardiologists have pioneered the use of innovative pacemaker-leads, one attached to each side of the heart, to control the heart so that both sides work in synchronization.

Neuro Stimulation for Chronic Refractory Angina

When a patient has severe angina pectoris, and other methods of treatment have not produced relief, the cardiologists at the Institute are investigating a technique whereby an electrical stimulator is introduced close to the spinal cord through the back so that the electrical signal generated reduces the pain significantly. Thus the patient is able to maintain a reasonable level of activity and quality of life.

Intraoperative Protection

Sometimes, when a patient has been on a heart lung machine, there is a postoperative mental impairment. The Institute scientists are studying ways to reduce the likelihood of such postoperative complications.

Cardiac Rehabilitation

The Institute is doing research designed to address such questions as how long should a cardiac rehabilitation program be? Is it best done at the rehab centre, or does a home-based program work as well?

Genetics

Genetic research is an exploding are. One example of future benefit lies in the area of medications we use. At present, heart patients receive a cocktail of medication that was developed by research on a large group of people. It has been proven to work on the group. But each person is genetically different and each may not need every medication in the cocktail. At present we don't know precisely who needs what. But someday we will each carry a document with our genetic code and cardiologists will be able to design a medication program for each specific individual. This will reduce the number of drugs we have to take and reduce the cost of health care.

Angiogenesis

An exciting new development now being tried on an experimental basis is the injection into the heart of a genetic compound designed to induce the heart to grow new arteries. It's too early to assess yet, but think of the potential.

Now after all that don't you wish that you were there too?

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