1. 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

2. 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.

3. 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.

4. 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.

5. 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

6. 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

7. 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

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

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

10. Heart’s Electrical Conduction
The Sinoatrial node or pacemaker beats
times per minute
Atrioventricular node can beat times per minute as a backup
Bundle of His and Ventricles can beat times per minute as a further backup

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. Heart Attack Occurs

19. Other Medical Conditions
Atrial Fibrillation
Heart Failure

20. 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

21. 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

22. 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

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

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

25. Diagnostic Tests

26. 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

27. Diagnostic testing – for the legs and head
Doppler studies
Angiograms

28. Treatments

29. Interventions
Angioplasty
Stent

30. 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

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

32. Angioplasty and stent

33. Surgical Procedures

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

35. 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.

36. 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

37. 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

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

39. 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

40. 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

41. 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

42. 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

43. Any Questions?