tag:theconversation.com,2011:/ca/topics/heart-8993/articlesHeart – The Conversation2024-03-25T20:27:48Ztag:theconversation.com,2011:article/2261302024-03-25T20:27:48Z2024-03-25T20:27:48ZCardiovascular risks and COVID-19: New research confirms the benefits of vaccination<figure><img src="https://images.theconversation.com/files/584210/original/file-20240325-19-khbs3w.jpg?ixlib=rb-1.1.0&rect=404%2C85%2C2191%2C1576&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Common cardiovascular complications of COVID-19 — including blood clots, stroke, arrhythmias and heart attacks — were substantially reduced in vaccinated patients.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>COVID-19 is a respiratory disease. Yet, from the earliest days of the pandemic, the <a href="https://doi.org/10.1161/CIRCRESAHA.121.317997">cardiovascular risks associated with SARS-CoV-2 infection</a> were clear: individuals with severe cases of COVID-19 often died from cardiovascular complications, and those with pre-existing cardiovascular disease were more likely to have severe illness or die. </p>
<p>In short, the cardiovascular system has played a central role in COVID-19 since the beginning.</p>
<p>It is not surprising that as debate over COVID-19 and vaccines flared that <a href="https://www.ctvnews.ca/health/coronavirus/cardiologists-weigh-in-on-whether-covid-19-or-vaccines-pose-a-greater-risk-of-heart-problems-1.6293061">cardiovascular disease was a central issue</a>. Those opposed to vaccination often make claims of cardiovascular risks that exceed any benefits. But when data on COVID-19, vaccines and cardiovascular health are reviewed, the conclusions are clear: vaccines are safe and effective at reducing the cardiovascular complications that are a hallmark of COVID-19.</p>
<h2>Hot off the presses</h2>
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<img alt="A person's arm and shoulder, with a small bandage on the upper arm and the other hand holding a heart with a syringe drawn on it" src="https://images.theconversation.com/files/584211/original/file-20240325-20-7px5a5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/584211/original/file-20240325-20-7px5a5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/584211/original/file-20240325-20-7px5a5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/584211/original/file-20240325-20-7px5a5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/584211/original/file-20240325-20-7px5a5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/584211/original/file-20240325-20-7px5a5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/584211/original/file-20240325-20-7px5a5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">A new study found that common cardiovascular complications of COVID-19 were substantially reduced in people who were vaccinated, with protective effects lasting up to a year after vaccination.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>A new <a href="https://doi.org/10.1136/heartjnl-2023-323483">study of 20.5 million people</a> in the United Kingdom, Spain and Estonia used electronic health records to determine how COVID-19 vaccines affect cardiovascular complications following SARS-CoV-2 infection. Roughly the same number of vaccinated and unvaccinated subjects were included, and the vaccinated group consisted of people who received at least one of the AstraZeneca, Pfizer, Moderna or Janssen vaccines. </p>
<p>The study found that common cardiovascular complications of COVID-19 — including blood clots, stroke, arrhythmias and heart attacks — were substantially reduced in the vaccinated group, with protective effects lasting up to a year after vaccination.</p>
<h2>Bigger picture</h2>
<p>While this most recent study represents one of the most comprehensive investigations into the cardiovascular benefits of COVID-19 vaccination, its findings are consistent with earlier, smaller studies. </p>
<p>A <a href="https://doi.org/10.1001/jama.2022.12992">2022 study of 231,037 people</a> found two doses of COVID-19 vaccines reduced the risk of stroke and heart attack up to four months after a breakthrough infection. </p>
<p>A subsequent <a href="https://doi.org/10.1016/j.jacc.2022.12.006">study of 1.9 million people</a> found that while two doses of the mRNA vaccines or one dose of the Johnson & Johnson vaccine protected against major cardiovascular events following COVID-19, even a single dose of the mRNA vaccines offered some benefit in reducing the risk of cardiovascular complications.</p>
<p>Health-care decisions require a weighing of the risk and benefits of treatments, and for COVID-19 vaccines the low cardiovascular risks favour vaccination. A <a href="https://doi.org/10.1161/CIRCULATIONAHA.122.063753">study of over four million vaccinated Australians</a> found no increase in sudden cardiac death. Even <a href="https://doi.org/10.1161/CIRCHEARTFAILURE.123.010617">patients with pre-existing heart failure</a> do not have an increased risk of worsening heart failure, myocarditis, or blood clots following vaccination.</p>
<h2>Weighing the risks</h2>
<p>Although the safety of COVID-19 vaccines is well-established, it does not mean there are no risks. A <a href="https://doi.org/10.1016/j.vaccine.2024.01.100">review of 99 million individuals in the Global Vaccine Data Network</a> confirmed earlier studies that found an increased risk of myocarditis and pericarditis, which is seen primarily in young males — historically the group most at risk for myocarditis before COVID-19 emerged. </p>
<p>While individuals at higher risk for these complications should consult with their health-care providers in making decisions about vaccination, it should be noted that the risk for myocarditis and pericarditis is generally higher with COVID-19, even in this cohort.</p>
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Read more:
<a href="https://theconversation.com/myocarditis-covid-19-is-a-much-bigger-risk-to-the-heart-than-vaccination-174580">Myocarditis: COVID-19 is a much bigger risk to the heart than vaccination</a>
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<p>Studies have also found that extending the time between first and second doses of the COVID-19 mRNA vaccines beyond the initially recommended three-week interval <a href="https://doi.org/10.1001/jamanetworkopen.2022.18505">decreases the risk of myocarditis</a>. Furthermore, <a href="https://doi.org/10.1016/j.hfc.2022.08.012">post-vaccine myocarditis</a> tends to be transient with very good recovery and is less severe than that associated with COVID-19.</p>
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<img alt="A health-care provider putting a bandage on a young man's arm" src="https://images.theconversation.com/files/584013/original/file-20240325-28-sqfpke.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/584013/original/file-20240325-28-sqfpke.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/584013/original/file-20240325-28-sqfpke.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/584013/original/file-20240325-28-sqfpke.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/584013/original/file-20240325-28-sqfpke.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/584013/original/file-20240325-28-sqfpke.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/584013/original/file-20240325-28-sqfpke.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Studies have found that extending the time between first and second doses of the COVID-19 mRNA vaccines beyond the initially recommended three-week interval decreases the risk of myocarditis.</span>
<span class="attribution"><span class="source">(CDC)</span></span>
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<p>The risk of myocarditis in young people has led some to claim that the benefits of COVID-19 vaccines are negated when stacked up against the chance of heart inflammation. A <a href="https://doi.org/10.1161/CIR.0000000000001064">statement from the American Heart Association</a> confirms that the risks of cardiovascular complications in young people with more mild cases of COVID-19 (symptoms lasting less than four days) are low, but notes that there are concerning signs for those who experience more severe illness with infection. </p>
<p>Furthermore, other cardiovascular risks associated with infection must be considered in weighing risks and benefits. These include <a href="https://www.cdc.gov/mis/about.html">multisystem inflammatory syndrome</a> or “MIS-C” and cardiac arrhythmias — a far more common risk of COVID-19 than myocarditis. </p>
<p>Finally, <a href="https://www.axios.com/2020/03/20/twitter-lets-musks-coronavirus-misinformation-stand">the claim that COVID-19 is harmless in children</a> is not true: <a href="https://doi.org/10.25318/1310039401-eng">in Canada</a> COVID-19 is the sixth leading cause of death for children aged one to 14 years, and tenth for people 15 to 19 years old. Overall, studies find that <a href="https://www.acc.org/latest-in-cardiology/articles/2022/02/09/12/56/vaccine-associated-myocarditis-risk-in-context">even in young people the benefits of vaccination exceed the risks</a>, particularly when it comes to cardiovascular disease.</p>
<h2>Take to heart</h2>
<p>There are individuals whose health conditions <a href="https://www.who.int/emergencies/diseases/novel-coronavirus-2019/covid-19-vaccines/advice">preclude COVID-19 vaccination</a>, and others for whom health risks may outweigh the benefits. But, for the vast majority of people — including young and otherwise healthy people — COVID-19 vaccination is not only safe, but the cardiovascular protection it offers could be life-saving.</p><img src="https://counter.theconversation.com/content/226130/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Glen Pyle receives funding from the Heart and Stroke Foundation of Canada, Canadian Institutes of Health Research, and the Natural Sciences and Engineering Research Council of Canada. He is a on the advisory board of "Royal City Science" and "Science Up First".</span></em></p>New research confirms that COVID-19 vaccines are safe and effective at reducing the cardiovascular complications that are a hallmark of COVID-19 infection.Glen Pyle, Member, IMPART (Initiative on Medication Management, Policy Analysis, Research & Training), Dalhousie UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2243502024-03-15T12:11:36Z2024-03-15T12:11:36ZPacemaker powered by light eliminates need for batteries and allows the heart to function more naturally − new research<figure><img src="https://images.theconversation.com/files/580746/original/file-20240308-16-3gcx17.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2000%2C1500&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Scientists have designed a solar panel-like pacemaker that can precisely control heartbeats.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/female-silhouett-and-heart-with-pacemaker-royalty-free-image/1490726996">Eugene Mymrin/Moment via Getty Images</a></span></figcaption></figure><p>By harnessing light, my colleagues <a href="https://scholar.google.com.sg/citations?user=hO6bRlwAAAAJ&hl=en">and I</a> designed a wireless, ultrathin pacemaker that operates like a solar panel. This design not only eliminates the need for batteries but also minimizes disruptions to the heart’s natural function by molding to its contours. Our research, recently <a href="https://doi.org/10.1038/s41586-024-07016-9">published in the journal Nature</a>, offers a new approach to treatments that require electrical stimulation, such as heart pacing.</p>
<p><a href="https://theconversation.com/how-do-pacemakers-and-defibrillators-work-a-cardiologist-explains-how-they-interact-with-the-electrical-system-of-the-heart-217429">Pacemakers are medical devices</a> implanted in the body to regulate heart rhythms. They’re composed of electronic circuits with batteries and leads anchored to the heart muscle to stimulate it. However, leads can fail and damage tissue. The location of the leads can’t be changed once they’re implanted, limiting access to different heart regions. Because pacemakers use rigid, metallic electrodes, they may also damage tissue when <a href="https://www.nhlbi.nih.gov/health/heart-surgery/during">restarting the heart after surgery</a> or <a href="https://www.mayoclinic.org/diseases-conditions/heart-arrhythmia/symptoms-causes/syc-20350668">regulating arrhythmia</a>.</p>
<p>Our team envisioned a leadless and more flexible pacemaker that could precisely stimulate multiple areas of the heart. So we designed a device that <a href="https://doi.org/10.1038/s41586-024-07016-9">transforms light into bioelectricity</a>, or heart cell-generated electrical signals. Thinner than a human hair, our pacemaker is made of an optic fiber and silicon membrane that the <a href="https://tianlab.uchicago.edu/">Tian lab</a> and colleagues at the University of Chicago <a href="https://pme.uchicago.edu/">Pritzker School of Molecular Engineering</a> have spent years developing. </p>
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<figcaption><span class="caption">Like solar panels, this pacemaker is powered by light.</span></figcaption>
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<p>Unlike <a href="https://www.energy.gov/eere/solar/solar-photovoltaic-cell-basics">conventional solar cells</a> that are usually designed to collect as much energy as possible, we tweaked our device to generate electricity only at points where light strikes so it can precisely regulate heartbeats. We did this by using a layer of very small pores that can trap light and electrical current. Only cardiac muscles exposed to light-activated pores are stimulated.</p>
<p>Because our device is so small and light, it can be implanted without opening the chest. We were able to <a href="https://doi.org/10.1038/s41586-024-07016-9">successfully implant it</a> in the hearts of rodents and an adult pig, pacing the beats of different heart muscles. Because <a href="https://theconversation.com/organs-from-genetically-engineered-pigs-may-help-shorten-the-transplant-wait-list-175893">pig hearts</a> are anatomically similar to human hearts, this accomplishment shows our device’s potential to translate to people.</p>
<h2>Why it matters</h2>
<p>Heart disease is the <a href="https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death">leading cause of death around the world</a>. Annually, <a href="https://www.nhlbi.nih.gov/health/heart-surgery">over 2 million people</a> undergo open-heart surgery to treat heart problems, including to <a href="https://theconversation.com/how-do-pacemakers-and-defibrillators-work-a-cardiologist-explains-how-they-interact-with-the-electrical-system-of-the-heart-217429">implant devices</a> that regulate heart rhythms and prevent heart attacks.</p>
<p>Our ultralight device gently conforms to the surface of the heart, enabling less invasive stimulation and improved pacing and synchronized contraction. To reduce postoperative trauma and recovery time, our device can be implanted with a minimally invasive technique.</p>
<h2>What still isn’t known</h2>
<p>Currently, our technology is best first used for urgent heart conditions, including restarting the heart after surgery, heart attack and ventricular defibrillation. We continue to explore its long-term effects and durability in the human body.</p>
<p>The body’s internal environment is <a href="https://doi.org/10.1017/jfm.2022.272">rich in fluids</a> that are disturbed by the heart’s constant mechanical motion. This could potentially compromise the device’s functionality over time. </p>
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<a href="https://images.theconversation.com/files/580750/original/file-20240308-28-ptbgx3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="ECG reading of patient with pacemaker syndrome" src="https://images.theconversation.com/files/580750/original/file-20240308-28-ptbgx3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/580750/original/file-20240308-28-ptbgx3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=303&fit=crop&dpr=1 600w, https://images.theconversation.com/files/580750/original/file-20240308-28-ptbgx3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=303&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/580750/original/file-20240308-28-ptbgx3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=303&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/580750/original/file-20240308-28-ptbgx3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=380&fit=crop&dpr=1 754w, https://images.theconversation.com/files/580750/original/file-20240308-28-ptbgx3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=380&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/580750/original/file-20240308-28-ptbgx3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=380&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Pacemaker syndrome is a condition that develops from stimulating heart muscles in isolation.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:E00031141_(CardioNetworks_ECGpedia).jpg">Michael Rosengarten BEng, MD.McGill/EKG World Encyclopedia via Wikimedia Commons</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
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<p>Moreover, researchers don’t fully understand how the body reacts to prolonged exposure to medical devices. The formation of <a href="https://theconversation.com/implants-like-pacemakers-and-insulin-pumps-often-fail-because-of-immune-attacks-stopping-them-could-make-medical-devices-safer-and-longer-lasting-211090">scar tissue</a> around the device after implantation can diminish its sensitivity. We are developing special surface treatments and biomaterial coatings to decrease the likelihood of rejection. </p>
<p>Although the breakdown of our device results in a nontoxic substance the body can safely absorb called <a href="https://doi.org/10.1038/s41578-020-0230-0">silicic acid</a>, evaluating how the body responds to extended implantation is essential to ensure safety and effectiveness.</p>
<h2>What’s next</h2>
<p>To achieve long-term implantation and tailor the device to each patient, we are refining the rate at which it dissolves naturally in the body. We are exploring enhancements to make the device compatible as a wearable pacemaker. This involves integrating a wireless light-emitting diode, or LED, beneath the skin that is connected to the device via an optical fiber.</p>
<p>Our ultimate goal is to broaden the scope of what we call photoelectroceuticals beyond cardiac care. This includes <a href="https://theconversation.com/brain-stimulation-can-rewire-and-heal-damaged-neural-connections-but-it-isnt-clear-how-research-suggests-personalization-may-be-key-to-more-effective-therapies-182491">neurostimulation</a>, neuroprostheses and pain management to treat neurodegenerative conditions such as <a href="https://www.parkinson.org/understanding-parkinsons/statistics">Parkinson’s disease</a>. </p>
<p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take on interesting academic work.</em></p><img src="https://counter.theconversation.com/content/224350/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Pengju Li consults to the Pritzker School of Molecular Engineering. He receives funding from the University of Chicago.</span></em></p>Researchers designed an ultrathin pacemaker that can be implanted via minimally invasive techniques, potentially improving recovery time and reducing the risk of complications.Pengju Li, Ph.D. Candidate in Molecular Engineering, University of Chicago Pritzker School of Molecular EngineeringLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2230802024-02-28T22:11:57Z2024-02-28T22:11:57ZStop breaking women’s hearts at work: 7 ways to make workplaces better for cardiovascular health<figure><img src="https://images.theconversation.com/files/578772/original/file-20240228-20-3fdqgt.jpg?ixlib=rb-1.1.0&rect=1581%2C73%2C6597%2C4329&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Research shows women are at higher risk for burnout and psychological, emotional and physical stress in the workplace in comparison to their male counterparts.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Prominent heart health messaging focuses on the <a href="https://www.heartandstroke.ca/stroke/recovery-and-support/make-healthy-choices#:%7E:text=Be%20more%20active,disease%20and%20stroke%20by%2030%25.">role of lifestyle behaviours</a> (such as physical activity and nutrition) in cardiovascular health. However, the role of <a href="https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1">social determinants of health</a> (or SoDH) — which include sex, gender, poverty, environment — is also well established. SDoH not only directly impact <a href="https://doi.org/10.1161/circresaha.121.319811">risk and progression</a> of heart disease, <a href="https://doi.org/10.1016/j.ajmo.2023.100047">but also health outcomes</a>.</p>
<p>Certain types of heart disease are <a href="https://www.heartandstroke.ca/what-we-do/media-centre/news-releases/system-failure-womens-heart-and-brain-health-are-at-risk">significantly more common in women</a>, compared to men. Moreover, compared with their non-Black counterparts, heart health for Black women is differentiated by a heavier burden of traditional risk factors, earlier development of the disease and nearly 20 per cent higher <a href="https://onlinecjc.ca/article/S0828-282X(23)01619-7/abstract#:%7E:text=Compared%20with%20their%20nonblack%20counterparts,higher%20rates%20of%20cardiovascular%20mortality.">rates of cardiovascular mortality</a>. </p>
<h2>Women, work and heart health</h2>
<p>Canadians spend an average of 7.5 hours per day at work, translating to roughly half of our waking hours. Several researchers have shown a relationship between <a href="https://www.hsph.harvard.edu/news/press-releases/increasing-workplace-flexibility-associated-with-lower-risk-of-cardiovascular-disease/">workplace and heart health</a>. For instance, <a href="https://doi.org/10.2105/ajph.2023.307413">research has linked</a> increased workplace flexibility (hybrid models, flexible schedule) with lower risk of cardiovascular disease. </p>
<p>Research also shows women are at higher risk for burnout and psychological, emotional and physical stress in the workplace <a href="https://www.cnbc.com/2023/03/14/burnout-is-on-the-rise-gen-z-millennials-and-women-are-the-most-stressed.html#:%7E:text=Two%20types%20of%20people%2C%20however,burnout%20than%20men%20(37%25)">in comparison to their male counterparts</a>. This disproportionate burden has been attributed to several factors in and outside the workplace, inextricably linked to <a href="https://doi.org/10.3389/fpsyg.2015.01400">gender roles, sexism, racism, ageism and misogyny</a>. For instance, women are more likely to experience gender-based violence, assumptions about gender-roles, and higher cognitive and emotional workload in and out of work. </p>
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<img alt="A woman bringing a mug to an older woman" src="https://images.theconversation.com/files/578728/original/file-20240228-22-q2iddp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/578728/original/file-20240228-22-q2iddp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/578728/original/file-20240228-22-q2iddp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/578728/original/file-20240228-22-q2iddp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/578728/original/file-20240228-22-q2iddp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/578728/original/file-20240228-22-q2iddp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/578728/original/file-20240228-22-q2iddp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Many women balance paid work with gendered labour in the home and care-taking roles.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Once again, these burdens are <a href="https://www.mckinsey.com/ca/%7E/media/mckinsey/locations/north%20america/canada/gender%20diversity%20at%20work/gender_diversity_at_work_in_canada.pdf">higher in equity-deserving groups</a>, especially for women experiencing <a href="https://www.mckinsey.com/featured-insights/diversity-and-inclusion/women-in-the-workplace">intersectional forms of discrimination</a>, such as <a href="https://canadianwomen.org/wp-content/uploads/2021/04/Resetting-Normal-Gender-Intersectionality-and-Leadership-Report-Final-EN.pdf">racism, colonialism, ableism and homophobia</a>. </p>
<p>It should not come as a surprise then that almost 90 per cent of reported <a href="https://www.health.harvard.edu/heart-health/takotsubo-cardiomyopathy-broken-heart-syndrome#:%7E:text=More%20than%2090%25%20of%20reported,no%20long%2Dterm%20heart%20damage.">stress-induced heart disease</a> — or “<a href="https://www.heart.org/en/news/2021/10/13/broken-heart-syndrome-is-on-the-rise-especially-among-older-women">broken heart syndrome</a>” — is found among women, and five per cent of women suspected of having a heart attack actually have this disorder.</p>
<p>Women are often the heart of their communities, and assume multiple, and intersecting, gendered social roles. For instance, many balance paid work, with <a href="https://cdn.dal.ca/content/dam/dalhousie/pdf/diff/ace-women-health/Healthy%20Balance/ACEWH_hbrp_thinking_it_through_women_work_caring_new_millennium.pdf">gendered labour in the home and in care-taking roles</a>. To make matters worse, women are then <a href="https://hbr.org/2022/04/stop-framing-wellness-programs-around-self-care">bombarded with wellness and self-management messaging</a> that tells them they are <a href="https://www.psychologytoday.com/ca/blog/the-psychology-of-weight-loss/202308/going-on-vacation-wont-cure-your-burnout">responsible for managing stress</a> and <a href="https://www.psychologytoday.com/ca/blog/the-psychology-of-weight-loss/202306/the-burnout-burger">risk in a “healthy” way</a>.</p>
<p>In terms of workplace health, women and equity-deserving groups have been compared to the “canary in the mine.” Canaries were traditionally used in coal mines to detect the presence of carbon monoxide. The bird would succumb to the toxicity before the miners, thereby providing time to take action. </p>
<p>However, psychologists Christina Maslach and Michael P. Leiter <a href="https://www.hup.harvard.edu/books/9780674251014">make an important point</a>: No one ever declared that the canaries needed to be more resilient or do more self-care to be less susceptible to the influence of carbon monoxide.</p>
<p>Women make up over half of the population, yet continue to be <a href="https://doi.org/10.1016%2Fj.neuron.2021.06.002">under-represented in the workplace in several ways</a>, including <a href="https://canadianwomen.org/the-facts/women-and-leadership-in-canada/#:%7E:text=Women%20are%2030%25%20less%20likely,%2C%20report%20finds%2C%202017">leadership and positions of influence</a>. </p>
<h2>Creating heart-healthy workplaces</h2>
<figure class="align-center ">
<img alt="A woman at a desk looking at a tablet" src="https://images.theconversation.com/files/578730/original/file-20240228-24-sbksv1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/578730/original/file-20240228-24-sbksv1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=379&fit=crop&dpr=1 600w, https://images.theconversation.com/files/578730/original/file-20240228-24-sbksv1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=379&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/578730/original/file-20240228-24-sbksv1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=379&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/578730/original/file-20240228-24-sbksv1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=476&fit=crop&dpr=1 754w, https://images.theconversation.com/files/578730/original/file-20240228-24-sbksv1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=476&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/578730/original/file-20240228-24-sbksv1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=476&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Hybrid work models can increase productivity and workers’ locus of control and support flexible hours.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Workplaces can have a positive impact on women’s health by ensuring knowledge about women and heart disease is translated into actions that support prevention and treatment. Here are seven evidence-based recommendations for co-creating heart-healthy workplaces:</p>
<ol>
<li><p><strong>Flexible hours</strong>: <a href="https://doi.org/10.1177/0002716211415608">Inflexible work schedules</a> have been shown to increase stress for <a href="https://workplaceinsight.net/working-mothers-disproportionately-more-stressed-study-claims/">women and families</a> — including stressors transmitted to children. Effective “flex hours” initiatives (for example, flex hours to support physical activity) show <a href="https://www.nhlbi.nih.gov/news/2023/workplace-flexibility-may-support-cardiovascular-health">positive impact on workers’ heart health</a>, physical activity and sleep patterns, especially in adults ages 45 and older and for those who had increased cardiovascular disease risks.</p></li>
<li><p><strong>Flexible hybrid work models</strong>: Evidence on hybrid work models has grown exponentially since March 2020. It appears that when using a non-fixed, worker-led approach, hybrid work models can <a href="https://www.hsph.harvard.edu/news/press-releases/increasing-workplace-flexibility-associated-with-lower-risk-of-cardiovascular-disease/">increase productivity, workers’ locus of control and support flexible hours</a>. Research supports that women are more likely to use this option, when offered, but also highlights that when employers fail to monitor impact, or properly design jobs for hybrid and remote working, <a href="https://www.theguardian.com/society/2022/sep/25/hybrid-working-may-hold-back-womens-careers-say-managers">hybrid work models can augment gender pay and promotion gaps</a>. </p></li>
<li><p><strong>Invest in psychological safety</strong>: A <a href="https://theconversation.com/fostering-psychological-safety-in-the-workplace-4-practical-real-life-tips-based-on-science-204661">psychologically safe workplace</a> is where employees feel comfortable taking risks and being themselves without fear of judgement, lateral violence (for example stonewalling, bullying) or negative consequences. Psychological safety is positively associated with workplace engagement, innovation, job performance and job satisfaction — all desirable outcomes for institutions, organizations, the bottom line, clients and the community. </p></li>
<li><p><strong>Offer health benefits</strong>: Mandatory benefits, also known as statutory benefits, are <a href="https://novascotia.ca/lae/employmentrights/docs/labourstandardscodeguide.pdf">required by Canadian employment law</a>. They include provincial health-care coverage, pension contributions, employment insurance, survivor insurance and workers’ compensation insurance. <a href="https://velocityglobal.com/resources/blog/employee-benefits-in-canada">Supplementary benefits</a> help attract and retain workers. Examples include dental care, medication insurance, disability insurance and many complementary medicine services. These <a href="https://doi.org/10.1007%2FBF03403639">supplementary benefits</a> have been associated with <a href="https://doi.org/10.1001/jamanetworkopen.2022.33020">improved health outcomes</a>, and <a href="https://www.who.int/news-room/fact-sheets/detail/universal-health-coverage-(uhc)">reduced chronic disease risk</a>.</p></li>
<li><p><strong>Invest in programs supporting health promotion</strong>: In addition to the examples above, <a href="https://www.cdc.gov/workplacehealthpromotion/initiatives/resource-center/pdf/WHRC-Workplace-Best-Practices-for-Heart-Healthy-Employees-508.pdf">workplaces can invest</a> in programming that supports health-promoting behaviours in and out of work. <a href="https://doi.org/10.1097/jom.0000000000000467">Such programming</a> has been associated with workplace satisfaction, productivity and favourable health-related outcomes. Additional examples of health promotion include health risk appraisals, lunch and learns, flexible and inclusive leave options, and time off for leisure activities, spiritual practices, volunteering or community engagement. </p></li>
<li><p><strong>Engage in collective conflict resolution strategies</strong>: Evidence supports that <a href="https://www.ncbi.nlm.nih.gov/books/NBK470432/">collaborative conflict resolution</a> approaches, like mediation, can provide a positive learning opportunity for those involved. This encourages workers to find a solution together, <a href="https://demlegaleagle.com/blog/2020/12/3-ways-workplace-mediation-may-beat-discipline/">rather than via formal disciplinary action</a>, where the root causes of conflict often go unaddressed.</p></li>
<li><p><strong>Commit to policy, procedure and protocols that combat ‘isms’</strong>: Ibram X. Kendi’s book, <a href="https://www.ibramxkendi.com/how-to-be-an-antiracist"><em>How To Be An Antiracist</em></a>, provides rationale and examples for how to ensure policy and procedures are anti-racist. Adopting this approach requires a significant, but worthwhile investment, learning and unlearning, but gains can be made through small changes. Workplaces can also adopt policies that combat other forms of discrimination, including ageism and sexism. For instance, several employers have started to <a href="https://www.indeed.com/career-advice/resumes-cover-letters/stay-at-home-mom-resume">encourage applicants</a> to <a href="https://www.forbes.com/sites/forbescoachescouncil/2023/02/24/how-stay-at-home-parents-returning-to-work-can-overcome-common-barriers/?sh=f500d7f2c091">report “stay at home mom” as part of their work experience</a>, and the several transferable skills this experience offers.</p></li>
</ol>
<figure class="align-right ">
<img alt="A yellow canary perched on a branch" src="https://images.theconversation.com/files/578731/original/file-20240228-18-alxd70.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/578731/original/file-20240228-18-alxd70.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=545&fit=crop&dpr=1 600w, https://images.theconversation.com/files/578731/original/file-20240228-18-alxd70.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=545&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/578731/original/file-20240228-18-alxd70.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=545&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/578731/original/file-20240228-18-alxd70.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=685&fit=crop&dpr=1 754w, https://images.theconversation.com/files/578731/original/file-20240228-18-alxd70.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=685&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/578731/original/file-20240228-18-alxd70.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=685&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Integrating health and safety strategies is a better option for workers than waiting until the ‘canary’ expires.</span>
<span class="attribution"><span class="source">(Pixabay)</span></span>
</figcaption>
</figure>
<p>Rather than waiting until the canary in the workplace coal mine expires, <a href="https://doi.org/10.1097/jom.0000000000000467">evidence shows</a> there are options available to integrate health and safety strategies that achieve measurable benefits to enhance the overall health and well-being of workers, their families and the community. </p>
<p>In acknowledging that factors like the built environment, social and health systems, and outdated policies are the problems needing to be addressed — rather than people, including women, those living with disability, and equity-deserving groups — we take a step towards healthier, safer and more accessible workplaces.</p><img src="https://counter.theconversation.com/content/223080/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Shannan M. Grant has received funding from Diabetes Canada, Dietitians of Canada and currently holds funding from Medavie, Tri-Council Funding Programs, Canadian Foundation for Dietetic Research, IWK Health, Mount Saint Vincent University. She is affiliated with Mount Saint Vincent University, IWK Health, Dalhousie University, Dietitians of Canada, Diabetes Canada, People in Pain (PIPN), and Dr. Lee-Baggley and Associates.</span></em></p><p class="fine-print"><em><span>Dayna Lee-Baggley dislosures: Consulting fees from: Bausch Health, Novo Nordisk; Clinical advisory committee: Tobacco Free Nova Scotia; Royalties: New Harbinger Publications; Funded by: Workplace Harassment and Violence Prevention Fund, Employment and Social Development Canada, Government of Canada; Canadian Foundation for Dietetic Research, Research Grants; Owner or co-owner: Dr. Lee-Baggley and Associates Inc and ImpACT Workplace Solutions Inc.
</span></em></p><p class="fine-print"><em><span>Jacquie Gahagan receives funding from SSHRC and CIHR.</span></em></p><p class="fine-print"><em><span>Barb Hamilton-Hinch, Jessica Mannette, and Leigh-Ann MacFarlane do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Acknowledging that factors like the built environment, social and health systems, and outdated policies are the problems — rather than people — is a step towards healthier and safer workplaces.Shannan M. Grant, Associate Professor, Registered Dietitian, Department of Applied Human Nutrition, Faculty of Professional Studies, Mount Saint Vincent UniversityBarb Hamilton-Hinch, Associate Professor, School of Health and Human Performance, and Assistant Vice Provost of Equity and Inclusion, Dalhousie UniversityDayna Lee-Baggley, Adjunct professor, Department of Family Medicine & Department of Psychology and Neuroscience, Dalhousie UniversityJacquie Gahagan, Full Professor and Associate Vice-President, Research, Mount Saint Vincent UniversityJessica Mannette, Research Assistant, Department of Psychology, Saint Mary’s UniversityLeigh-Ann MacFarlane, Educational Developer, Mount Saint Vincent UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2161252024-02-21T13:19:09Z2024-02-21T13:19:09ZYour heart changes in size and shape with exercise – this can lead to heart problems for some athletes and gym rats<p>Exercise has long been recognized by clinicians, scientists and public health officials as an <a href="https://www.nhlbi.nih.gov/health/heart/physical-activity/benefits">important way to maintain health</a> throughout a person’s lifespan. It improves overall fitness, helps build strong muscles and bones, reduces the risk of chronic disease, improves mood and slows physical decline. </p>
<p>Exercise can also significantly reduce the risk of developing conditions that negatively affect heart heath, such as high blood pressure, high cholesterol and obesity. But large amounts of exercise throughout life may also harm the heart, leading to the development of a condition called <a href="https://www.merckmanuals.com/professional/cardiovascular-disorders/sports-and-the-heart/athlete%E2%80%99s-heart">athletic heart</a>.</p>
<p>As the <a href="https://medschool.cuanschutz.edu/cardiology/clinical-programs/multidisciplinary-programs/sports-cardiology">sports cardiology director</a> at the University of Colorado Anschutz Medical Campus, I’m often asked how much and what kind of exercise is necessary to get the benefits of exercise. Many people also wonder about the risks of exercise, and what happens if you exercise too much. </p>
<p>The <a href="https://www.heart.org/en/healthy-living/fitness/fitness-basics/aha-recs-for-physical-activity-in-adults">American Heart Association generally recommends</a> 150 minutes of moderate-intensity exercise, such as brisk walking, or 75 minutes of vigorous-intensity exercise, such as running, each week. It also recommends muscle strengthening exercises at least twice per week.</p>
<p>When people exceed these guidelines, the heart may remodel itself in response – that is, it begins to change its size and shape. As a result, heart function may also change. These changes in heart structure and function among people who engage in high levels of exercise are referred to as the athletic heart, or athlete’s heart. Athletic heart doesn’t necessarily cause problems, but in some people it can increase the risk of certain heart issues.</p>
<h2>What is athletic heart?</h2>
<p>To understand how exercise affects the heart, it’s important to consider what kind of exercise you’re participating in. </p>
<p>Exercise is generally divided into <a href="https://doi.org/10.1016/j.jacc.2015.09.033">two broad categories</a>: dynamic and static. </p>
<p>Dynamic exercises, like running, cross-country skiing and soccer, require the heart to pump an increased amount of blood, compared to the amount delivered to the body at rest, in order to sustain the activity. For example, when running, the amount of blood the heart pumps to the body may increase by threefold to fivefold compared to at rest.</p>
<p>Static exercises, like weightlifting, gymnastics or rock climbing, require the body to use skeletal muscle in order to push or pull heavy amounts of weight. While the heart does pump more blood to skeletal muscles that are working during these activities, these kinds of exercises depend on a muscle’s ability to move the weight. For example, in order to do curls with dumbbells, the biceps must be strong enough to lift the desired weight. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/576223/original/file-20240216-28-rwjbi1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Close-up of lower half of the back of a person cycling, one hand outstretched towards the vegetation on the side of the road" src="https://images.theconversation.com/files/576223/original/file-20240216-28-rwjbi1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/576223/original/file-20240216-28-rwjbi1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/576223/original/file-20240216-28-rwjbi1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/576223/original/file-20240216-28-rwjbi1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/576223/original/file-20240216-28-rwjbi1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/576223/original/file-20240216-28-rwjbi1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/576223/original/file-20240216-28-rwjbi1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Cycling involves both dynamic and static exercise.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/man-in-black-shorts-riding-bicycle-on-road-during-daytime-vRuoDd-Qnq8">Judit Murcia/Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>Some exercises, like rowing or cycling, are both highly dynamic and highly static because they require the heart to pump large amounts of blood while simultaneously requiring a large amount of muscle strength to sustain effort.</p>
<p>It is important to distinguish between dynamic and static exercise because the heart adapts differently according to the type of exercise you engage in over time. Dynamic exercise increases the volume of blood pumping through the heart and can cause the heart to become enlarged, or dilated, over time. Static exercise increases the amount of pressure on the heart and can also cause it to become enlarged over time but with thickened walls.</p>
<h2>Who develops athletic heart?</h2>
<p>Exercise that exceeds guidelines, such as exercising more than an hour most days of the week, may lead to development of athletic heart. Athletic heart commonly occurs <a href="https://doi.org/10.1161/01.CIR.101.3.336">among endurance athletes</a>, who regularly compete in activities like marathons or other long-duration events. Many exercise several hours per day and more than 12 to 15 hours per week.</p>
<p>Among runners, for example, the heart remodels itself in response to having to pump a high volume of blood. As a result, the chambers of the heart enlarge to hold and pump more blood. Among weightlifters, the heart remodels itself by thickening in response to the increase in pressure applied on the heart.</p>
<p>Exercise is good for the body, and athletic heart results from a lifelong commitment to an activity that promotes good health. But there may be some issues that arise from an athletic heart.</p>
<p>First, athletes with markedly enlarged hearts may be at risk of developing <a href="https://www.acc.org/Latest-in-Cardiology/Articles/2019/08/16/08/20/Atrial-Fibrillation-in-Competitive-Athletes">atrial fibrillation</a>, which is abnormal heart rhythms that typically occur among older adults or people with high blood pressure or heart failure. Abnormal heart rhythms are worrisome because they may lead to a stroke. </p>
<p>There are many potential reasons atrial fibrillation occurs in athletes. A dilated atrium – the top chamber in the heart – may become inflamed and develop scar tissue, increasing the risk of atrial fibrillation. <a href="https://doi.org/10.1161/01.CIR.0000031733.51374.C1">Stress and environmental factors</a> may also work together to increase the risk of arrhythmia.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/576219/original/file-20240216-28-p2nrzu.gif?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Clip of an ultrasound reading of an enlarged heart beating" src="https://images.theconversation.com/files/576219/original/file-20240216-28-p2nrzu.gif?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/576219/original/file-20240216-28-p2nrzu.gif?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=537&fit=crop&dpr=1 600w, https://images.theconversation.com/files/576219/original/file-20240216-28-p2nrzu.gif?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=537&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/576219/original/file-20240216-28-p2nrzu.gif?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=537&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/576219/original/file-20240216-28-p2nrzu.gif?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=675&fit=crop&dpr=1 754w, https://images.theconversation.com/files/576219/original/file-20240216-28-p2nrzu.gif?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=675&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/576219/original/file-20240216-28-p2nrzu.gif?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=675&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">This is an echocardiogram of a 30-year-old athlete with an enlarged heart.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:4_chamber_(1).gif">Runandbike/Wikimedia Commons</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p><a href="https://doi.org/10.1161/CIRCULATIONAHA.117.027834">Coronary artery calcification, or CAC</a>, is another concern among elite athletes. Coronary artery calcification, which commonly occurs in older adults or those with risk factors for coronary artery disease, increases the risk of having a heart attack or stroke. In recent years, doctors have been using imaging tests to monitor calcium buildup in the arteries of their patients to try to determine their risk of heart attack or stroke over time.</p>
<p>It is not entirely clear why elite athletes develop coronary artery calcification. Fortunately, it does not appear that athletes have an increased risk of heart attack, even among those with very high levels of CAC. For example, a large study of almost 22,000 participants found that even athletes who engaged in high amounts of exercise and had elevated levels of CAC <a href="https://doi.org/10.1001/jamacardio.2018.4628">did not have an increased risk</a> of death from cardiovascular disease over a decade of follow-up.</p>
<p>Some athletes are appropriately concerned about having calcium buildup in their heart arteries and may wonder whether or not they should be taking medications like aspirin or statins. But risks <a href="https://doi.org/10.1016/j.mayocpiqo.2019.03.007">vary from person to person</a>, so anyone concerned about CAC should talk to their doctor</p>
<h2>Putting exercise in its place</h2>
<p>Though elite athletes may have an increased risk of developing athletic heart, exercise undoubtedly remains one of, if not the best, methods to maintain a healthy lifestyle.</p>
<p>For example, if someone does not exercise routinely, their heart <a href="https://doi.org/10.1161/circulationaha.105.541078">will become stiff</a> and not pump blood as well as it once did. Routine exercise – especially dynamic exercise like running – maintains a compliant heart and prevents stiffening. A compliant heart will expand a lot more as it fills with blood and, in turn, pump out more blood with each heartbeat. A stiff heart has difficulty filling up with blood and has difficulty pumping blood through the body.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/576226/original/file-20240216-24-i1u421.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two people running on a road lined with trees -- the younger person is trailing behind the older person who has leaped into the air with arms raised" src="https://images.theconversation.com/files/576226/original/file-20240216-24-i1u421.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/576226/original/file-20240216-24-i1u421.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=440&fit=crop&dpr=1 600w, https://images.theconversation.com/files/576226/original/file-20240216-24-i1u421.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=440&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/576226/original/file-20240216-24-i1u421.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=440&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/576226/original/file-20240216-24-i1u421.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=553&fit=crop&dpr=1 754w, https://images.theconversation.com/files/576226/original/file-20240216-24-i1u421.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=553&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/576226/original/file-20240216-24-i1u421.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=553&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Regular exercise can help keep your heart young.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/the-old-and-young-sportsmen-running-on-the-road-royalty-free-image/1086683052">Viacheslav Peretiatko/iStock via Getty Images Plus</a></span>
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<p>Generally, routine exercise throughout adulthood encourages the heart to <a href="https://doi.org/10.1016/j.jacc.2014.03.062">remain strong and flexible</a> even in old age. Even if someone were only to begin regularly exercising in their 40s to 50s, it is possible to <a href="https://doi.org/10.1161/circulationaha.117.030617">reverse some of the effects</a> of sedentary aging.</p>
<p>For example, a 2018 study of 53 sedentary people mostly in their early 50s found that those who participated in a two-year exercise training program using a combination of running, cycling and elliptical exercise had hearts that <a href="https://doi.org/10.1161/circulationaha.117.030617">became more compliant</a> compared to the hearts of those who did not exercise.</p>
<p>It is never too late to start exercising. Routinely following exercise guidelines can help promote physical and mental health and help your heart stay young throughout your life.</p><img src="https://counter.theconversation.com/content/216125/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>William Cornwell does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>People who regularly engage in significant amounts of exercise, as endurance athletes do, may develop enlarged hearts. While athletic heart is adapted for performance, it can be cause for concern.William Cornwell, Associate Professor of Cardiology, University of Colorado Anschutz Medical CampusLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2232422024-02-13T10:32:14Z2024-02-13T10:32:14ZRomance isn’t always rosy, sometimes it’s sickening – lovesickness, erotomania and death by heartbreak explained<figure><img src="https://images.theconversation.com/files/574771/original/file-20240211-31-lmr4xk.jpg?ixlib=rb-1.1.0&rect=25%2C17%2C5681%2C3773&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.gettyimages.co.uk/detail/photo/lovesick-love-hurts-royalty-free-image/1500791667?phrase=love+hurts&adppopup=true">Irina Marwan</a></span></figcaption></figure><p>Absence makes the heart grow fonder. All you need is love. It’s better to have loved and lost than never to have loved at all.</p>
<p>If cliches and pop songs are anything to go by, humans spend a substantial portion of waking and sleeping hours thinking and dreaming about the pursuit of love – in all its many forms. </p>
<p>But is love all pink hearts, roses and teddy bears – or is there a darker side? Can love, or the absence of love, generate a form of sickness? Can it even lead to lasting physical or mental illness? And is it possible to die of a broken heart?</p>
<h2>Pathological Love</h2>
<p>Love can hurt. Ian McEwan framed a pathological form of affection, leading to obsession in his 1997 novel <a href="https://www.rogerebert.com/reviews/enduring-love-2004">“Enduring Love”</a>. The central character, Joe, is stalked and harassed by the mentally unwell Jed, following a tragic accident that unites them both. </p>
<p>The condition that McEwan explores so vividly is <a href="https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/de-clerambaults-syndrome-in-organic-affective-disorder/CF53A60A1E29C1AF88C13BB038C4B406">erotomania</a>, which was described by de Clerembault in 1942, and the syndrome still bears his name today. It describes the delusional but unwavering belief of being secretly but nonetheless intensely loved by another person. </p>
<p>De Clerembault was not the first person to notice these symptoms. They appear even in the words of Hippocrates, described as a form of unrequited love. The condition has seen a renaissance, over the past three centuries, shifting from unanswered love to sex addiction, to its current standing of delusions of love. </p>
<p>There are many true life examples of erotomania documented in the press. Like in “Enduring Love”, the condition can have murderous undertones. In 1981, John Hinckley Jr was arrested and institutionalised for attempting to assassinate US president Ronald Reagan. His motive? An attempt to impress the actress Jodie Foster, with whom he had become obsessed. </p>
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<h2>I love Paris in the springtime</h2>
<p>Love, or perceptions of love for material objects or places rather than individuals might also be enough to trigger psychiatric illness. </p>
<p>Take the observations of Stendhal, the pseudonym of 19th century Frenchman Marie-Henri Beyle. Stendhal was not a psychiatrist, but a writer, who found himself overcome by the <a href="https://www.scielo.br/j/anp/a/3yRYFFQsTRBfhjCzGPjnsNm/?lang=en">beauty of Florence</a> when travelling there in 1817. Both art and architecture – such as the statue of Michaelangelo’s David or the Basilica of Santa Croce - were overwhelming enough to induce dizziness, palpitations, even fainting episodes in both Stendhal and in many other <a href="https://casereports.bmj.com/content/2009/bcr.06.2008.0317.long">Florentine tourists</a> since. A resident psychiatrist recounted many observations of the cluster of symptoms during her time at the local hospital.</p>
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<p>Stendhal syndrome lacks the evidence to be classified formally as a disease – but visits to other cities can also induce similar symptoms. Anyone who seen depictions of Paris in film and fiction, as a city dripping with romance, fantasy and allure, often form a detailed and exciting image of it in their mind.</p>
<p>For many tourists, Paris lives up to these expectations, and more. For others, unfortunately not – leading to a condition known as Paris Syndrome. Realising that the city and its residents don’t conform to their preconceived ideas can prove too great a disappointment for some, who can suffer from a severe form of <a href="https://www.independent.co.uk/travel/europe/france/paris/paris-syndrome-france-b2481464.html">culture shock</a>; sweating, racing heart, nausea and vomiting, even hallucinations may ensue. </p>
<h2>Too many broken hearts in the world</h2>
<p>For centuries, romance novels have included the <a href="https://books.google.co.uk/books?hl=en&lr=&id=KtIFRJXo9XYC&oi=fnd&pg=PP2&dq=broken+heart+trope+romance+&ots=pebYRUqrIt&sig=29yj9D3-kaOp_H7cTlV3nOKa2OU&redir_esc=y#v=onepage&q&f=false">trope of the tragic</a> brokenhearted character, wasting away because of lost love – but is there science to back up this claim? </p>
<p>Well, yes. The term broken heart syndrome applies to a genuine cardiac condition – <a href="https://www.bhf.org.uk/informationsupport/conditions/cardiomyopathy/takotsubo-cardiomyopathy">Takotsubo cardiomyopathy</a>. This rare condition can generate patterns of acute heart failure, appearing in signs and symptoms, and even in blood tests and ECG (or electrocardiogram – the electrical tracing of cardiac function) to be a myocardial infarction, or heart attack. </p>
<p><a href="https://nataliemeister.ch/TAKOTSUBO">Takotsubo</a>, in case you were wondering, is a specialised Japanese fishing pot used to fish for octopus, to which the ballooned and dysfunctional heart bears a close resemblance.</p>
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<p>The underlying cause of <a href="https://heart.bmj.com/content/103/18/1461.long">broken heart syndrome?</a> Severe stress – from the emotional upheaval of a relationship break up, or <a href="https://www.bhf.org.uk/informationsupport/conditions/cardiomyopathy/takotsubo-cardiomyopathy">death of a loved one</a>. It is an example of how psychologically driven stress can impact upon the body physically. The biological response which helps our bodies to respond to stressors causes the release of <a href="https://www.medicalnewstoday.com/articles/catecholamines">catecholamine hormones</a> – among them, adrenaline. The raised levels of adrenaline have been proposed as an underlying cause of broken heart syndrome – a link between heart and mind – though more research is required to tell for sure. </p>
<p>The good news is that <a href="https://pubmed.ncbi.nlm.nih.gov/32039951/">broken heart syndrome is treatable</a>, using the same medications as are used for a heart attack, and in the vast majority of cases is a reversible phenomenon. </p>
<p>Love really is all around, and has more consequences for health and wellbeing than you might think. The brain and heart are inextricably linked, and conditions of each give us insight into the complexity of love and its effect on our bodies and minds.</p><img src="https://counter.theconversation.com/content/223242/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dan Baumgardt does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Love conquers all… apart from obsession, heart break or those seriously disappointed with ParisDan Baumgardt, Senior Lecturer, School of Physiology, Pharmacology and Neuroscience, University of BristolLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2225162024-02-11T13:50:24Z2024-02-11T13:50:24ZIt’s time for a heart-to-heart about women’s cardiovascular health, unique risk factors and symptoms<p>Cardiovascular disease — also called heart disease — is a condition affecting the heart and blood vessels, and is the leading cause of death among <a href="https://doi.org/10.1016/S0140-6736(21)00684-X">women worldwide</a>. In fact, a women dies of heart disease every <a href="https://www.heartandstroke.ca/-/media/pdf-files/canada/2018-heart-month/hs_2018-heart-report_en.ashx#">20 minutes in Canada</a>. </p>
<p>Although cardiovascular disease is often considered a disease of men, women are more likely to die from a <a href="https://doi.org/10.1016/j.cjco.2020.10.009">heart attack</a> when compared with men. This fact often surprises women and even their health-care providers. Many women are not aware that heart disease is a significant health threat to them, but the reality is that <a href="https://www.heartandstroke.ca/-/media/pdf-files/canada/2018-heart-month/hs_2018-heart-report_en.ashx#">five times</a> as many women die from heart disease as breast cancer. </p>
<p>Despite dramatic improvements in management of cardiovascular disease over time, the death rate due to heart disease is <a href="https://doi.org/10.1093/ehjqcco/qcaa099">actually increasing</a> in women, especially those under age 65. It has become clear that <a href="https://www.heartandstroke.ca/-/media/pdf-files/canada/2018-heart-month/hs_2018-heart-report_en.ashx#">women remain</a> under-researched, under-diagnosed, under-treated, under-supported an under-aware of their cardiovascular risk. </p>
<p>That’s why it is critical that moving forward, we recognize that women’s hearts are unique. Additionally, there is an urgent need to start a conversation with Canadians to improve awareness of women’s heart health to help save the lives of mothers, sisters, daughters, family and friends. </p>
<h2>Women’s hearts are different</h2>
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<a href="https://images.theconversation.com/files/574087/original/file-20240207-26-jtv39j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A group of women wearing red and with the title Wear Red Canada wearredcanada.ca" src="https://images.theconversation.com/files/574087/original/file-20240207-26-jtv39j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/574087/original/file-20240207-26-jtv39j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/574087/original/file-20240207-26-jtv39j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/574087/original/file-20240207-26-jtv39j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/574087/original/file-20240207-26-jtv39j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/574087/original/file-20240207-26-jtv39j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/574087/original/file-20240207-26-jtv39j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">On Feb. 13, Wear Red Canada raises awareness for women’s cardiovascular health.</span>
<span class="attribution"><span class="source">(Canadian Women's Heart Health Centre)</span></span>
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<p>From the outside, women’s hearts may look the same as men’s, but there are important differences. Specifically, women experience unique events over the course of their lifespan which may impact their cardiovascular health. For example, an individual’s <a href="https://doi.org/10.1016/j.cjco.2021.09.013">menstrual health and patterns, or conditions related to fertility</a>, such as polycystic ovary syndrome or endometriosis, may influence her cardiovascular well-being. </p>
<p>Pregnancy complications, such as hypertensive disorders of pregnancy and gestational diabetes, can also play a role in cardiovascular health. Finally, menopause factors, including timing of menopause and menopause-related treatments, may also be indicators of cardiovascular health. </p>
<p>In addition to such risk factors that are inherent to the female experience, women are <a href="https://www.cjcopen.ca/cms/attachment/a2d5edd9-5a5a-41d4-b824-7749ae0d9a67/gr1.jpg">disproportionately impacted by other risk factors for heart disease</a>. These risk factors may include conditions such as depression, chronic kidney disease and autoimmune disease. </p>
<p>Women need to not only be aware of how their risk for heart disease may change across the lifespan, but also how they can be proactive and make informed decisions regarding their heart health at all stages of life. </p>
<h2>Heart attack symptoms</h2>
<p>Early heart attack symptoms are missed in up to <a href="https://www.heartandstroke.ca/-/media/pdf-files/canada/2018-heart-month/hs_2018-heart-report_en.ashx#:%7E:text=Every%2020%20minutes%20a%20woman%20in%20Canada%20dies%20from%20heart%20disease.&text=Five%20times%20as%20many%20women%20die%20from%20heart%20disease%20as%20breast%20cancer.&text=Two%2Dthirds%20of%20heart%20disease%20clinical%20research%20focuses%20on%20men.&text=Women%20who%20have%20a%20heart,heart%20attack%20compared%20to%20men.">78 per cent</a> of women, in part related to the fact that women may present with different symptoms than men. </p>
<p>Similar to men, women often present with chest pain or discomfort, though they may have additional or <a href="https://doi.org/10.1161/CIRCULATIONAHA.117.031650">alternative symptoms</a> such as jaw, neck or back pain, shortness of breath, nausea, indigestion and extreme fatigue. In fact, women are more likely to present with three or more symptoms in addition to chest pain when having a heart attack. </p>
<p>An awareness of the differences in heart attack symptoms may lead to improved recognition and timely care for women. </p>
<p>Recognizing that women can have different cardiovascular risk factors, symptoms and even types of heart disease can be scary and overwhelming. However, there is good news! It is estimated that approximately <a href="https://world-heart-federation.org/what-we-do/prevention/#:%7E:text=An%20estimated%2080%25%20of%20cardiovascular,and%20">80 per cent</a> of cardiovascular disease is preventable.</p>
<h2>Reducing heart risks</h2>
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<img alt="Group of women outdoors in athletic clothes carrying yoga mats" src="https://images.theconversation.com/files/574724/original/file-20240209-18-8p1xc4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/574724/original/file-20240209-18-8p1xc4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/574724/original/file-20240209-18-8p1xc4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/574724/original/file-20240209-18-8p1xc4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/574724/original/file-20240209-18-8p1xc4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/574724/original/file-20240209-18-8p1xc4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/574724/original/file-20240209-18-8p1xc4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">It’s estimated that about 80 per cent of heart disease is preventable.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>There are many steps that you can take to reduce your risk of heart disease. <a href="https://www.heartandstroke.ca/heart-disease/risk-and-prevention/lifestyle-risk-factors">Staying active</a> and moving every day, and even small steps to reduce sedentary time can be beneficial. </p>
<p>Eating a healthy and <a href="https://www.heartandstroke.ca/healthy-living/healthy-eating">balanced diet</a> is also important. Aim to eat a variety of healthy foods and try to limit highly processed foods and salt. How you eat also matters: listen to your body by eating when you are hungry, but stopping once you are satisfied. </p>
<p>Living free from commercial tobacco and vaping, reducing alcohol intake and managing stress are also key ways to reduce your risk. Finally, take your medications as prescribed and have regular check-ups with your health-care providers.</p>
<h2>Wear red and learn more</h2>
<p>On Feb. 13, we invite you to celebrate <a href="https://wearredcanada.ca">Wear Red Canada</a> to raise awareness for women’s cardiovascular health, hosted by the <a href="http://cwhhc.ottawaheart.ca/national-alliance/cwhha">Canadian Women’s Heart Health Alliance</a> and the <a href="https://cwhhc.ottawaheart.ca/">Canadian Women’s Heart Health Centre</a>. Wear red and share selfies or pictures of your participation by using the hashtag #HerHeartMatters and tagging @WearRedCanada to help spread this important message. </p>
<p>Attend free <a href="https://wearredcanada.ca/educational-webinars">presentations and webinars</a> by Canadian experts, join the <a href="https://raceroster.com/events/2024/77122/wear-red-canada-movement-challenge?utm_source=Cyberimpact&utm_medium=email&utm_campaign=Countdown-1-Week-Until-the-Wear-Red-Canada-Movement-Challenge-Begins--Register-Today">Wear Red Canada Movement Challenge</a> and take part in local events. </p>
<p>By wearing red on Feb. 13 and starting conversations about women’s heart health, we all can increase awareness and improve the heart health of the women we love.</p><img src="https://counter.theconversation.com/content/222516/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nabilah Gulamhusein has received funding from the Canadian Institutes of Health Research through the Canada Graduate Scholarship - Master’s.</span></em></p><p class="fine-print"><em><span>Sandi Dumanski receives funding from the Canadian Fertility and Andrology Society and the Kidney Foundation.</span></em></p>It’s important for women to not only be aware of their risk for heart disease, but also how they can be proactive and make informed decisions regarding their heart health at all stages of life.Nabilah Gulamhusein, PhD Student, Medical Sciences, University of CalgarySandi Dumanski, Assistant Professor, Department of Medicine, University of CalgaryLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1941532023-11-27T19:27:23Z2023-11-27T19:27:23ZRepeated concussions can alter heart activity and impact the ‘heart-brain’ axis<figure><img src="https://images.theconversation.com/files/513107/original/file-20230302-16-tocrry.jpg?ixlib=rb-1.1.0&rect=114%2C122%2C2510%2C1803&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Exploring the interaction between the heart and the brain, known as the heart-brain axis, has shown how heart function changes due to a concussion.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/repeated-concussions-can-alter-heart-activity-and-impact-the-heart-brain-axis" width="100%" height="400"></iframe>
<p>Mild traumatic brain injury or sport-related concussions occur frequently in contact sports such as football, rugby and ice hockey. A concussion doesn’t just affect the brain; <a href="https://doi.org/10.3390/brainsci7080100">it results in stress to the entire body</a>. </p>
<p>In our laboratory comprised of exercise scientists and clinicians, we focus on studying heart function in patients with a concussion. After a concussion, there are increased demands on the body to maintain proper brain activity. To compensate for these demands, there are changes in heart function.</p>
<p>We have explored this interaction between the heart and the brain, known as the heart-brain axis, and have identified how heart function changes due to a concussion. For example, a hit to the head can send signals to the heart that <a href="https://doi.org/10.1111/cpf.12487">shifts the body to a stressful “fight-or-flight” mode</a>. This increases the stress on the body by causing a change in heart function.</p>
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<a href="https://theconversation.com/concussion-is-more-than-sports-injuries-whos-at-risk-and-how-canadian-researchers-are-seeking-better-diagnostics-and-treatments-189899">Concussion is more than sports injuries: Who's at risk and how Canadian researchers are seeking better diagnostics and treatments</a>
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<p>This mechanism is related to what we would describe as a neuro-autonomic cardiovascular dysfunction. This means that problems with the autonomic nervous system (ANS) are causing altered signals going to the heart. </p>
<p>The ANS controls things that we don’t actively think about like breathing, digestion and heart function. The ANS is also <a href="https://doi.org/10.1111/cpf.12487">responsible for controlling the rhythm of a heartbeat</a>.</p>
<h2>Changes in systole following a concussion</h2>
<p>Each heartbeat contains both a heart muscle contraction (systole) and relaxation (diastole) phase. That’s why a <a href="https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/blood-pressure/art-20050982">blood pressure reading results in two numbers</a>: the systolic and diastolic pressures. Systolic blood pressure, which is usually listed at the top of a blood pressure reading, is generated by the heart as it contracts, pushing out blood during each heartbeat. </p>
<p>Approximately 120 mmHg is a good systolic number, and the blood pressure varies with each heartbeat. These variations between heartbeats in systolic blood pressure is known as blood pressure variability, and it is a measure that provides information about stress on the body.</p>
<figure class="align-center ">
<img alt="Illustration of a heart rhythm and a brain and a heart" src="https://images.theconversation.com/files/559964/original/file-20231116-15-2k6zrn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/559964/original/file-20231116-15-2k6zrn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=343&fit=crop&dpr=1 600w, https://images.theconversation.com/files/559964/original/file-20231116-15-2k6zrn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=343&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/559964/original/file-20231116-15-2k6zrn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=343&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/559964/original/file-20231116-15-2k6zrn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=431&fit=crop&dpr=1 754w, https://images.theconversation.com/files/559964/original/file-20231116-15-2k6zrn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=431&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/559964/original/file-20231116-15-2k6zrn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=431&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Within five days after sustaining a concussion, systole — the phase of the heartbeat when the heart muscle contracts to allow blood to flow into the body — is impaired, with the heart contracting for a shorter period of time during each heart beat.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Concussion can also alter blood pressure. Since blood pressure can also be influenced by breathing, we controlled breathing rates in concussed athletes when conducting tests within five days of injury. We showed that <a href="https://doi.org/10.3390/life12091400">blood pressure variability is suppressed during concussion</a>. </p>
<p>Within five days after sustaining a concussion, systole — the phase of the heartbeat when the heart muscle contracts to allow blood to flow into the body — is impaired, with the heart contracting for a shorter period of time during each heart beat. This has the potential to lower the efficiency with which blood is pumped from the heart. </p>
<p>Furthermore, there is <a href="https://doi.org/10.1080/15438627.2022.2102918">elevated stress on the heart</a>, causing it to squeeze harder to get blood into the body. These changes are typically transient and return to normal as concussion symptoms alleviate.</p>
<h2>Long-term concussion symptoms</h2>
<p>Concussion symptoms such as headache and pressure build-up in the head reflect the ANS not working properly. These symptoms can last if the brain is injured. Research suggests that a history of repeated concussions can have long-lasting effects. Specifically, those with a history of at least three concussions <a href="https://doi.org/10.1080/02699052.2022.2109737">show altered oxygen activity in the brain</a>.</p>
<p>Each heartbeat provides blood and oxygen to the brain. Therefore, heart complications can result in altered brain activity. This is evident during strenuous activity such as repeated squat-stand manoeuvres (10-second squat, then a 10-second stand, repeated 15 times), which <a href="https://doi.org/10.1080/02699052.2022.2109737">can result in reduced brain oxygen in those with a history of concussion</a>. This reduction in brain oxygen activity can be <a href="https://doi.org/10.3390/brainsci12111443">associated with elevated stress on the heart due to the concussion</a>.</p>
<p>Similarly, in our lab, four women suffering from post-concussion syndrome (symptoms that last for months or even years after a concussion) presented with <a href="https://doi.org/10.1139/cjpp-2021-0395">decreased systolic blood pressure variability</a>. Monitoring heart function in patients with sustained concussion complications can aid with recovery.</p>
<p>In another case study, a male patient had a history of multiple concussions that elicited heart complications. Remarkably, treatment of the heart issues alleviated all concussion symptoms in a matter of days when the patient’s cardiologist <a href="https://doi.org/10.1155/2020/7154120">treated him with the heart medication amiodarone, which is used to treat heart rhythm problems</a>.</p>
<p>Specifically, our case study presented a patient with almost 20 per cent abnormal heartbeats, which is very unusual. The stress on the heart stresses the body, which can worsen the concussion symptoms. This is the first report of a patient in whom treatment of abnormal heartbeat cleared concussion symptoms.</p>
<p>There is still limited research about the heart-brain axis. For example, it is known that <a href="https://www.heart.org/en/news/2020/02/04/chronic-stress-can-cause-heart-trouble">stress and anxiety are risk factors for heart disease</a>. For concussion, a hit to the head can send signals to the heart, resulting in higher stress levels on the heart. As shown in our research, the higher stress levels on the heart can be <a href="https://doi.org/10.3390/life12091400">measured by systolic blood pressure activity</a>. More research is being done to better understand the heart-brain axis.</p>
<h2>Future research and potential treatment options</h2>
<p>Research is beginning to investigate how compounds from the cannabis plant, such as cannabidiol (CBD), may help concussion recovery. For example, four female patients between the ages of 42 and 52 suffering from post-concussion syndrome consumed CBD oil under guidance from their physician. This was followed by improvements in their <a href="https://doi.org/10.1139/cjpp-2021-0395">systolic blood pressure variability</a>. Furthermore, their concussion symptoms improved, leading to reduced perception of anxiety. </p>
<p>This led us to complete a literature review on the implications of cannabinoids, such as CBD, on concussion. Our findings suggest that <a href="https://doi.org/10.1017/cjn.2020.23">cannabinoid therapy may have a beneficial effect on concussion recovery</a>.</p>
<p>We have recently been funded by the National Football League/National Football League Players Association to <a href="https://www.nfl.com/playerhealthandsafety/health-and-wellness/pain-management/nfl-awards-1-million-to-study-impact-of-cannabis-and-cbd-on-pain-management">study CBD’s potential influence on brain-heart function and effect on concussion symptoms</a>. This will enable us to better understand how these cannabinoids may influence the heart-brain axis relationship.</p><img src="https://counter.theconversation.com/content/194153/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>J. Patrick Neary receives funding from the National Football League/National Football League Players Association for his cannabinoid and concussion research. </span></em></p><p class="fine-print"><em><span>Jyotpal Singh and Payam Dehghani do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Concussion doesn’t just affect the brain, but the whole body. The interaction of the ‘heart-brain axis’ means that as the brain works to heal its injury, it puts extra stress on the heart.Jyotpal Singh, Postdoctoral fellow, Kinesiology & Health Studies, University of ReginaJ. Patrick Neary, Professor, Faculty of Kinesiology & Health Studies, University of ReginaPayam Dehghani, Associate Professor, Cardiology, University of SaskatchewanLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2082802023-08-08T01:52:59Z2023-08-08T01:52:59ZWhat is POTS? And how is it related to long COVID?<figure><img src="https://images.theconversation.com/files/539703/original/file-20230727-19-zyb8o6.jpg?ixlib=rb-1.1.0&rect=1%2C1%2C997%2C664&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hand-on-temples-young-unhappy-sadness-2217929751">Shutterstock</a></span></figcaption></figure><p>POTS or “postural orthostatic tachycardia syndrome” is a poorly recognised condition we’ve been <a href="https://www.smh.com.au/lifestyle/life-and-relationships/what-is-pots-and-how-is-it-related-to-covid-20230529-p5dc3v.html">hearing more</a> about recently.</p>
<p>When people stand up, get out of bed or off the sofa, their heart races and they feel dizzy and fatigued, severely impacting their quality of life. Everyday tasks, such as washing their hair in the shower or working, become challenging because people cannot stay upright.</p>
<p>Before COVID, this debilitating condition was not widely talked about. But during the pandemic, we’ve been learning about the strong similarities with long COVID. </p>
<p>In fact, our recent research shows more than <a href="https://www.amjmed.com/article/S0002-9343(23)00402-3/fulltext">three-quarters</a> of people with long COVID we studied had POTS.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/when-does-covid-become-long-covid-and-whats-happening-in-the-body-when-symptoms-persist-heres-what-weve-learnt-so-far-188976">When does COVID become long COVID? And what's happening in the body when symptoms persist? Here's what we've learnt so far</a>
</strong>
</em>
</p>
<hr>
<h2>What triggers it?</h2>
<p><a href="https://onlinelibrary.wiley.com/doi/10.1111/joim.12895">Multiple studies</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/37338634/">including our own</a>, have shown viral infection is the most common trigger for POTS. </p>
<p>Then came the pandemic, with <a href="https://covid19.who.int">almost 800 million people</a> infected so far with SARS-CoV-2, the virus that causes COVID. The World Health Organization <a href="https://www.who.int/europe/news-room/fact-sheets/item/post-covid-19-condition">says</a> 10-20% of people infected with COVID are likely to develop long COVID – when unexplained symptoms persist three months or more after the infection.</p>
<p>Now, more research is showing how long COVID resembles POTS. Many people with long COVID show similar symptoms.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1553878655536807936"}"></div></p>
<h2>What we and others have found</h2>
<p>Our recent study found <a href="https://www.amjmed.com/article/S0002-9343(23)00402-3/fulltext">nearly 80%</a> of people with long COVID had POTS. In people who had both and were of similar age, symptoms were indistinguishable from those who got POTS from other causes.</p>
<p>The people in our study either attended a specialist cardiology clinic for people with POTS or long COVID, or came via a long COVID support group on social media. So we cannot generalise our results to people managing their long COVID at home or with their GP. </p>
<p>Earlier this year, a <a href="https://www.nature.com/articles/s41569-023-00842-w">review</a> said about 30% of people with people with “highly symptomatic” long COVID also had POTS. <a href="https://www.onlinecjc.ca/article/S0828-282X(22)01091-1/fulltext">Most (73%)</a> met criteria for POTS and other types of dysfunction of the autonomic nervous system.</p>
<p>Taken together, we can conclude that many, but not all, cases of long COVID can be explained by POTS – a condition we’ve known about for years and know how to manage.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/we-can-learn-a-lot-about-long-covid-from-years-of-diagnosing-and-treating-chronic-fatigue-syndrome-196128">We can learn a lot about long COVID from years of diagnosing and treating chronic fatigue syndrome</a>
</strong>
</em>
</p>
<hr>
<h2>What happens if you have POTS?</h2>
<p>We suspect some cases of POTS result from a hyper-vigilant immune response to an invading pathogen, such as a virus. This, or another trigger, affects the autonomic nervous system.</p>
<p>This part of the nervous system balances a vast array of functions including maintaining blood flow to vital organs, digestion, temperature control, sweating and even sexual function. </p>
<p>Even if the autonomic nervous system is marginally disturbed, it leads to the physiological equivalent of anarchy. </p>
<p>The simplest of daily tasks – such as washing your hair in the shower – can result in profound symptoms of dizziness, a racing heart, breathlessness, brain fog and general exhaustion.</p>
<p>In other research <a href="https://link.springer.com/article/10.1007/s10286-023-00955-9">published</a> earlier this year, we found people with POTS have a poor quality of life – poorer than people with chronic illnesses such as HIV, cancer, or cardiovascular and kidney disease.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/539705/original/file-20230727-19-q8v1t8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Man washing hair in shower, dark hair with shampoo suds" src="https://images.theconversation.com/files/539705/original/file-20230727-19-q8v1t8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/539705/original/file-20230727-19-q8v1t8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/539705/original/file-20230727-19-q8v1t8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/539705/original/file-20230727-19-q8v1t8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/539705/original/file-20230727-19-q8v1t8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/539705/original/file-20230727-19-q8v1t8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/539705/original/file-20230727-19-q8v1t8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Washing hair in the shower can leave people debilitated.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-man-washing-his-hair-taking-428660125">Shutterstock</a></span>
</figcaption>
</figure>
<h2>A long path to diagnosis</h2>
<p>Many patients are also forced to negotiate a diagnostic odyssey littered with tales of disbelief and dismissal by medical professionals, friends and family. Diagnosis can <a href="https://onlinelibrary.wiley.com/doi/10.1111/joim.12895">take years</a>.</p>
<p>In our <a href="https://www.aph.gov.au/Parliamentary_Business/Committees/House/Health_Aged_Care_and_Sport/LongandrepeatedCOVID/Submissions">submission</a> to the parliamentary inquiry into long COVID, we shared the experiences of people with POTS symptoms and their frustration at the lack of recognition by the medical profession. One health worker said:</p>
<blockquote>
<p>I am a nurse myself and specifically brought up that I believed I had POTS after COVID infection. I was treated like a hypochondriac and told I had anxiety, which was absolutely ludicrous as I had physical symptoms […] I had many presentations to [the emergency department] with no help or diagnosis whatsoever.</p>
</blockquote>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/we-got-some-key-things-wrong-about-long-covid-here-are-5-things-weve-learnt-199974">We got some key things wrong about long COVID. Here are 5 things we've learnt</a>
</strong>
</em>
</p>
<hr>
<h2>We can do better</h2>
<p>Prompt diagnosis is vital in the face of what we suspect are rising numbers of newly diagnosed cases associated with long COVID. </p>
<p>Although many people with POTS report they were referred to <a href="https://onlinelibrary.wiley.com/doi/10.1111/joim.12895">multiple specialists</a> before they were diagnosed, this is not always necessary.</p>
<p>GPs can ask you to do a <a href="https://potsfoundation.org.au/wp-content/uploads/2023/03/NASA-Lean-Test-vFinal.pdf">ten-minute standing test</a> to help diagnose it. They can also exclude other common causes of POTS symptoms, such as lung and heart conditions. </p>
<p>There is no known cure for POTS. However, once diagnosed, there are <a href="https://www.ausdoc.com.au/therapy-update/postural-orthostatic-tachycardia-syndrome/">multiple things</a> that can improve and manage the condition. A <a href="https://potsfoundation.org.au/wp-content/uploads/2023/03/Malmo-POTS-Score-vFinal.pdf">questionnaire</a> your GP can give you can help prioritise which symptoms to manage. You then work with your trusted GP to manage these.</p>
<p>Increasing fluid and salt intake (under the supervision of your GP), and using full-length compression tights is recommended. These help control heart rate and blood pressure, and reduce dizziness.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/539706/original/file-20230727-23-d93682.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Woman adding salt to pot of boiling water on stove" src="https://images.theconversation.com/files/539706/original/file-20230727-23-d93682.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/539706/original/file-20230727-23-d93682.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/539706/original/file-20230727-23-d93682.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/539706/original/file-20230727-23-d93682.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/539706/original/file-20230727-23-d93682.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/539706/original/file-20230727-23-d93682.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/539706/original/file-20230727-23-d93682.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Eating more salt can help.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-adding-salt-boiling-water-pot-2183938315">Shutterstock</a></span>
</figcaption>
</figure>
<p>Avoiding triggers is important. These include avoiding standing still for extended periods, hot showers, large meals high in carbohydrates, and hot environments.</p>
<p>Many people also benefit from <a href="https://www.ausdoc.com.au/therapy-update/postural-orthostatic-tachycardia-syndrome/">medicines</a> to help control their blood pressure and heart rate.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-should-my-heart-rate-be-and-what-affects-it-98945">What should my heart rate be and what affects it?</a>
</strong>
</em>
</p>
<hr>
<h2>How about referral?</h2>
<p>If referral to specialist services are required, this can be complex and expensive. There are no specialised clinics for POTS in public hospitals. Instead, POTS is mainly managed in the private sector. </p>
<p>Referral options can be overwhelming. People may benefit from referral to a range of health professionals to manage their symptoms, including a physiotherapist, psychologist, occupational therapist or exercise physiologist – ideally ones familiar with POTS.</p>
<p>All these barriers means access to diagnosis and treatment largely depends on someone having sufficient money, or being confident enough to navigate the health system.</p>
<hr>
<p><em>If you have symptoms such as those we’ve described, see your GP for assessment. For more information about the condition, see the Australian POTS Foundation <a href="https://potsfoundation.org.au">website</a>, which also <a href="https://potsfoundation.org.au/clinician-directory/">lists</a> doctors and allied health professionals who are “POTS aware”.</em></p><img src="https://counter.theconversation.com/content/208280/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marie-Claire Seeley receives funding from The Australian Government Research Training Scholarship and Standing up to POTS . </span></em></p><p class="fine-print"><em><span>Celine Gallagher receives funding from The University of Adelaide and the Australian POTS Foundation. </span></em></p>Everyday tasks, such as washing your hair, become impossible.Marie-Claire Seeley, PhD Candidate, Australian Dysautonomia and Arrhythmia Research Collaborative, University of AdelaideCeline Gallagher, Postdoctoral Fellow, Australian Dysautonomia and Arrhythmia Research Collaborative, University of AdelaideLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2082022023-07-20T08:03:37Z2023-07-20T08:03:37ZWhat is atrial fibrillation, the heart condition US President Joe Biden lives with?<p>US President Joe Biden <a href="https://www.whitehouse.gov/wp-content/uploads/2023/02/Health-Summary-2.16.pdf">has</a> the heart condition atrial fibrillation. This increases his risk of having a stroke <a href="https://www.stroke.org.uk/what-is-stroke/are-you-at-risk-of-stroke/atrial-fibrillation">five-fold</a> and <a href="https://academic.oup.com/eurheartj/article/42/5/373/5899003?login=false">doubles</a> the risk of a heart attack or dementia.</p>
<p>More than <a href="https://journals.sagepub.com/doi/full/10.1177/1747493019897870?casa_token=xNrhAk_qBIQAAAAA%3A2DRaB1b1avVWKJFlBsKmEgRYXienljZDL4qhdajIGcOp4F4MwX9r_77vySuqdNS7pzHbY9RiZXuwkpw">37.5 million</a> people globally also have atrial fibrillation, but many don’t realise they have it. </p>
<p>For most, the condition has few symptoms and does not limit daily life. However, identifying it and treating it is the only way to reduce its serious health consequences.</p>
<p>Our research, <a href="https://heart.bmj.com/content/early/2023/07/03/heartjnl-2023-322602">just published</a> in the journal Heart, looks at the importance of managing blood pressure in reducing such risks.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-what-do-my-blood-pressure-numbers-mean-29212">Health Check: what do my blood pressure numbers mean?</a>
</strong>
</em>
</p>
<hr>
<h2>What is atrial fibrillation?</h2>
<p>Atrial fibrillation is when the heart <a href="https://www.heartfoundation.org.au/bundles/your-heart/atrial-fibrillation">beats irregularly</a>, sometimes fast, sometimes slow. It’s the <a href="https://journals.sagepub.com/doi/full/10.1177/1747493019897870?casa_token=xNrhAk_qBIQAAAAA%3A2DRaB1b1avVWKJFlBsKmEgRYXienljZDL4qhdajIGcOp4F4MwX9r_77vySuqdNS7pzHbY9RiZXuwkpw">most common</a> heart rhythm disorder and is more common as you get older. But some people develop it in their 30s and 40s.</p>
<p>The abnormal heart rhythm starts in the top chambers of the heart, meaning the heart does not propel the blood forward properly. This, and the erratic movements of these heart chambers, result in blood pooling, and occasionally clots.</p>
<p>The heart can go into atrial fibrillation for short periods of time, and then return to normal rhythm, or stay in this abnormal heart rhythm continuously.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/UOkseyF-wrA?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Here’s what happens if you have atrial fibrillation and your heart beats irregularly.</span></figcaption>
</figure>
<h2>How do I know if I have it?</h2>
<p>Some people have lots of symptoms, such as heart palpitations (a feeling of fluttering or pounding heart), breathlessness or even discomfort, and know exactly when they have gone into atrial fibrillation. Their symptoms can stop what they would normally do. But others have no symptoms and don’t know they have atrial fibrillation. We know very little about why some people have symptoms and others do not.</p>
<p>If you have symptoms, discuss these <a href="https://academic.oup.com/eurheartj/article/42/5/373/5899003?login=false">with your GP</a>. Your GP will ask about triggers for your symptoms, your general health and other risk factors, and will likely organise an <a href="https://www.heartfoundation.org.au/bundles/your-heart/medical-tests-for-heart-disease">electrocardiogram</a> (also called an ECG). This is a type of non-invasive test where 12 leads are attached to your chest to measure the electrical activity of the heart.</p>
<p>Generally, your GP will refer you to a cardiologist (heart specialist) or a hospital clinic if they suspect you have a heart rhythm problem, including atrial fibrillation, for further testing and treatment.</p>
<p>Some people say you can detect atrial fibrillation using <a href="https://theconversation.com/should-you-really-use-your-smartwatch-or-fitness-wearable-to-monitor-your-heart-194060">consumer wearables</a>, such as smartwatches. However, it’s not clear how accurate these are.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/536191/original/file-20230707-25-yl4bur.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Health worker with ECG trace in hand, man lying on hospital bed in background" src="https://images.theconversation.com/files/536191/original/file-20230707-25-yl4bur.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/536191/original/file-20230707-25-yl4bur.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=403&fit=crop&dpr=1 600w, https://images.theconversation.com/files/536191/original/file-20230707-25-yl4bur.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=403&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/536191/original/file-20230707-25-yl4bur.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=403&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/536191/original/file-20230707-25-yl4bur.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=507&fit=crop&dpr=1 754w, https://images.theconversation.com/files/536191/original/file-20230707-25-yl4bur.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=507&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/536191/original/file-20230707-25-yl4bur.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=507&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">An ECG measures the electrical activity of your heart.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/electrocardiogram-ecg-hand-clinic-cardiology-heart-566691763">Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/is-this-love-or-an-arrhythmia-your-heart-really-can-skip-a-beat-when-youre-in-love-176537">Is this love ... or an arrhythmia? Your heart really can skip a beat when you're in love</a>
</strong>
</em>
</p>
<hr>
<h2>What happens after you’re diagnosed?</h2>
<p>Once diagnosed with atrial fibrillation, you will be assessed for serious potential complications, such as an increased risk of stroke.</p>
<p>You’ll be advised to manage any risk factors that worsen atrial fibrillation and increase your risk of stroke. This includes cutting down on alcohol, managing your weight and doing more exercise.</p>
<p>Some people at higher risk of a stroke will be started on blood thinning medicines. Some people may also need to take medicines to control their heart rhythm or have a procedure called “ablation”. This is when wires are passed into the heart to identify and treat the electrical origin of the condition.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-should-my-heart-rate-be-and-what-affects-it-98945">What should my heart rate be and what affects it?</a>
</strong>
</em>
</p>
<hr>
<h2>How about high blood pressure?</h2>
<p>More than <a href="https://www.ahajournals.org/doi/10.1161/CIRCRESAHA.117.311402#:%7E:text=Hypertension%20ultimately%20increases%20the%20risk,%25%20to%2080%25%20of%20individuals">three in five</a> people with atrial fibrillation also have high blood pressure (hypertension). This is another major cause of stroke and heart attack. So managing blood pressure is very important.</p>
<p>In our <a href="https://heart.bmj.com/content/early/2023/07/03/heartjnl-2023-322602">new research</a>, we analysed data from the electronic medical records from about 34,000 Australian GP patients with both atrial fibrillation and hypertension. We found one-in-three had poorly controlled blood pressure. This places a group already at a high risk of stroke at an even greater risk.</p>
<p>When someone’s blood pressure is poorly controlled, this is usually because their medicines are not adequately bringing down their blood pressure. This could be because doctors are not increasing the number of different types of medicine when needed, or because patients cannot afford their medicines, or forget to take them.</p>
<p>We also found that people who visited the same GP regularly were more likely to have their blood pressure controlled, so were at lower risk of stroke.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/537245/original/file-20230713-15-lr4gwj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Female doctor checking blood pressure of older male" src="https://images.theconversation.com/files/537245/original/file-20230713-15-lr4gwj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/537245/original/file-20230713-15-lr4gwj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/537245/original/file-20230713-15-lr4gwj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/537245/original/file-20230713-15-lr4gwj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/537245/original/file-20230713-15-lr4gwj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/537245/original/file-20230713-15-lr4gwj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/537245/original/file-20230713-15-lr4gwj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Our research highlighted the importance of seeing the same GP regularly.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-woman-doctor-wearing-white-uniform-1805492158">Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-recognise-a-stroke-and-what-you-should-know-about-their-treatment-63651">How to recognise a stroke and what you should know about their treatment</a>
</strong>
</em>
</p>
<hr>
<h2>Why is this important?</h2>
<p>It is important people at the highest risk of stroke – such as those with both atrial fibrillation and high blood pressure – are receiving appropriate treatment to minimise their risk.</p>
<p>Strokes, heart attacks and dementia are still leading causes <a href="https://www.aihw.gov.au/reports/life-expectancy-death/deaths-in-australia/contents/leading-causes-of-death">of death</a> and <a href="https://www.aihw.gov.au/reports/burden-of-disease/australian-burden-of-disease-study-2022/contents/summary#">ill health</a> in Australia. Prevention is so much better than treating them when they develop.</p><img src="https://counter.theconversation.com/content/208202/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ritu Trivedi is a recipient of the Commonwealth Government Research Training Program Stipend Scholarship to support her PhD studies.</span></em></p><p class="fine-print"><em><span>Clara Chow receives funding from National Health and Medical Research Council. Dr Chow is affiliated with the Cardiac Society of Australia and New Zealand. </span></em></p><p class="fine-print"><em><span>Liliana Laranjo receives funding from the National Health and Medical Research Council. </span></em></p>This common heart condition puts you at increased risk of having a stroke, especially if you also have high blood pressure. But our new research shows what you can do to lower your risk.Ritu Trivedi, PhD Student, University of SydneyClara Chow, Cardiologist at Westmead Hospital; Director of the Westmead Applied Research Centre, University of SydneyLiliana Laranjo, Senior Lecturer in Digital Health and Community and Primary Health Care Practice, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2100882023-07-19T16:38:30Z2023-07-19T16:38:30ZAs heat records fall, how hot is too hot for the human body?<figure><img src="https://images.theconversation.com/files/538320/original/file-20230719-19-ktr6ea.jpg?ixlib=rb-1.1.0&rect=0%2C19%2C4288%2C2824&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Outdoor workers face higher risks on hot, humid days.</span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/HotWeather/3ff9206529d3441f8a6ec71da8ed26da/photo">AP Photo/Swoan Parker</a></span></figcaption></figure><p>Extreme heat has been breaking records <a href="https://www.copernicus.eu/en/media/image-day-gallery/heatwave-grips-southern-europe">across Europe</a>, <a href="https://www.dw.com/en/dangerous-heat-waves-hit-parts-of-asia-us-and-europe/video-66251132">Asia</a> and <a href="https://www.cnn.com/world/live-news/global-heat-wave-weather-temperatures-07-18-23/index.html">North America</a>, with millions of people sweltering in heat and humidity well above “normal” for days on end.</p>
<p>Death Valley hit a temperature of <a href="https://twitter.com/NWSVegas/status/1680701657167048704">128 degrees Fahrenheit</a> (53.3 degrees Celsius) on July 16, 2023 – not quite the world’s hottest day on record, but close. Phoenix broke a record heat streak with <a href="https://www.azcentral.com/story/news/local/phoenix-weather/2023/07/18/phoenix-hits-110-degrees-for-record-19th-day-in-a-row/70426475007/">19 straight days</a> with temperatures above 110 F (43.3 C), and had more in the forecast, accompanied by several nights that never got below 90 F (32.2 C). Globally, Earth likely had its <a href="https://public.wmo.int/en/media/news/preliminary-data-shows-hottest-week-record-unprecedented-sea-surface-temperatures-and">hottest week on modern record</a> in early July.</p>
<p>Heat waves are <a href="https://doi.org/10.1038/s41467-020-16970-7">becoming supercharged as the climate changes</a> – lasting longer, becoming more frequent and getting just plain hotter. </p>
<p>One question a lot of people are asking is: “When will it get too hot for normal daily activity as we know it, even for young, healthy adults?”</p>
<p>The answer goes beyond the temperature you see on the thermometer. It’s also about humidity. <a href="https://scholar.google.com/citations?user=zsXN72cAAAAJ&hl=en">Our</a> <a href="https://scholar.google.com/citations?user=xuBw4jQAAAAJ&hl=en">research</a> is designed to come up with the combination of the two, measured as “wet-bulb temperature.” Together, heat and humidity put people at greatly increased risk, and the combination <a href="https://doi.org/10.1152/japplphysiol.00738.2021">gets dangerous at lower levels</a> than scientists previously believed.</p>
<figure class="align-center ">
<img alt="A construction worker cools his head in the stream of a fountain outside an office building." src="https://images.theconversation.com/files/538362/original/file-20230719-15-92axgr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/538362/original/file-20230719-15-92axgr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=441&fit=crop&dpr=1 600w, https://images.theconversation.com/files/538362/original/file-20230719-15-92axgr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=441&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/538362/original/file-20230719-15-92axgr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=441&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/538362/original/file-20230719-15-92axgr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=554&fit=crop&dpr=1 754w, https://images.theconversation.com/files/538362/original/file-20230719-15-92axgr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=554&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/538362/original/file-20230719-15-92axgr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=554&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Long-term exposure to high heat can become lethal.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/construction-worker-stops-to-cool-off-in-the-water-news-photo/1162996602?adppopup=true">Mark Wilson/Getty Images</a></span>
</figcaption>
</figure>
<h2>The limits of human adaptability</h2>
<p>Scientists and other observers have become alarmed about the increasing frequency of extreme heat paired with high humidity.</p>
<p>People often point to a <a href="https://doi.org/10.1073/pnas.0913352107">study published in 2010</a> that theorized that a wet-bulb temperature of 95 F (35 C) – equal to a temperature of 95 F at 100% humidity, or 115 F at 50% humidity – would be the upper limit of safety, beyond which the human body can no longer cool itself by evaporating sweat from the surface of the body to maintain a stable body core temperature.</p>
<p>It was not until recently that this limit was tested on humans in laboratory settings. The results of these tests show an even greater cause for concern.</p>
<h2>The PSU H.E.A.T. Project</h2>
<p>To answer the question of “how hot is too hot?” we brought young, healthy men and women into the <a href="https://hhd.psu.edu/kines/get-started/research-labs-and-initiatives">Noll Laboratory at Penn State University</a> to experience heat stress in a controlled environmental chamber.</p>
<p>These experiments provide insight into which combinations of temperature and humidity begin to become harmful for even the healthiest humans.</p>
<figure class="align-center ">
<img alt="A young man in shorts walks on a treadmill with a towel beside him in a glass-enclosed room while a scientist monitors his body temperature and other conditions on computer screens on the other side of the glass." src="https://images.theconversation.com/files/470808/original/file-20220624-17-za2vp8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/470808/original/file-20220624-17-za2vp8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/470808/original/file-20220624-17-za2vp8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/470808/original/file-20220624-17-za2vp8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/470808/original/file-20220624-17-za2vp8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/470808/original/file-20220624-17-za2vp8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/470808/original/file-20220624-17-za2vp8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">S. Tony Wolf, a postdoctoral researcher in kinesiology at Penn State and coauthor of this article, conducts a heat test in the Noll Laboratory as part of the PSU Human Environmental Age Thresholds project.</span>
<span class="attribution"><a class="source" href="https://www.psu.edu/news/research/story/humans-cant-endure-temperatures-and-humidities-high-previously-thought/">Patrick Mansell/Penn State</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span>
</figcaption>
</figure>
<p>Each participant swallowed a small <a href="https://www.nasa.gov/topics/nasalife/thermometer_pill.html">telemetry pill</a> that continuously monitored their deep body or core temperature. They then sat in an environmental chamber, moving just enough to simulate the minimal activities of daily living, such as showering, cooking and eating. Researchers slowly increased either the temperature in the chamber or the humidity in hundreds of separate experiments and monitored when the subject’s core temperature started to rise.</p>
<p>That combination of temperature and humidity at which the person’s core temperature starts to continuously rise is called the “<a href="https://doi.org/10.1152/japplphysiol.00738.2021">critical environmental limit</a>.” </p>
<p>Below those limits, the body is able to maintain a relatively stable core temperature over long periods of time. Above those limits, core temperature rises continuously and the risk of heat-related illnesses with prolonged exposures is increased.</p>
<p>When the body overheats, the heart has to work harder to pump blood flow to the skin to dissipate the heat, and when you’re also sweating, that decreases body fluids. In the direst case, prolonged exposure can result in heat stroke, a life-threatening problem that requires immediate and rapid cooling and medical treatment. </p>
<p>Our studies on young healthy men and women show that this upper environmental limit <a href="https://doi.org/10.1152/japplphysiol.00738.2021">is even lower</a> than the theorized 35 C. It occurs at a wet-bulb temperature of about 87 F (31 C) across a range of environments above 50% relative humidity. That would equal 87 F at 100% humidity or 100 F (38 C) at 60% humidity.</p>
<figure class="align-center ">
<img alt="A chart allows users to see when the combination of heat and humidity becomes dangerous at each degree and percentage." src="https://images.theconversation.com/files/470813/original/file-20220624-14-jt7lbq.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/470813/original/file-20220624-14-jt7lbq.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=516&fit=crop&dpr=1 600w, https://images.theconversation.com/files/470813/original/file-20220624-14-jt7lbq.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=516&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/470813/original/file-20220624-14-jt7lbq.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=516&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/470813/original/file-20220624-14-jt7lbq.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=648&fit=crop&dpr=1 754w, https://images.theconversation.com/files/470813/original/file-20220624-14-jt7lbq.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=648&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/470813/original/file-20220624-14-jt7lbq.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=648&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Similar to the National Weather Service’s heat index chart, this chart translates combinations of air temperature and relative humidity into critical environmental limits, above which core body temperature rises. The border between the yellow and red areas represents the average critical environmental limit for young men and women at minimal activity.</span>
<span class="attribution"><span class="source">W. Larry Kenney</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<h2>Dry vs. humid environments</h2>
<p>Current heat waves around the globe are exceeding those critical environmental limits, and approaching, if not exceeding, even the theorized 95 F (35 C) wet-bulb limits.</p>
<p>In the Middle East, Asaluyeh, Iran, recorded an extremely dangerous <a href="https://www.weather.gov/wrh/timeseries?site=OIBP&hours=72">maximum wet-bulb temperature</a> of 92.7 F (33.7 C) on <a href="https://twitter.com/US_Stormwatch/status/1680700765265072128">July 16, 2023</a>. <a href="https://www.indiatimes.com/news/india/at-400c-delhis-real-feel-was-above-500c-on-tuesday-573438.html">India</a> and <a href="https://www.telegraph.co.uk/global-health/climate-and-people/hotter-human-body-can-handle-pakistan-city-broils-worlds-highest/">Pakistan</a> have both reached hazardous levels in recent years, as well. </p>
<p>In hot, dry environments, the critical environmental limits aren’t defined by wet-bulb temperatures, because almost all the sweat the body produces evaporates, which cools the body. However, the amount humans can sweat is limited, and we also gain more heat from the higher air temperatures.</p>
<p>Keep in mind that these cutoffs are based solely on keeping your body temperature from rising excessively. Even lower temperatures and humidity can place stress on the heart and other body systems. </p>
<p>A recent paper from our laboratory showed that <a href="https://pubmed.ncbi.nlm.nih.gov/37348014/">heart rate begins to increase</a> well before our core temperature does, as we pump blood to the skin. And while eclipsing these limits does not necessarily present a worst-case scenario, prolonged exposure may become dire for vulnerable populations such as the elderly and those with chronic diseases. </p>
<p>Our experimental focus has now turned to testing older men and women, since even healthy aging makes people less heat-tolerant. The increased prevalence of heart disease, respiratory problems and other health problems, as well as certain medications, can put them at even higher risk of harm. People over the age of 65 comprise some <a href="https://doi.org/10.2105/AJPH.87.9.1515">80% to 90% of heat wave casualties</a>.</p>
<h2>How to stay safe</h2>
<p>Staying well hydrated and seeking areas in which to cool down – even for short periods – are important in high heat.</p>
<p>While more cities in the United States are expanding <a href="https://www.cdc.gov/climateandhealth/docs/UseOfCoolingCenters.pdf">cooling centers</a> to help people escape the heat, there will still be many people who will experience these dangerous conditions with <a href="https://www.latimes.com/world-nation/story/2022-06-20/sweltering-streets-hundreds-of-homeless-die-in-extreme-heat-each-year">no way to cool themselves</a>. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/vo93rjdHXVo?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The lead author of this article, W. Larry Kenney, discusses the impact of heat stress on human health with PBS NewsHour.</span></figcaption>
</figure>
<p>Even those with access to air conditioning might not turn it on because of the <a href="http://dx.doi.org/10.15585/mmwr.mm7124a1">high cost of energy</a> – a common occurrence in Phoenix – or because of <a href="https://apnews.com/article/climate-change-government-and-politics-business-environment-and-nature-6a66be20ed86ad18ed131156c9f7a517">large-scale power outages</a> during heat waves or wildfires, as is becoming more common in the western U.S.</p>
<p>All told, the evidence continues to mount that climate change is not just a problem for the future. It is one that humanity is currently facing and must tackle head-on.</p>
<p><em>This is an update to an article <a href="https://theconversation.com/how-hot-is-too-hot-for-the-human-body-our-lab-found-heat-humidity-gets-dangerous-faster-than-many-people-realize-185593">originally published</a> July 6, 2022.</em></p><img src="https://counter.theconversation.com/content/210088/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>W. Larry Kenney receives research grant funding from the National Institutes of Health/National Institute on Aging.</span></em></p><p class="fine-print"><em><span>Daniel Vecellio is supported by a training grant from the National Institute on Aging through the Penn State Center for Healthy Aging.</span></em></p><p class="fine-print"><em><span>Rachel Cottle is supported by a training grant from the National Institute on Aging through the Penn State Center for Healthy Aging.</span></em></p><p class="fine-print"><em><span>S. Tony Wolf is supported by the National Institutes of Health.</span></em></p>The biggest risks aren’t always the biggest numbers on the thermometer – humidity gets dangerous faster than many people realize.W. Larry Kenney, Professor of Physiology, Kinesiology and Human Performance, Penn StateDaniel Vecellio, Geographer-climatologist and Postdoctoral Fellow, Penn StateRachel Cottle, Ph.D. Candidate in Exercise Physiology, Penn StateS. Tony Wolf, Postdoctoral Researcher in Kinesiology, Penn StateLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1983422023-06-20T09:33:09Z2023-06-20T09:33:09ZIs hot yoga good for you? Exploring the science behind the sweat<iframe id="noa-web-audio-player" style="border: none" src="https://embed-player.newsoveraudio.com/v4?key=x84olp&id=https://theconversation.com/is-hot-yoga-good-for-you-exploring-the-science-behind-the-sweat-198342&bgColor=F5F5F5&color=D8352A&playColor=D8352A" width="100%" height="110px"></iframe>
<p><a href="https://theconversation.com/yoga-isnt-timeless-its-changing-to-meet-contemporary-needs-97162">Hot yoga</a> also known as <a href="https://www.yoga-society.com/blogs/types-of-yoga/what-is-bikram-yoga">Bikram yoga</a> (more on that later) has <a href="https://www.cnet.com/health/fitness/benefits-of-hot-yoga/">gained significant popularity in recent years</a> as a fairly ferocious form of exercise. It combines yoga poses and breathing exercises and is practised in a heated studio – with room temperatures close to 40°C.</p>
<p>This style of yoga is designed to replicate the environmental conditions of India and is typically practised for around 90 minutes, leaving students (and teachers) dripping in sweat come the end of class.</p>
<p>Practising hot yoga challenges the mind and places additional physiological strain on the body. It makes you very sweaty and increases your heart rate, which can feel pretty intense. Indeed, hot yoga can lead to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5433110/">dehydration and dizziness</a>, especially if it’s your first time and you don’t begin the class hydrated.</p>
<p>Designed to develop strength, flexibility and balance, hot yoga is believed to offer enhanced physical and <a href="https://journals.copmadrid.org/pi/art/pi2022a4">mental health benefits</a> – including improved levels of fitness and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4609431/">reduced stress levels</a>. </p>
<p>But it can also feel uncomfortable – think sweat trickling into your eyes while doing a headstand – and hard going: with fast, dynamic sequences repeated numerous times. Then there are also those tricky balances and multiple lunges, all done at high temperatures, meaning that at times classes can feel pretty gruelling.</p>
<p>So are all these hot sweaty postures actually any good for you? Let’s take a look at the science. </p>
<h2>The origins of hot yoga</h2>
<p>Before we go into the evidence, a bit on the history. Originally known as “<a href="https://www.shape.com/fitness/workouts/things-you-need-know-about-bikram-yoga">Bikram yoga</a>”, named after its creator Bikram Choudhury, the traditional style of hot yoga was developed in the early 1970s. It involves a series of 26 fixed postures, carried out over 90 minutes while experiencing extreme heat stress. </p>
<p>In recent years many yoga studios have chosen to <a href="https://www.theguardian.com/tv-and-radio/2019/dec/03/he-made-a-fortune-from-his-trademarked-bikram-yoga-but-now-his-empire-is-in-tatters">rebrand</a> these classes as “hot yoga”, having changed from the original 26 fixed postures to be more flowing and individual and to include music (which Bikram classes don’t). </p>
<p>Another reason many yoga studios have chosen to <a href="https://www.huffingtonpost.co.uk/entry/bikram-choudhury-sexual-assault_n_5d4dc527e4b0fd2733f0286f">move away from the Bikram style</a> of yoga is that <a href="https://www.theguardian.com/lifeandstyle/2017/feb/18/bikram-hot-yoga-scandal-choudhury-what-he-wanted">multiple women</a> have <a href="https://www.independent.co.uk/life-style/bikram-choudhury-yoga-rape-sexual-abuse-netflix-documentary-who-a9210771.html">come forward</a> with <a href="https://www.vogue.in/culture-and-living/content/bikram-hot-yoga-controversy-bikram-choudhury-sexual-assault-netflix-documentary">accusations of sexual harassment</a> and <a href="https://www.theguardian.com/film/2019/nov/20/bikram-choudhury-yoga-founder-abuse-netflix-documentary">assault against Choudhury</a>. This has led to <a href="https://www.latimes.com/local/lanow/la-me-ln-bikram-yoga-lawsuit-20160126-story.html">legal action</a> and been the focus of a 2019 Netflix documentary: <a href="https://www.netflix.com/gb/title/80221584">Bikram: Yogi, Guru, Predator</a>.</p>
<p>Even before the <a href="https://www.refinery29.com/en-gb/2019/11/8874728/bikram-yoga-founder-scandal-new-netflix-documentary">Bikram scandal</a>, not everyone in the yoga community backed the idea of hot yoga. This is because traditional yoga practice involves a series of postures known as sun salutations, which are performed early in the morning (when it’s cooler), not during the midday heat. </p>
<h2>What the science says</h2>
<p>Although <a href="https://hfjc.library.ubc.ca/index.php/HFJC/article/view/220">comprehensive scientific reviews</a> are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4609431/">still lacking</a>, some studies have indicated potential health benefits from hot yoga. Modified Bikram yoga performed regularly has been <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4609431/">associated with</a> increased aerobic fitness and improved cardiovascular function. </p>
<p>Hot yoga has <a href="https://journals.lww.com/nsca-jscr/Fulltext/2018/10000/Efficacy_of_Hot_Yoga_as_a_Heat_Stress_Technique.23.aspx">shown promise</a> in terms of <a href="https://www.liebertpub.com/doi/full/10.1089/acm.2012.0709">heart health</a>, by lowering “bad cholesterol” levels and <a href="https://pubmed.ncbi.nlm.nih.gov/24138995/">improving glucose tolerance</a>. Glucose intolerance may indicate an increased risk of metabolic conditions, such as diabetes.</p>
<p>It has <a href="https://journals.lww.com/nsca-jscr/fulltext/2013/03000/bikram_yoga_training_and_physical_fitness_in.35.aspx?casa_token=6VxlqbNhg6YAAAAA:Q1t8bes2-X1blvLrO0vMe7AdpxJyZ4xtU69WSWoLbTtwTb7kHur2Lv5XjeIsy7OIRntbCb5Le1ciqCsWq60MElzJaEqJWDQ">also been linked</a> to an increase in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4609431/">strength</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7241641/">flexibility</a> <a href="https://scielo.isciii.es/pdf/inter/v31n2/1132-0559-inter-31-2-0067.pdf">and enhanced mental health</a>, including improved stress management and sleep quality.</p>
<figure class="align-center ">
<img alt="Women in hot yoga studio sweating." src="https://images.theconversation.com/files/531979/original/file-20230614-21-cbnbgo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/531979/original/file-20230614-21-cbnbgo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/531979/original/file-20230614-21-cbnbgo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/531979/original/file-20230614-21-cbnbgo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/531979/original/file-20230614-21-cbnbgo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/531979/original/file-20230614-21-cbnbgo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/531979/original/file-20230614-21-cbnbgo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Getting a sweat on for that mind-body connection.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/fitness-asian-female-group-doing-namaste-527129368">Southtownboy Studio/Shutterstock</a></span>
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<p>Yoga is classified as a “light-intensity exercise” by the <a href="http://www.alternative-therapies.com/openaccess/ATHM_20_4_pate.pdf">American College of Sports Medicine</a> but <a href="https://www.researchgate.net/profile/Rajasree-Nambron-2/publication/281017791_Unilateral_spontaneous_adrenal_hemorrhage_in_pregnancy/links/55d14c3a08ae6a881385ec32/Unilateral-spontaneous-adrenal-hemorrhage-in-pregnancy.pdf#page=6">studies</a> show that hot yoga sessions can result in high heart rates, increased core temperatures of 38˚C-40˚C and substantial sweat losses – <a href="https://pubmed.ncbi.nlm.nih.gov/33230967/">up to 1.5 litres per session</a> – making it a more <a href="https://cdnsciencepub.com/doi/abs/10.1139/apnm-2017-0495">intense exercise</a>.</p>
<p>When it comes to hot yoga classes, <a href="https://www.lboro.ac.uk/microsites/lds/EEC/ICEE/textsearch/13proceedings/Environmental%20Ergonomics%20XV_Proceedings%20for%20Webpage_V1.pdf#page=153">research</a> has also found that novices and experienced practitioners exhibit similarities in heart rate but can differ in sweat rate and core temperature changes. The more experienced you are, the more you sweat and the hotter you may get. This is likely because more experienced hot yogis will be better adapted to the heat and so able to push harder.</p>
<p>It’s often claimed that practising yoga in a heated environment may help with “<a href="https://www.yogajournal.com/practice/does-yoga-detox-your-body/">detoxification</a>” and the release of <a href="https://www.cbsnews.com/news/reality-check-yoga-does-not-release-toxins-from-the-body/">toxins from the body</a> due to excessive sweating. But this is rubbish – that’s what our kidneys are for. The reality is that those who practice hot yoga will probably lose more <a href="https://physoc.onlinelibrary.wiley.com/doi/full/10.14814/phy2.14647#:%7E:text=Abstract,cation%20of%20the%20extracellular%20fluid.">sodium</a> (or salt) and so are more likely to become dehydrated through increased sweat loss compared to yoga in cooler conditions. </p>
<p>Given this, hot yoga may be of benefit to those wishing to adapt to heat stress. For example, athletes preparing for elite sports such as <a href="https://pubmed.ncbi.nlm.nih.gov/29979281/">hockey</a> – if performed safely. </p>
<h2>And the risks?</h2>
<p>Because hot yoga can be physically demanding, <a href="https://www.hindawi.com/journals/ecam/2015/428427/">it may not be suitable for everyone</a>, especially for those with certain medical conditions or sensitivity to heat. Plus, some of the research looking at the benefits of hot yoga <a href="https://pubmed.ncbi.nlm.nih.gov/22592178/">hasn’t been replicated</a> – essentially meaning that further investigations are required to fully understand the true value of hot yoga in terms of physical fitness.</p>
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<p>So while it does seem that there are some potential benefits, it’s important to be mindful of the potential risks associated with hot yoga, too. The heated environment, for example, can increase the risk of dehydration, heat exhaustion and potentially heat stroke, especially if <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5433110/">proper hydration practices</a> are not followed.</p>
<p>People with certain medical conditions, such as heart disease or high blood pressure, or those who are pregnant may need to exercise caution or consult their doctor before participating in hot yoga. And it’s vital that students listen to their bodies, take breaks when needed and stay hydrated throughout their practice.</p>
<p>With hot and humid conditions, on top of excessive sweating, hygiene and cleanliness is also important for you and your mat. So don’t forget your towel and wipe your mat down afterwards too.</p><img src="https://counter.theconversation.com/content/198342/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Sweating it out can be beneficial for maintaining fitness and good mental health, but it’s not right for everyone.Ash Willmott, Senior Lecturer in Sport and Exercise Science, Anglia Ruskin UniversityJessica Mee, Senior Lecturer in Sport and Exercise Science, University of WorcesterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2002282023-03-19T11:51:51Z2023-03-19T11:51:51Z3 ways to unlock the power of food to promote heart health<figure><img src="https://images.theconversation.com/files/515920/original/file-20230316-2393-gn90tf.jpg?ixlib=rb-1.1.0&rect=172%2C111%2C5146%2C3700&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Heart-healthy approaches to eating include the Mediterranean diet, the DASH diet and the Portfolio diet.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Your diet — the foods and drinks you eat, not short-term restrictive programs — can impact your heart disease risk. Evidence-based approaches to eating are used by dietitians and physicians to prevent and treat cardiovascular (heart) disease. </p>
<p>National Nutrition Month, with its 2023 theme of <a href="https://www.dietitians.ca/Advocacy/Nutrition-Month/Nutrition-Month-2023?lang=en-CA">Unlock the Potential of Food</a>, is an ideal opportunity to learn more about these approaches and adopt more heart-friendly behaviours.</p>
<p>The <a href="https://doi.org/10.1016/j.cjca.2016.07.510">Canadian Cardiovascular Society (CCS) Clinical Practice Guidelines</a> recommend three main dietary patterns for lowering heart disease risk: the Mediterranean Diet, Dietary Approaches to Stop Hypertension (DASH) and the Portfolio Diet.</p>
<ol>
<li><p><strong>The Mediterranean Diet</strong> is rich in colourful vegetables and fruits, whole grains, legumes, nuts, olive oil and seafood. Research studies have shown that this diet <a href="https://doi.org/10.1056/nejmoa1800389">reduces risk of having a heart attack or stroke</a>, even <a href="https://doi.org/10.1016/s0140-6736(22)00122-2">if you already have heart disease</a>, and provides several other health benefits. <a href="https://www.dietitians.ca/DietitiansOfCanada/media/Documents/Mediterranean%20Diet%20Toolkit/Mediterranean-Diet-Toolkit-A-Guide-to-Healthy-Eating-(handout).pdf">Dietitians of Canada has created a resource</a> that summarizes the details of this approach to eating. </p></li>
<li><p><strong>The DASH Diet</strong> focuses on eating plenty of vegetables, fruit, low-fat dairy, whole grains and nuts, while limiting red and processed meats, foods with added sugar, and sodium. <a href="https://doi.org/10.3390/nu11020338">Originally developed to treat high blood pressure</a>, this diet can also lower low-density lipoprotein cholesterol (LDL-C — the unhealthy type of cholesterol) and provides several other health benefits. <a href="https://www.heartandstroke.ca/healthy-living/healthy-eating/dash-diet">Heart & Stroke has several resources</a> on this approach to eating. </p></li>
<li><p><strong>The Portfolio Diet</strong> was originally developed in Canada to treat high cholesterol. It emphasises plant proteins (for example, soy and other legumes); nuts; viscous (or “sticky”) fibre sources such as oats, barley and psyllium; plant sterols; and healthy oils like olive oil, canola oil and avocado. <a href="https://doi.org/10.1016/j.pcad.2018.05.004">Many research studies</a> have shown that this diet can lower LDL-C, and provides several other health benefits. Research shows that <a href="https://doi.org/10.1161/jaha.121.021515">even small additions of Portfolio Diet heart-healthy foods</a> can make a difference; the more you consume of these recommended foods, the greater your reductions in LDL-C and heart disease risk. The <a href="https://ccs.ca/app/uploads/2020/11/Portfolio_Diet_Scroll_editable_eng.pdf">Canadian Cardiovascular Society has an infographic</a> on how to follow the Portfolio Diet. </p></li>
</ol>
<p>A common theme among these three approaches to eating is that they are all considered plant-based, and small changes can make a difference in your overall heart disease risk. “Plant based” does not necessarily mean you have to be 100 per cent vegan or vegetarian to get their benefits. Plant-based diets can range from entirely vegan to diets that include small to moderate amounts of animal products.</p>
<p>Knowledge of healthy eating approaches is key, but behaviours unlock the power of food. Below are three strategies to use to apply the potential of food to promote heart health. They show that by combining the power of nutrition and psychology, you can <a href="https://www.newharbinger.com/9781684033331/healthy-habits-suck/">improve your chances of making long-term changes</a>.</p>
<p>You don’t need to do this alone. We recommend requesting a referral from your physician (this helps with getting the appointment covered by your insurance) to work with a registered dietitian and/or psychologist (behaviourist) to co-create your own ways to unlock the potential of food. </p>
<h2>3 ways to unlock the power of food</h2>
<figure class="align-center ">
<img alt="A woman in a white coat holding an apple, with a bowl of fresh produce on her desk, consulting with a woman who has her back to the camera" src="https://images.theconversation.com/files/516092/original/file-20230317-4846-oh3wlb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/516092/original/file-20230317-4846-oh3wlb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/516092/original/file-20230317-4846-oh3wlb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/516092/original/file-20230317-4846-oh3wlb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/516092/original/file-20230317-4846-oh3wlb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/516092/original/file-20230317-4846-oh3wlb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/516092/original/file-20230317-4846-oh3wlb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Working with a registered dietitian or psychologist (behaviourist) can help you create a personalized plan to unlock the potential of food. A physician’s referral can help with getting the appointment covered by insurance.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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</figure>
<h2>1. Master and conquer the 90 per cent goal</h2>
<p>Pick a goal you’re 90 per cent sure you can succeed at, while creating a plan to meet larger and harder goals in the future. This approach will help you build confidence in your skills and give you valuable information about what does and does not work for you.</p>
<p><a href="https://www.newharbinger.com/9781608824342/the-abcs-of-human-behavior/">Research shows</a> starting with 90 per cent goals makes it more likely we meet future goals. A 90 per cent goal could be swapping out animal protein for plant protein — such as tofu or beans — at lunch on Mondays (<a href="https://www.mondaycampaigns.org/meatless-monday">Meatless Mondays</a>). Another example: use a meal delivery service that provides measured ingredients with plant-based recipes on Monday, Wednesday and Friday, so you can get some new ideas about how to incorporate more plants into your meals.</p>
<h2>2. Why eliminate and restrict, when you can substitute?</h2>
<p>Pick a “do instead” goal or work with a registered dietitian to substitute healthier choices for your current foods and drinks. Avoid setting goals that may <a href="https://doi.org/10.1016/j.eatbeh.2010.03.001">make you focus MORE on the foods you’re trying to avoid</a> (for example, “stop eating sugar”).</p>
<p>Instead, the substitution approach can include things like choosing lower-sodium soup or purchasing pre-cut vegetables with the aim of reducing your starch portion at meals by half. <a href="https://food-guide.canada.ca/en/tips-for-healthy-eating/make-healthy-meals-with-the-eat-well-plate/">Canada’s Food Guide</a>, <a href="https://www.diabetes.ca/resources/tools---resources/basic-meal-planning">Diabetes Canada</a> and <a href="https://www.heartandstroke.ca/-/media/pdf-files/what-we-do/publications/living-well-with-heart-disease/chapter-3.ashx?rev=bae93023086643e8873730f4bd29b946">Heart & Stroke</a> recommend that half your plate be vegetables.</p>
<h2>3. Set value-based goals</h2>
<p>Connect your goal to something that deeply matters to you. While long-term outcomes (such as heart disease) may be the impetus for change, <a href="https://doi.org/10.1093/oxfordhb/9780197550076.013.18">research shows that things that matter to us right now motivate us most</a>. Picking personal and meaningful reasons for change will help with sustained change.</p>
<p>For example, choose to cook one meal that incorporates a vegetable with a close friend or family member, so you can share the experience and spend time together. This example may be rooted in the following values: kindness, relational values, cultural values, empathy, courage.</p>
<h2>Unlock the power of food</h2>
<p><a href="https://obesitycanada.ca/wp-content/uploads/2021/07/10-Psych-Interventions-2-v7-with-links-1.pdf">Research shows</a> a key to changing diet is focusing on changing eating habits and food behaviours, one at a time. The support of a nutrition professional, such as a registered dietitian and/or a psychologist, can help you make informed choices and plans, tailored to your unique needs, situation, preferences, traditions, abilities and capacity.</p><img src="https://counter.theconversation.com/content/200228/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Shannan M. Grant has received funding from Diabetes Canada, Dietitians of Canada and currently holds funding from Medavie, Tri-Council Funding Programs, Canadian Foundation for Dietetic Research, IWK Health, Mount Saint Vincent University. She is affiliated with Mount Saint Vincent University, IWK Health, Dalhousie University, Dietitians of Canada, Diabetes Canada, People in Pain (PIPN), and Dr. Dayna Lee-Baggley and Associates.</span></em></p><p class="fine-print"><em><span>Andrea J. Glenn receives postdoctoral research funding from the Canadian Institutes of Health Research (CIHR). She has received honoraria from the Soy Nutrition Institute (2020) and the Academy of Nutrition and Dietetics (2022). </span></em></p><p class="fine-print"><em><span>Dayna Lee-Baggley, Ph.D, Registered Psychologist owns shares in Dr. Lee-Baggley and Associates. She has received funding in the past from the Kidney Foundation of Canada (research grant), QEII Foundation (research grant), CIHR (research grant), SSHRC (research grant) and honoraria/speaking fees from Tobacco Free Nova Scotia, Bausch Health, and Novo Nordisk. She receives royalties from New Harbinger. </span></em></p>Research shows the key to changing your diet is focusing on changing eating habits and food behaviours, one at a time.Shannan M. Grant, Associate Professor, Registered Dietitian, Department of Applied Human Nutrition, Mount Saint Vincent UniversityAndrea J. Glenn, Postdoctoral research fellow, Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard UniversityDayna Lee-Baggley, Adjunct professor, Department of Family Medicine & Department of Psychology and Neuroscience, Dalhousie UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1982302023-02-01T22:40:40Z2023-02-01T22:40:40ZDying to be seen: Why women’s risk for heart disease and stroke is still higher than men’s in Canada<figure><img src="https://images.theconversation.com/files/507691/original/file-20230201-17242-xvmqx2.jpg?ixlib=rb-1.1.0&rect=81%2C73%2C5381%2C3546&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Women continue to experience disparities in treatment and prevention of heart disease in comparison with other Canadians.</span> <span class="attribution"><span class="source">(AP Photo/Eraldo Peres)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/dying-to-be-seen--why-women-s-risk-for-heart-disease-and-stroke-is-still-higher-than-men-s-in-canada" width="100%" height="400"></iframe>
<p>Heart disease affects <a href="https://www.canada.ca/en/public-health/services/publications/diseases-conditions/heart-disease-canada.html">2.6 million Canadians</a>, and is the second-leading cause of death in Canada. <a href="https://www.cjcopen.ca/article/S2589-790X(20)30168-2/fulltext">Women continue to be at higher risk</a> than men.</p>
<p><a href="https://www.heartandstroke.ca/">Heart and Stroke Canada</a> has <a href="https://www.heartandstroke.ca/what-we-do/media-centre/news-releases/system-failure-womens-heart-and-brain-health-are-at-risk">released a new report</a> for Heart Health Month in February. It highlights several disparities women continue to experience in the prevention and treatment of heart attack and stroke, in comparison to other Canadians. According to this report, <a href="https://www.heartandstroke.ca/women/the-research">women are generally unaware of their individual risk</a> and risk factors, and are often under-diagnosed and under-treated. </p>
<p>This is despite heart disease and stroke being a key cause of premature death for women in Canada. Approximately 50 per cent of women who experience a heart attack had symptoms that went unrecognized. </p>
<p>This report also reminds us that these health outcomes are not always under the control of the individual, highlighting the role clinical and <a href="https://doi.org/10.1016/j.cjco.2021.09.014">social determinants of health</a> (which include health care, food insecurity, housing precarity, race/racism, gender and sexism) play in this disease process. </p>
<p><a href="https://doi.org/10.1186/s12939-019-0954-x">Two-thirds of clinical research</a> has historically excluded women as research participants, or ignored the various factors that intersect with sex and gender in terms of disease risk or intervention evaluation. The <a href="https://doi.org/10.1016%2Fj.ahjo.2022.100093">absence of women in heart-related research</a> continues to have life-altering effects on the lives of women throughout Canada and their communities. </p>
<h2>Sex, gender and the heart</h2>
<figure class="align-left ">
<img alt="A red neon rendering of an anatomical heart" src="https://images.theconversation.com/files/507693/original/file-20230201-10326-t71a6a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/507693/original/file-20230201-10326-t71a6a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/507693/original/file-20230201-10326-t71a6a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/507693/original/file-20230201-10326-t71a6a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/507693/original/file-20230201-10326-t71a6a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/507693/original/file-20230201-10326-t71a6a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/507693/original/file-20230201-10326-t71a6a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The absence of women in heart-related research continues to have life-altering effects on the lives of women and their communities.</span>
<span class="attribution"><span class="source">(Unsplash/Olivier Collet)</span></span>
</figcaption>
</figure>
<p>When it comes to heart health, it is important to note that there is significant evidence that <a href="https://cwhhc.ottawaheart.ca/node/7">biological and social differences</a> between women, men, girls, boys and gender-diverse people contribute to differences in their overall health and experiences of disease. </p>
<p>Sex (biological attributes) and gender (sociocultural factors) influence our risk of developing diseases, how well we access and respond to medical treatments and how often we attempt to seek health care. Currently, several funding agencies, including the <a href="https://cihr-irsc.gc.ca/e/193.html">Canadian Institutes of Health Research</a> (CIHR, a <a href="https://www.sshrc-crsh.gc.ca/about-au_sujet/collaboration/tri-agency_funding_programs-programmes_financement_trois_organismes-eng.aspx">Tri-Council Funding Program</a>), expect researchers to integrate <a href="https://cihr-irsc.gc.ca/e/50833.html">sex and gender</a> into their research design, including methodologies and data analysis where appropriate. </p>
<p>Despite this, sub-populations of women who are more likely to experience the effects of poor heart health are still not being seen in research studies, public health campaigns and clinical settings. This invisibility is killing them. </p>
<p>For instance, on the Heart and Stroke Canada website’s page on women’s unique risk factors for heart disease and stroke, specific attention is given to the role of estrogen, oral contraceptives, pregnancy, <a href="https://doi.org/10.1016/S1474-4422(11)70269-1">menopause</a> and “modifiable risks” like diet (not always as modifiable as we like to think). </p>
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Read more:
<a href="https://theconversation.com/canadas-food-guide-is-easy-to-follow-if-youre-wealthy-or-middle-class-114963">Canada's food guide is easy to follow if you're wealthy or middle class</a>
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<p>These communications, and data used to develop them, clearly rely on empirical medical research. However, they may miss the mark in terms of representing the unique risks, needs and experiences of sub-populations of diverse women like lesbians, bisexual women and transgender individuals. If these sub-populations are not purposefully included in research protocols, the resultant data may not reflect their <a href="https://doi.org/10.2105%2FAJPH.2016.303630">unique experiences and related risks</a> for poor heart health. </p>
<h2>Intersecting risks</h2>
<figure class="align-center ">
<img alt="a printout from an electrocardiogram machine" src="https://images.theconversation.com/files/507699/original/file-20230201-17070-rsj2qx.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/507699/original/file-20230201-17070-rsj2qx.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=277&fit=crop&dpr=1 600w, https://images.theconversation.com/files/507699/original/file-20230201-17070-rsj2qx.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=277&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/507699/original/file-20230201-17070-rsj2qx.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=277&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/507699/original/file-20230201-17070-rsj2qx.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=349&fit=crop&dpr=1 754w, https://images.theconversation.com/files/507699/original/file-20230201-17070-rsj2qx.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=349&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/507699/original/file-20230201-17070-rsj2qx.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=349&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">There are established and intersecting axes of oppression that impact heart health, assessment and treatment of cardio-metabolic conditions, including the success of treatment and prevention measures.</span>
<span class="attribution"><span class="source">(AP Photo/Jeff Roberson)</span></span>
</figcaption>
</figure>
<p>There are established and intersecting axes of oppression that impact heart health, assessment and treatment of cardio-metabolic conditions, including the success of treatment and prevention measures. For instance, <a href="https://cihr-irsc.gc.ca/e/50104.html">risk prevention for stroke</a> is affected by a variety of intersecting factors including race, income and stress caused by lifelong and systematic discrimination and harassment. </p>
<p>Current <a href="https://cwhhc.ottawaheart.ca/national-alliance/projects-and-initiatives/canadian-womens-heart-health-education-course">evidence supports</a> collectively committing to critical reflection on the development, implementation and evaluation of interventions, programs, campaigns, communication and education, as well as the need to better represent the narratives of the outliers. </p>
<p>As advocated by the CIHR, and in particular the <a href="https://cihr-irsc.gc.ca/e/8673.html">CIHR Institute of Gender and Health</a>, advances are being made in terms of changes to research study protocols including <a href="https://cihr-irsc.gc.ca/e/51326.html">sex- and gender-based analysis</a> of data and in reporting of key findings. </p>
<p>The government of Canada in partnership with a number of health research organizations such as Heart and Stroke Canada is pushing for more attention to how both sex and gender uniquely and intersectionally affect heart health. These efforts are instrumental in how, for example, heart and stroke data repositories reflect the diverse needs and <a href="https://www.heartandstroke.ca/stroke/what-is-stroke/types-of-stroke/women-and-stroke">realities facing Canadian women</a>. They also advance our collective understanding and approaches to addressing heart and stroke inequities.</p>
<p>Everyone has a role to play in advocating for women’s heart health. For example, by pushing for changes in clinical and research practices, in heart health promotion campaigns that reflect the diversity of women in Canada, and by ensuring that women are rendered visible in the process.</p><img src="https://counter.theconversation.com/content/198230/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jacquie Gahagan receives funding from the Canadian Institutes of Health Research, the Social Sciences and Humanities Research Council, the Canadian Blood Services, and Research Nova Scotia.</span></em></p><p class="fine-print"><em><span>Shannan M. Grant receives funding from Medavie, Tri-Council Funding Programs, Research Nova Scotia, IWK Health, Mount Saint Vincent University. She is affiliated with IWK Health, Dalhousie University, Dietitians of Canada, Diabetes Canada, People in Pain (PIPN), and Dr. Dayna Lee Baggley and Associates. </span></em></p>Women are often under-diagnosed and under-treated for heart disease and may be unaware of their specific risk factors. Clinical and research practices need to reflect the diversity of women in Canada.Jacquie Gahagan, Full Professor and Associate Vice-President, Research, Mount Saint Vincent UniversityShannan M. Grant, Associate Professor, Registered Dietitian, Department of Applied Human Nutrition, Mount Saint Vincent UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1973442023-01-08T13:26:19Z2023-01-08T13:26:19ZDamar Hamlin’s cardiac arrest shows need for CPR training and emergency defibrillators in public spaces<figure><img src="https://images.theconversation.com/files/503471/original/file-20230106-16856-utpr0c.jpg?ixlib=rb-1.1.0&rect=0%2C238%2C4016%2C2619&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Buffalo Bills' Damar Hamlin is examined after collapsing on the field on Jan. 2. He received CPR and defibrillation on site before being sent to hospital by ambulance.</span> <span class="attribution"><span class="source"> (AP Photo/Jeff Dean)</span></span></figcaption></figure><p>Football — a sport that involves violent collisions — came under shocking scrutiny on Jan. 2 when Buffalo Bills player Damar Hamlin collapsed from a <a href="https://www.sportingnews.com/ca/nfl/news/damar-hamlin-injury-collapses-field-hit-tackle-cpr-ambulance-bills-bengals/hayshufiopjoaeuomfxagwt4">cardiac event immediately following an on-field collision</a>.</p>
<p>Most fans already knew <a href="https://www.espn.com/nfl/injuries">the sport was dangerous</a>, often leading to broken limbs, torn ligaments and life-altering <a href="https://theconversation.com/nfl-player-tua-tagovailoas-concussion-might-have-been-prevented-with-rugbys-stricter-protocols-191830">concussions</a>. What Damar Hamlin’s catastrophic incident reminded many is that death might be close by if critical medical equipment and care is not readily applied following a cardiac arrest.</p>
<p>Hamlin seems to have benefited from top-notch, immediate care from trained medics and team staff who responded with life-saving speed and skill. Doctors who treated Hamlin told reporters on Jan. 5 that <a href="https://www.usatoday.com/story/sports/nfl/2023/01/05/damar-hamlin-doctors-bills-player-health-recovery/10997780002/">both cardiopulmonary resuscitation (CPR) and an automated external defibrillator (AED) had been used</a> to restart his heart and restore a pulse on the field before being taken to hospital.</p>
<p>They placed a tube down his throat to help him breathe, supplied oxygen and transferred him to hospital where he is receiving intensive care. Later reports indicated that Hamlin was <a href="https://www.usatoday.com/story/sports/nfl/2023/01/06/damar-hamlin-health-updates-what-we-know-friday/10997169002/">responding and communicating</a> to family and doctors.</p>
<p>The average citizen — at home or at play, engaged in contact sports or casual interaction — may not be so lucky.</p>
<h2>Cardiac arrest</h2>
<p>Globally, 3.8 million people experience cardiac arrests outside a hospital setting, according to the <a href="https://doi.org/10.1161/CIR.0000000000001013">American Heart Association</a> (AHA). Fewer than three per cent get CPR and AED. Only eight to 12 per cent survive to hospital discharge.</p>
<p>CPR is the act of applying pressure to the heart manually, until its normal rhythm and activity resumes. An AED, a portable automated device that is easy and safe to use, can help shock the heart back into such an appropriate rhythm in certain circumstances.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/503472/original/file-20230106-9978-znu74w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A person in a blue shirt with hands on the chest of a dummy, while other people observe." src="https://images.theconversation.com/files/503472/original/file-20230106-9978-znu74w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/503472/original/file-20230106-9978-znu74w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=429&fit=crop&dpr=1 600w, https://images.theconversation.com/files/503472/original/file-20230106-9978-znu74w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=429&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/503472/original/file-20230106-9978-znu74w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=429&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/503472/original/file-20230106-9978-znu74w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=539&fit=crop&dpr=1 754w, https://images.theconversation.com/files/503472/original/file-20230106-9978-znu74w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=539&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/503472/original/file-20230106-9978-znu74w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=539&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Demonstration of CPR on a first aid dummy. CPR is the act of applying pressure to the heart manually, until its normal rhythm and activity resumes.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p><a href="https://www.heartandstroke.ca/heart-disease/conditions/cardiac-arrest">Cardiac arrests</a> occur when the heart stops beating suddenly. They are not the same as <a href="https://www.heartandstroke.ca/heart-disease/conditions/heart-attack">heart attacks</a>, which are an interruption of blood flow to the heart that leads to damage to the heart muscle. Heart attacks can certainly lead to cardiac arrest, but they are not synonymous. </p>
<p>A third term, <a href="https://www.heartandstroke.ca/heart-disease/conditions/heart-failure">heart failure</a>, similarly represents a distinct condition in which the heart is not able to pump as effectively. Usually this syndrome, which has multiple causes, occurs more chronically to those who have sustained heart damage.</p>
<p>Canadian figures show more than 35,000 cardiac arrests every year — two-thirds of them at home. One in five occur in public where a defibrillator and/or CPR can increase the chance of survival. Bystander intervention with CPR and AED saves more than 400 lives annually, the <a href="https://www.heartandstroke.ca/-/media/pdf-files/canada/2017-position-statements/final-en-addressingcardiacarreststatement-nov-2019.Ashx?Rev=388eeef4069747dcb4ab6353d36b3f7b&hash=9e27a3232e8f908e45e115b0b9dcc9d5">Heart and Stroke Foundation (HSF) reports</a>.</p>
<h2>The life-saving importance of CPR and AEDs</h2>
<p>Academics and scientists who study CPR say cardiac arrest survival rates increase greatly when bystanders use an AED. However, these rates are still low and warrant further public awareness and education efforts as well as increased, widespread access to AEDs. This is especially so in rural, remote, and Indigenous communities, the HSF says.</p>
<figure class="align-center ">
<img alt="A white box reading Defibrillator with a red box inside it hanging on a wall" src="https://images.theconversation.com/files/503474/original/file-20230106-17-y5vchz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/503474/original/file-20230106-17-y5vchz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/503474/original/file-20230106-17-y5vchz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/503474/original/file-20230106-17-y5vchz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/503474/original/file-20230106-17-y5vchz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/503474/original/file-20230106-17-y5vchz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/503474/original/file-20230106-17-y5vchz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">In a cardiac arrest, survival is significantly decreased for every minute without access to CPR or an AED.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Dr. Mike Howlett, president of the Canadian Association of Emergency Physicians, said in an interview that he supports “widespread education for the public on CPR and AED use” as well as “increased availability of AEDs in public settings, especially recreational and sport settings.” This is consistent with the position of the AHA and the HSF.</p>
<p>The <a href="https://www.heartandstroke.ca/-/media/pdf-files/canada/2017-position-statements/final-en-addressingcardiacarreststatement-nov-2019.Ashx?Rev=388eeef4069747dcb4ab6353d36b3f7b&hash=9e27a3232e8f908e45e115b0b9dcc9d5">HSF data shows that when a bystander uses an AED, the chance of survival nearly triples</a>. Survival is significantly decreased for every minute without access to CPR or an AED.</p>
<h2>Installing AEDs in Canada</h2>
<p>Canada has made strides with the increase in AEDs at sporting facilities, notably thousands of arenas. Through a <a href="https://www.canada.ca/en/public-health/services/chronic-diseases/cardiovascular-disease/national-automated-external-defibrillator-initiative.html">pilot program that ran in conjunction with the HSF from 2012 to 2016</a>, officials installed 3,000 AEDs and trained 23,000 Canadians in their use.</p>
<p>Nine lives have been saved to date as a result of this initiative, according to a program summary from the government of Canada. Further expansion to other recreational facilities is planned.</p>
<p>While this is a step in the right direction, hurdles remain. A 2016 article in the <a href="https://doi.org/10.1503/cmaj.150544">Canadian Medical Association Journal</a> showed that living on higher floors in apartment buildings is associated with lower survival rates for cardiac arrest in Canada. The <a href="https://doi.org/10.1016/j.resuscitation.2021.11.001">closer one is</a> to life saving equipment, and providers trained in its use, the better the chance of recovery.</p>
<figure class="align-center ">
<img alt="A sign reading AED with a heart icon in the foreground, with athletes in a gymnasium in the background." src="https://images.theconversation.com/files/503473/original/file-20230106-19-ytjfqf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/503473/original/file-20230106-19-ytjfqf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/503473/original/file-20230106-19-ytjfqf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/503473/original/file-20230106-19-ytjfqf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/503473/original/file-20230106-19-ytjfqf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/503473/original/file-20230106-19-ytjfqf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/503473/original/file-20230106-19-ytjfqf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Canada has made strides with the increase in AEDs at sporting facilities, but more work is needed.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>This highlights again the importance of timely recognition and response as well as the availability of equipment in private settings. Survival rates decrease with every minute of delay. AEDs and trained providers need to be as close as possible.</p>
<p>Hamlin’s diagnosis is still unclear but what is evident is that he had a cardiac arrest due to an abnormal heart rhythm, and that prompt resuscitation restored his pulse.</p>
<p>The HSF and AHA both advocate for increased <a href="https://www.heartandstroke.ca/how-you-can-help/learn-cpr">CPR education</a> and AED use for the treatment of acute cardiac events. As Hamlin continues to heal, he provides proof that this approach seems to have merit.</p><img src="https://counter.theconversation.com/content/197344/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Adam Pyle currently does education work with the Heart and Stroke Foundation on CPR and AED use.</span></em></p>Survival rates for cardiac arrest outside of hospitals is very low. The fast response to Damar Hamlin’s cardiac arrest during an NFL game shows the value of access to CPR and emergency defibrillators.Adam Pyle, Emergency Medicine Physician and Lecturer, University of TorontoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1971922023-01-05T13:27:38Z2023-01-05T13:27:38ZSports broadcasters have a duty to report injuries responsibly – in the case of NFL’s Damar Hamlin, they passed the test<figure><img src="https://images.theconversation.com/files/503131/original/file-20230104-64877-4qdtfn.jpg?ixlib=rb-1.1.0&rect=7%2C11%2C2542%2C1686&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Medical personnel attend to Buffalo Bills safety Damar Hamlin after he collapsed on the field during an NFL game in Cincinnati on Jan. 2, 2023.</span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/BillsBengalsFootball/cb4e320fc1b7472cbe0c692d94d07a6e/photo?Query=damar%20hamlin&mediaType=photo&sortBy=arrivaldatetime:desc&dateRange=Anytime&totalCount=453&currentItemNo=112">AP Photo/Joshua A. Bickel</a></span></figcaption></figure><p>Injuries are an unfortunate part of any sport – none more so than in the NFL, where players can be felled in front of a TV audience <a href="https://espnpressroom.com/us/press-releases/2022/09/espns-monday-night-football-nabs-nearly-20-million-viewers-in-record-setting-season-opener/">in the tens of millions</a>.</p>
<p>Typically, when a player suffers an injury, the media cuts to commercial and returns with replays of the injury – sometimes running it over and over, using every available camera angle, while analyzing what might have happened and the ramifications for the player and team.</p>
<p><a href="https://www.espn.com/nfl/story/_/id/35368372/damar-hamlin-collapses-field-bills-bengals-temporarily-suspended">But in the case of Buffalo Bills safety Damar Hamlin</a>, who collapsed to the ground after a tackle during the “Monday Night Football” game between the Bills and the Cincinnati Bengals, it quickly became apparent that this was no broken arm or torn ACL. This was a matter of life and death. Paramedics worked to keep him alive on the field before he was transported to a hospital, where he <a href="https://www.cnn.com/2023/01/04/football/damar-hamlin-collapse-bills-status-wednesday/index.html">remains in critical condition</a>.</p>
<p>As the tragic scene played out, ESPN’s broadcasters and studio hosts were left to explain what was happening in real time, with virtually no information.</p>
<p><a href="https://comm.osu.edu/people/kraft.42">I am a professor of sports journalism</a> and spend much of my time teaching students how to cover games. As a sportswriter, I have covered many contests as if they were battles, <a href="https://theconversation.com/the-warspeak-permeating-everyday-language-puts-us-all-in-the-trenches-121356">with the language of war</a> interwoven with feats of extraordinary human accomplishment.</p>
<p>When crisis strikes sports, however, it is left to the media to report in, around, about and through the moment. Some do it well and some fail miserably.</p>
<p>In its coverage of Hamlin’s injury, ESPN was, I believe, a sound and responsible broadcaster during one of football’s darkest on-field moments.</p>
<h2>ESPN’s measured, restrained response</h2>
<p>ESPN’s broadcasting duo of Troy Aikman and Joe Buck, along with sideline reporter Lisa Salters, relayed the scene as it unfolded. But instead of filling the live airtime with rambling commentary and sensationalism, they responded with compassion and care. They avoided speculating about Hamlin’s condition and ultimately <a href="https://www.si.com/nfl/bills/news/damar-hamlin-collapse-injury-buffalo-bills-cincinnati-bengals-ambulance-nflpa-postponement">appealed to the NFL to suspend the game</a>, with Aikman asking, “How do you, as a member of the Buffalo Bills or the Cincinnati Bengals, continue on to play football?”</p>
<p><a href="https://www.washingtonpost.com/sports/2023/01/02/espn-damar-hamlin-bengals-bills/">As The Washington Post noted</a>, “The broadcast was measured, informative and emotional.” </p>
<p>From the studio, former NFL players Booger McFarland and Ryan Clark offered their perspectives on what it might feel like to be a player on the field, in that moment – whether as a member of the Bills or the Bengals. They reminded the audience that players are first and foremost people. McFarland <a href="https://thehill.com/homenews/media/3797278-damar-hamlin-injury-tests-espn-with-terrifying-live-television-moment/">acknowledged the inherent violence of the game</a>, adding, “I think we reached a point where nobody is concerned about football anymore tonight.” </p>
<p>Clark, who himself was hospitalized for a splenic infarction in 2007 <a href="https://www.on3.com/news/ryan-clark-provides-unique-insight-reflection-terrifying-damar-hamlin-injury-collapsed-cpr/">shortly after playing a game for the Pittsburgh Steelers</a>, <a href="https://www.mediaite.com/opinion/espns-ryan-clark-earns-rightful-plaudits-for-powerful-handling-of-damar-hamlins-life-threatening-injury/">acknowledged</a> that part of living an NFL dream is “putting your life at risk.”</p>
<p>“Tonight we got to see a side of football that is extremely ugly, a side of football that no one ever wants to see or never wants to admit exists,” he said.</p>
<p>The gravity of the situation was reflected in ESPN curtailing all commercials for more than an hour to provide uninterrupted coverage. In doing so, the network <a href="https://awfulannouncing.com/nfl/damar-hamlin-collapse-espn-coverage.html">stressed the importance of a player’s life over the game or profit motive</a>. </p>
<h2>When the media misfires</h2>
<p>When disaster strikes on a live sports broadcast, it’s easy to say something wrong, especially in an age where words can be distributed widely, dissected and criticized on social media.</p>
<p>Just ask controversial sports commentator Skip Bayless, who wasn’t even on the air, but nonetheless went viral for all the wrong reasons <a href="https://twitter.com/realskipbayless/status/1610101204687949827">after tweeting</a>: “No doubt the NFL is considering postponing the rest of this game - but how? This late in the season, a game of this magnitude is crucial to the regular-season outcome … which suddenly seems so irrelevant.”</p>
<p>Bayless may have had a point – the NFL must now work out how to address the outcome of this game and the implications for the postseason – but his tone and timing led to <a href="https://www.mediaite.com/sports/skip-bayless-apologizes-after-tweet-on-bills-safety-damar-hamlin-sparks-outrage/">much criticism</a>.</p>
<p>Bayless is far from the only broadcaster to be accused of insensitively following the death or serious injury of sports stars.</p>
<p>The 2020 death of Kobe Bryant and his daughter Gianna was a model for what can go wrong, with TMZ breaking the news <a href="https://thehill.com/homenews/media/480066-tmz-scolded-by-police-for-breaking-news-of-kobe-bryants-death-before-his/">before their family was notified</a>. ESPN relegated the news to ESPN2 <a href="https://www.si.com/extra-mustard/2020/01/27/kobe-bryant-media-coverage-espn-mike-breen-jay-williams">so as not to interrupt Pro Bowl coverage</a>. In their rush to break details from the story, some reporters trafficked in misinformation. <a href="https://www.latimes.com/entertainment-arts/business/story/2020-01-29/abc-news-has-suspended-correspondent-who-said-four-kobe-bryant-daughters-were-on-his-helicopter-matt-gutman">ABC News ultimately suspended a reporter</a> who said on air that all four of Bryant’s daughters were among the crash victims, while the BBC ran footage of LeBron James instead of Bryant.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1221686041083613186"}"></div></p>
<p>Driver Kevin Ward, Jr. was killed during a 2014 sprint car race, but it was Tony Stewart, the man whose car struck him, <a href="https://www.indystar.com/story/opinion/2014/08/11/tony-stewart-crash-coverage-challenge-media/13916449/">who garnered most of the media coverage</a>. The media was quick to lay the blame squarely on Stewart before an investigation absolved the driver and revealed Ward was under the influence of enough marijuana to <a href="https://www.usatoday.com/story/sports/nascar/2014/09/24/column-tony-stewart-grand-jury-no-charges-kevin-ward-jr-death/16165885/">impair him at the time of the crash</a>.</p>
<p>Sports media was perhaps never more criticized for incident coverage than it was in 2020, when Danish soccer player Christian Eriksen suffered cardiac arrest on the field. BBC cameras <a href="https://theconversation.com/christian-eriksen-broadcast-the-bbc-and-the-question-of-public-interest-162726">showed not only medical professionals performing chest compressions as Eriksen struggled for life</a>, but also his crying life partner and traumatized teammates. Cameras lingered for a full 15 minutes before cutting to the studio hosts. </p>
<figure class="align-center ">
<img alt="Man stands at podium speaking before a mass of reporters." src="https://images.theconversation.com/files/503156/original/file-20230104-105135-rlymua.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/503156/original/file-20230104-105135-rlymua.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/503156/original/file-20230104-105135-rlymua.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/503156/original/file-20230104-105135-rlymua.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/503156/original/file-20230104-105135-rlymua.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/503156/original/file-20230104-105135-rlymua.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/503156/original/file-20230104-105135-rlymua.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Tony Stewart, front right, speaks to the media three weeks after his car hit and killed sprint car driver Kevin Ward, Jr. during a dirt track race.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/tony-stewart-driver-of-the-bass-pro-shops-mobil-1-chevrolet-news-photo/454335928?phrase=kevin%20ward%20jr&adppopup=true">Jamie Squire/Getty Images</a></span>
</figcaption>
</figure>
<h2>Prioritizing mourning over moneymaking</h2>
<p>From the tragic deaths of basketball players Hank Gathers and Reggie Lewis, to the deaths of auto racers Dan Weldon and Dale Earnhardt and to Chuck Hughes who, in 1971, became the first and only NFL football player to die in a game, it is the media’s responsibility to navigate a tragedy on behalf of the public.</p>
<p>Research has shown that the <a href="https://journals.sagepub.com/doi/epdf/10.1177/0163443708098251">media is often responsible for modeling appropriate public displays of emotion</a> when traumatic or tragic events occur, be it respect for victims and their families or public mourning. It <a href="https://doi.org/10.1080/17512780701275457">can be argued</a> that the media – especially in the digital age – is a key conduit to community connection amid a tragedy, when people seek to show their support and share their grief.</p>
<p>There is a fine line when it comes to sports and catastrophe, for much of what people love about football is its warlike nature. Players are depicted like gladiators in a coliseum. Media quote athletes saying <a href="https://twitter.com/bethhooleVNL/status/1599313686199345152?s=20&t=_2oFgUiDhSlJgUGe8BGcnA">they will die for their teammates</a>.</p>
<p>But when life and death become all too real, the athlete’s well-being takes precedence over wins and losses. At that point, the media, in my view, has one main job: help remind viewers of the player’s humanity.</p>
<p>As “SportsCenter” <a href="https://ftw.usatoday.com/2023/01/damar-hamlin-bills-espn-salters-ryan-clark-booger">host Scott Van Pelt put it</a>: “Sports is important. And suddenly it’s not.”</p>
<p><em>This article has been updated to correctly identify Skip Bayless.</em></p><img src="https://counter.theconversation.com/content/197192/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Kraft does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>ESPN commentators avoided speculation and struck a compassionate tone.Nicole Kraft, Associate Professor of Clinical Communication, The Ohio State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1972682023-01-05T00:17:33Z2023-01-05T00:17:33ZDamar Hamlin injury: Was it commotio cordis? How to prevent a potentially fatal blow to the heart in young athletes<figure><img src="https://images.theconversation.com/files/503162/original/file-20230104-130036-uc4c1u.jpg?ixlib=rb-1.1.0&rect=0%2C19%2C3131%2C2093&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">NFL player Damar Hamlin's injury during a game on Jan. 2 may have been a heart injury called commotio cordis. Researchers are working on ways to prevent this rare but often fatal sports injury.</span> <span class="attribution"><span class="source">(AP Photo/Joshua A. Bickel)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/damar-hamlin-injury--was-it-commotio-cordis-how-to-prevent-a-potentially-fatal-blow-to-the-heart-in-young-athletes" width="100%" height="400"></iframe>
<p>A routine tackle in an NFL game on Jan. 2 almost turned fatal when Damar Hamlin of the Buffalo Bills was injured during a play, <a href="https://www.cbsnews.com/news/damar-hamlin-collapse-buffalo-bills-football/">leading to cardiac arrest</a>. </p>
<p>After popping up briefly after the play, Hamlin suddenly collapsed. Within seconds, Paycor Stadium, the home of the Cincinnati Bengals, went from a raucous crowd to hearing a pin drop as Hamlin lay unresponsive on the ground, requiring immediate external defibrillation to restart his heart. </p>
<p>This appears to have all the characteristics of commotio cordis. The NFL’s chief medical officer said that is a possibility, but doctors are <a href="https://www.cnn.com/us/live-news/damar-hamlin-nfl-buffalo-bills-news-01-04-23/h_5fffef4ac321b89bcc65334e13229069">investigating every possible cause</a>.</p>
<p><a href="https://www.ncbi.nlm.nih.gov/books/NBK526014/">Commotio cordis</a> is the result of <a href="https://doi.org/10.1056/nejmra0910111">blunt trauma to the heart</a> and is one of the leading causes of sudden cardiac death in youth sports. Fatal blows to the heart <a href="https://doi.org/10.1016/j.amjcard.2021.05.053">occur predominately in young athletes</a> with an average age of 13. </p>
<figure class="align-center ">
<img alt="A player wearing the number 3 falling onto the field, surrounded by other players" src="https://images.theconversation.com/files/503158/original/file-20230104-129741-1lh5zw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/503158/original/file-20230104-129741-1lh5zw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/503158/original/file-20230104-129741-1lh5zw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/503158/original/file-20230104-129741-1lh5zw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/503158/original/file-20230104-129741-1lh5zw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/503158/original/file-20230104-129741-1lh5zw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/503158/original/file-20230104-129741-1lh5zw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Cincinnati Bengals wide receiver Tee Higgins (85) collides with Buffalo Bills safety Damar Hamlin (3) during the first half of an NFL football game on Jan. 2 in Cincinnati. Hamlin was injured on the play, and collapsed on the field.</span>
<span class="attribution"><span class="source">(AP Photo/Joshua A. Bickel)</span></span>
</figcaption>
</figure>
<p>Commotio cordis causes the heart to go into <a href="https://www.heart.org/en/health-topics/arrhythmia/about-arrhythmia/ventricular-fibrillation">ventricular fibrillation</a>, leading to pump failure. Although rare, this condition is fatal unless immediate resuscitation is conducted. Currently, commotio cordis still occurs <a href="https://doi.org/10.1016/j.amjcard.2006.10.053">despite the use of chest protection</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/damar-hamlins-cardiac-arrest-during-monday-night-football-could-be-commotio-cordis-or-a-more-common-condition-a-heart-doctor-answers-4-questions-197177">Damar Hamlin’s cardiac arrest during 'Monday Night Football' could be commotio cordis or a more common condition – a heart doctor answers 4 questions</a>
</strong>
</em>
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<hr>
<p>As a PhD student in biomedical engineering, I specialize in commotio cordis. My colleagues and I research how we can create safer chest protectors and safety regulations to prevent this tragic incident from occurring in sports globally. </p>
<p>While commotio cordis predominately occurs in youth sports, it can happen at all ages. Survival rates have increased over the years, but <a href="https://doi.org/10.1016/j.hrthm.2012.10.034">commotio cordis is still often fatal</a>. </p>
<h2>The perfect storm</h2>
<figure class="align-center ">
<img alt="People seen from behind, crouching around an unseen person on a field." src="https://images.theconversation.com/files/503159/original/file-20230104-129813-x4inu6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/503159/original/file-20230104-129813-x4inu6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/503159/original/file-20230104-129813-x4inu6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/503159/original/file-20230104-129813-x4inu6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/503159/original/file-20230104-129813-x4inu6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/503159/original/file-20230104-129813-x4inu6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/503159/original/file-20230104-129813-x4inu6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Buffalo Bills’ Damar Hamlin is examined after collapsing during the first half of an NFL football game against the Cincinnati Bengals on Jan. 2.</span>
<span class="attribution"><span class="source">(AP Photo/Joshua A. Bickel)</span></span>
</figcaption>
</figure>
<p>Previous <a href="https://doi.org/10.1056/NEJM199806183382504">pig model studies established a series of conditions</a> that <a href="https://doi.org/10.1056/NEJMra0910111">must be met simultaneously</a> in order for commotio cordis to occur: </p>
<ol>
<li><p>The impact must occur over or around the heart, </p></li>
<li><p>the impact speed ranges from 48 to 80 kph (30 to 50 mph), and </p></li>
<li><p>the impact occurs during the vulnerable period of the cardiac cycle which is approximately 20 milliseconds in length, just before the peak of the T-wave on an <a href="https://myhealth.alberta.ca/Health/Pages/conditions.aspx?hwid=zm2308">electrocardiogram</a>.</p></li>
</ol>
<p>The only known treatment for commotio cordis is immediate defibrillation, and the quicker an athlete’s heart can be electrically restarted, the higher the chances of their survival. </p>
<h2>Developing new commotio cordis injury metrics</h2>
<p>In 2021 our lab group developed <a href="https://doi.org/10.1080/10255842.2021.1948022">new injury metrics for commotio cordis</a> safety which provided the analysis of measuring rib cage deformation from impact. </p>
<p>The <a href="https://nocsae.org/">National Operating Committee on Standards for Athletic Equipment</a> (NOCSAE) has established chest protector safety protocols to prevent against commotio cordis, and while they are not perfect they exist for baseball and lacrosse. Unfortunately, these regulations are absent for both hockey and American football. </p>
<p>They are urgently needed to prevent incidents occurring in all levels of sport, and our lab continues to pursue these goals of safety for all. We believe that, in addition to measuring force from impact, the inclusion of rib deformation would greatly improve the accuracy and effectiveness of these injury metrics. We also believe the inclusion of hockey and football in commotio cordis safety standards would help prevent these injuries. </p>
<h2>Identifying vulnerable impact locations</h2>
<p>Piggybacking on our initial commotio cordis injury metric study in 2021, our lab was able to <a href="https://doi.org/10.1115/1.4052886">identify potentially vulnerable impact locations over the heart</a> which are currently not considered as a point of emphasis in commercially available chest protection on the market. </p>
<p>Using simulations, we were able to recreate these injuries and designed heat maps that overlay the chest of individuals to really highlight where the most dangerous locations may occur. We found that impacts slightly offset of the heart resulted in high strain values of cardiac tissue elements. </p>
<p>It is important to note that this location becomes exposed quite easily from athletic movement in which the chest protector may move around on the body of the athlete. </p>
<h2>Optimizing commotio cordis safety standards</h2>
<p>Recently, our lab group collaborated with cardiologist <a href="https://physiologie.unibe.ch/%7Erohr/">Stephan Rohr’s</a> <a href="https://physiologie.unibe.ch/%7Erohr/group/">lab at the University of Bern</a> in Switzerland. We conducted a study to identify further ways to optimize commotio cordis safety standards, while improving on the current regulations. This research is currently under peer-review. </p>
<p>To our knowledge, this is the first study to report on peak strain values that can be expected to occur at the level of the left ventricle of the heart during commotio cordis — inducing impacts for different age groups. The results from this study may contribute to the understanding of the cellular mechanisms responsible for commotio cordis, alongside sport safety and equipment regulations. </p>
<p>Our lab group is committed to ensuring we can reduce instances of commotio cordis. To make sports safer for people of all ages, and prevent the tragic loss of athletes on our playing fields, we will keep investigating the fundamental mechanisms and developing novel countermeasures. </p>
<p>Recent events may increase awareness of this rare but serious injury, and help promote improvements in protective equipment in many sports.</p><img src="https://counter.theconversation.com/content/197268/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Grant James Dickey has previously received funding from Mitacs to assist in the Cellular Optics laboratory in Bern, Switzerland to further understand cardiac cell stretching from impact. </span></em></p><p class="fine-print"><em><span>Haojie Mao, Kewei Bian, and Sakib Ul Islam do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Commotio cordis is the result of blunt trauma to the heart, and is one of the leading causes of sudden cardiac death in youth sports. Improvements in protective equipment may help prevent it.Grant James Dickey, PhD Student in Biomedical Engineering, Western UniversityHaojie Mao, Assistant Professor/Faculty of Engineering/School of Biomedical Engineering/Mechanical and Materials Engineering, Western UniversityKewei Bian, PhD Candidate, Department of Mechanical and Materials Engineering, Western UniversitySakib Ul Islam, PhD Candidate, Department of Mechanical and Materials Engineering, Western UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1948982022-12-26T20:52:15Z2022-12-26T20:52:15ZHeart rate variability – what to know about this biometric most fitness trackers measure<figure><img src="https://images.theconversation.com/files/500755/original/file-20221213-14408-pvtw3d.jpg?ixlib=rb-1.1.0&rect=1047%2C901%2C6039%2C3884&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">An increase in this particular biometric is a good thing.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/senior-man-using-smartwatch-in-bed-royalty-free-image/1371086366">visualspace/E+ via Getty Images</a></span></figcaption></figure><p>Your heart beats <a href="https://www.pbs.org/wgbh/nova/heart/heartfacts.html">around 100,000 times every day</a>. <a href="https://theconversation.com/tracking-your-heart-rate-5-questions-answered-about-what-that-number-really-means-124066">Heart rate</a> is a key marker of cardiovascular activity and an important vital sign. But your pulse is not as steady as a precision clock – nor would you want it to be.</p>
<p><a href="https://scholar.google.com/citations?hl=en&user=uXcM0scAAAAJ">As a cardiovascular physiologist</a>, I measure heart rate in nearly every experiment my students and I perform. Sometimes we use an <a href="https://medlineplus.gov/lab-tests/electrocardiogram/">electrocardiogram</a>, such as you’d see in a medical clinic, which uses sticky electrodes to measure electrical signals between two points of your body. Other times we use a chest strap monitor, like ones you might see on someone at the gym, which also detects heartbeats based on electrical activity.</p>
<p>As wearable technology has grown more popular, it’s not just researchers and cardiologists who are paying attention to heart rate. You might be monitoring your own all day long via a fitness tracker you wear on your wrist. This kind of wearable device <a href="https://help.fitbit.com/articles/en_US/Help_article/1565.htm">uses green light to detect blood flow</a> beneath your skin and deduces your heart rate.</p>
<p>Here are what heart rate and other measurements derived from this biometric can tell you about your body’s health.</p>
<h2>Pumping blood where it needs to go</h2>
<p>The heart’s primary job is to contract and generate pressure that helps pump blood to the lungs to be oxygenated and then on to the rest of the body to deliver oxygen and other nutrients. Heart rate is simply how fast your heart is beating. Sometimes called a pulse rate, it’s normally presented in beats per minute. You can <a href="https://www.health.harvard.edu/heart-health/want-to-check-your-heart-rate-heres-how">count your own heart rate</a> by feeling for your pulse inside your wrist or behind your jaw. </p>
<p>When your body demands more oxygen, such as during exercise, heart rate will increase along with the increasing workloads.</p>
<p>While many people are familiar with tracking their heart rate during exertion, the heart rate at rest can also provide valuable information. The two parts of the <a href="https://www.webmd.com/heart/what-is-heart-rate-variability">autonomic nervous system</a>, the sympathetic and parasympathetic, influence resting heart rate. The sympathetic branch helps coordinate your body’s stress response. The more active it is, the higher it dials up your heart rate, preparing you for fight or flight. </p>
<p>The parasympathetic branch of your nervous system is responsible for keeping lots of your body’s functions running smoothly while you’re at ease. Via the vagus nerve that runs from the brain all the way to the abdomen, the parasympathetic nervous system actively slows the heart down to resting values between <a href="https://www.heart.org/en/health-topics/high-blood-pressure/the-facts-about-high-blood-pressure/all-about-heart-rate-pulse">60 and 100 beats</a> per minute for the average healthy adult. Without any parasympathetic activity putting the brakes on the sympathetic nervous system’s signals, your heart would beat at approximately 100 beats per minute. </p>
<p>A lower resting heart rate indicates an efficient heart and a higher level of parasympathetic activity. When you’re at rest your nervous system is ideally minimizing sympathetic activity, so you’re conserving energy and avoiding unnecessary stress to the body.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/500523/original/file-20221212-119183-4pofku.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="chart of red peaks of a heartbeat at slightly different intervals" src="https://images.theconversation.com/files/500523/original/file-20221212-119183-4pofku.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/500523/original/file-20221212-119183-4pofku.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=274&fit=crop&dpr=1 600w, https://images.theconversation.com/files/500523/original/file-20221212-119183-4pofku.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=274&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/500523/original/file-20221212-119183-4pofku.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=274&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/500523/original/file-20221212-119183-4pofku.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=344&fit=crop&dpr=1 754w, https://images.theconversation.com/files/500523/original/file-20221212-119183-4pofku.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=344&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/500523/original/file-20221212-119183-4pofku.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=344&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The chart of a heart rate reveals tiny differences in spacing between the peaks representing heartbeats.</span>
<span class="attribution"><span class="source">YitzhakNat via Wikimedia Commons</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<h2>Time between each heartbeat</h2>
<p>One specific way to understand the balance of the nervous system’s influence on heart rate is to look at <a href="https://my.clevelandclinic.org/health/symptoms/21773-heart-rate-variability-hrv#:%7E:text=Heart%20rate%20variability%20is%20where,issues%20like%20anxiety%20and%20depression.">heart rate variability</a>, or HRV – the slight fluctuation in the time between each heartbeat. Even if your heart rate is 60 beats a minute, that doesn’t mean your heart is pumping exactly once every second.</p>
<p>Less variability is a sign that your body is under greater stress and that the balance in your autonomic nervous system is tipping toward the sympathetic branch being in charge. Greater variability suggests you’re more relaxed and your parasympathetic nervous system is in control. </p>
<p>For nearly 30 years, scientists have been interested in <a href="https://doi.org/10.1161/01.CIR.93.5.1043">how to measure and interpret HRV</a>, specifically as it relates to this balance of autonomic control.</p>
<p>The clinical utility of HRV emerged in patients following cardiac events, but researchers are now considering how this measure can help explain patient outcomes in a range of <a href="https://doi.org/10.2147/VHRM.S279322">cardiac</a>, <a href="https://doi.org/10.1371/journal.pone.0195166">endocrine</a> and <a href="https://doi.org/10.1016/j.jad.2018.04.071">psychiatric</a> disorders.</p>
<p>More recently, researchers have investigated <a href="https://doi.org/10.15420/aer.2018.27.2">how to use HRV</a> in <a href="https://doi.org/10.15420/aer.2018.30.2">athletic training and prognosis of medical conditions</a>.</p>
<p>Several fitness wearables also report <a href="https://support.whoop.com/WHOOP_Data/Recovery__HRV/What_is_Heart_Rate_Variability_(HRV)%3F">heart rate variability</a>, either as a <a href="https://support.ouraring.com/hc/en-us/articles/360025441974-An-Introduction-to-Heart-Rate-Variability#:%7E:text=How%20Oura%20Measures%20HRV,samples%20measured%20while%20you%20sleep.">stand-alone metric</a> or used in the calculation of “readiness” or “recovery” scores. <a href="https://doi.org/10.1055/a-1864-9726">Endurance athletes now commonly track HRV</a> as one way to monitor their overall physiological state.</p>
<p>Researchers have started checking which <a href="https://doi.org/10.3390/s22166317">commercially available wearable devices are most reliable and accurate</a> at measuring HRV, which can vary from tracker to tracker. Many of these devices use colored lights, or optical sensors, to measure pulse rate and other variables at the wrist or finger. Unfortunately, the <a href="https://www.statnews.com/2019/07/24/fitbit-accuracy-dark-skin/">accuracy of this method can vary based on skin type and skin color</a>. It is important that companies include diverse populations in the design, testing and validation of these products to help address potential racial health disparities.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/500758/original/file-20221213-19390-g5huck.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="woman doing standing pose on yoga mat" src="https://images.theconversation.com/files/500758/original/file-20221213-19390-g5huck.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/500758/original/file-20221213-19390-g5huck.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/500758/original/file-20221213-19390-g5huck.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/500758/original/file-20221213-19390-g5huck.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/500758/original/file-20221213-19390-g5huck.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/500758/original/file-20221213-19390-g5huck.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/500758/original/file-20221213-19390-g5huck.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Another health benefit of stress-busting activities can be an increase in heart rate variability.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/woman-standing-on-yoga-mat-in-warrior-pose-while-royalty-free-image/1397801043">David Espejo/Moment via Getty Images</a></span>
</figcaption>
</figure>
<h2>Nudging HRV in a good direction</h2>
<p>One of the biggest influences on heart rate variability is stress; along with increased sympathetic nervous system activity, stress is associated with lower HRV. Stress-reducing interventions, <a href="https://my.clevelandclinic.org/health/treatments/13354-biofeedback">biofeedback</a> and <a href="https://doi.org/10.1016/s0828-282x(10)70395-0">increased fitness</a> can increase heart rate variability. Remember, an increase is good for this metric. Overall, <a href="https://www.webmd.com/heart/what-is-heart-rate-variability#091e9c5e82171840-2-4">heart rate variability depends on</a> a range of physiological, psychological, environmental, lifestyle and nonmodifiable genetic <a href="https://doi.org/10.3389/fpubh.2017.00258">factors</a>.</p>
<p>The most useful way to consider heart rate variability as a metric is to look at data trends. Are there consistent changes in HRV in either direction? Examine these changes alongside other health factors such as fitness, mood, illness, sleep and dietary intake to see if you can draw any conclusions about lifestyle modifications you may want to make.</p>
<p>In general, the <a href="https://www.va.gov/WHOLEHEALTHLIBRARY/tools/heart-rate-variability-and-arrhythmias.asp">same approaches</a> you would take to lowering resting heart rate can also improve heart rate variability, such as increasing cardiovascular fitness, maintaining a healthy weight, reducing stress and getting sufficient sleep.</p>
<p>It’s important to remember that heart rate variability is the normal, healthy, very slight fluctuation of timing of heartbeats – just milliseconds of difference from beat to beat. More dramatic changes in heart rhythms or the way in which the heart contracts, known as <a href="https://www.mayoclinic.org/diseases-conditions/heart-arrhythmia/symptoms-causes/syc-20350668">arrhythmias</a>, may signal a more serious condition that requires medical attention.</p><img src="https://counter.theconversation.com/content/194898/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anne R. Crecelius does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Tiny fluctuations in the time between each beat of your heart can provide clues about how much stress your body is experiencing.Anne R. Crecelius, Associate Professor of Health and Sport Science, University of DaytonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1966832022-12-19T15:50:01Z2022-12-19T15:50:01ZSports journalist Grant Wahl died of an aortic aneurysm — here’s what it is<figure><img src="https://images.theconversation.com/files/501842/original/file-20221219-18-rmhn1m.jpg?ixlib=rb-1.1.0&rect=44%2C0%2C5946%2C3000&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There are two types of aortic aneurysms: thoracic and abdominal.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/3d-rendered-medically-accurate-illustration-aneurysm-1391792330">SciePro/ Shutterstock</a></span></figcaption></figure><p>American journalist Grant Wahl, who died while reporting on a match during the 2022 Qatar World Cup, is said to have suffered from a <a href="https://www.bbc.co.uk/sport/football/63973929">ruptured aortic aneurysm</a>. This happens when bulging in the aorta (the main blood vessel that supplies oxygenated blood from the heart to the rest of the body) ruptures. Although the exact aneurysm Grant suffered is relatively uncommon, it is very dangerous if not caught in an early stage when it can be managed. </p>
<p>Our blood vessels fall into three main categories: arteries, capillaries and veins. The arteries take oxygenated blood from the heart and deliver it throughout the body, running through capillaries in the tissues and then passing into veins to return it to the heart. </p>
<p>While aneurysms can occur in any blood vessel, they most commonly happen in major arteries (such as the aorta) or blood vessels in the brain. The aorta is the largest of the more than <a href="https://www.bhf.org.uk/informationsupport/heart-matters-magazine/research/how-are-blood-vessels-made">60,000 miles of blood vessels</a> that run through our body. It receives the highest-pressure blood, which is freshly ejected from the heart as it beats. </p>
<p>The aorta runs through the thorax and the abdomen. As such, there are two main types of aortic aneurysms. Thoracic aortic aneurysms – the location of the aneurysm Wahl had – form in the chest area. These are rare, being seen in only <a href="https://vascular.org/patients-and-referring-physicians/conditions/thoracic-aortic-aneurysm">6-10 people per 100,000</a>. They can form anywhere along the aorta in the chest. In Wahl’s case, it was on the first part of the aorta, which is also called an ascending aortic aneurysm. </p>
<p>Abdominal aortic aneurysms occur in the abdomen. These are much more common, affecting between <a href="https://www.bsir.org/patients/aortic-aneurysms/#what-is-the-incidence-of-aortic-aneurysm-in-the-uk">4%</a> and <a href="https://www.uptodate.com/contents/abdominal-aortic-aneurysm-beyond-the-basics">13%</a> of men and <a href="https://www.uptodate.com/contents/abdominal-aortic-aneurysm-beyond-the-basics">6%</a> of women over the age of 65.</p>
<p>Both types of aortic aneurysm are associated with <a href="https://www.nhs.uk/conditions/atherosclerosis/">atherosclerosis</a>, a condition that hardens and narrows the arteries. This damages and alters the lining of the blood vessel, causing the artery to bulge and the blood vessel wall to weaken. If this bulge isn’t treated, it can then tear through the innermost layer of the blood vessel or rupture the artery entirely.</p>
<h2>Risk factors</h2>
<p>There are several common risk factors for developing either type of aortic aneurysm.</p>
<p>Men are <a href="https://www.sciencedirect.com/science/article/pii/S0741521415022144">three to four times more likely</a> to have an abdominal aortic aneurysm and <a href="https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.118.11851#d1e314">two to three times more likely</a> to have a thoracic aortic aneurysm. However, women are twice as likely to have a <a href="https://www.frontiersin.org/articles/10.3389/fcvm.2022.815668/full">brain aneurysm</a> and are much more likely to die from a thoracic aortic aneurysm as the disease progression is much quicker. </p>
<p>Age is another big factor, with both <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5523737/">thoracic</a> and <a href="https://www.ncbi.nlm.nih.gov/books/NBK470237/">abdominal</a> aortic aneurysms being most common in men over 65 years of age. The <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4687424/">likelihood of developing an abdominal one</a> also increases between 2% and 4% <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3076160/">every decade</a> after 65.</p>
<figure class="align-center ">
<img alt="A digital image comparing a normal heart to a heart with a thoracic (ascending) aortic aneurysm." src="https://images.theconversation.com/files/501848/original/file-20221219-20-cph9c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/501848/original/file-20221219-20-cph9c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=375&fit=crop&dpr=1 600w, https://images.theconversation.com/files/501848/original/file-20221219-20-cph9c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=375&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/501848/original/file-20221219-20-cph9c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=375&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/501848/original/file-20221219-20-cph9c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=471&fit=crop&dpr=1 754w, https://images.theconversation.com/files/501848/original/file-20221219-20-cph9c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=471&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/501848/original/file-20221219-20-cph9c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=471&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Thoracic (ascending) aortic aneurysms are rarer than abdominal aortic aneurysms.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/ascending-aortic-aneurysm-damaged-normal-heart-1034285962">Maniki_rus/ Shutterstock</a></span>
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</figure>
<p>White people have a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5869065">greater risk of aortic aneurysm</a> – though black people are more likely to experience complications after having an aortic aneurysm repaired. A <a href="https://pubmed.ncbi.nlm.nih.gov/23809203/">family history</a> of aneurysm also increases the likelihood of having one. If your parent or sibling had an abdominal aortic aneurysm, your <a href="https://pubmed.ncbi.nlm.nih.gov/10215559/">risk increases fourfold</a>, whereas <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5031368/">20% of people</a> with a thoracic aortic aneurysm, will have a first-degree family member with the condition. </p>
<p>People with the genetic condition <a href="https://marfan.org/resource-library/know-the-signs-of-an-aortic-aneurysm-and-dissection/">Marfan syndrome</a> – which affects their connective tissues – have an <a href="https://www.ahajournals.org/doi/full/10.1161/01.cir.91.3.728">increased risk</a> of aneurysms due to the blood vessel walls being weak.</p>
<p><a href="https://www.sciencedirect.com/science/article/pii/S074152140700969X">Cocaine</a> use is also associated with an increased risk, particularly in <a href="https://www.hindawi.com/journals/cric/2017/1785410/">younger people</a> with no other risk factors. It’s believed cocaine use causes severe hypertension and weakens arterial walls.</p>
<p>Smoking is the <a href="https://www.ahajournals.org/doi/10.1161/cir.0b013e3181f432c3#d1e3805">biggest risk factor</a> for abdominal aortic aneurysms. This is because the nicotine in tobacco contributes to atherosclerosis.</p>
<h2>Symptoms and treatment</h2>
<p>Aneurysms are usually symptomless. But if abdominal aortic aneurysms become large enough, a doctor <a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/485262">may be able to feel it</a> “pulsating” through the abdominal wall. Abdominal pain and <a href="https://www.jospt.org/doi/10.2519/jospt.2014.4935">back pain</a> may also occur, usually before rupture.</p>
<p>Thoracic aneurysms are much more <a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/thoracic-aortic-aneurysm">difficult to diagnose</a>, and they cannot be felt by a doctor. They may cause persistent cough, chest and neck pain, as well as difficulty breathing. These become significantly worse with rupture.</p>
<p>Abdominal aortic aneurysms are usually identified using an ultrasound, while thoracic aneurysms require an X-ray, CT or MRI scan or an ECG. This will only be done if a doctor suspects you have an aneurysm, though in some countries men over the age of 65 are offered an ultrasound as part of <a href="https://www.nhs.uk/conditions/abdominal-aortic-aneurysm-screening/">screening programmes</a> for abdominal aortic aneurysms. </p>
<p>The diameter of a normal aorta is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1861012/">between 2cm and 3cm</a>. To be considered aneurysmal, the diameter of the vessel must be <a href="https://www.ahajournals.org/doi/10.1161/circulationaha.109.880724">1.5 times its normal size</a>. People with small and medium aneurysms (between 3cm and 5.4cm) may not need surgery and can slow the growth of their aneurysm by making lifestyle changes – such as stopping smoking, exercising and eating a healthy diet. </p>
<p>But aneurysms bigger than 5.5cm carry a high risk of rupture, so surgery will be recommended to repair it. If an aneurysm this size ruptures, there is a <a href="https://www.aafp.org/pubs/afp/issues/2006/0401/p1198.html">90% chance of death</a> if it happens outside of a hospital. The surgery can be done using two methods.</p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7540643/">Open surgery</a> involves making a large incision in the abdomen or chest wall. An artificial graft made of synthetic material, such as polyester, is put in where the damaged aorta is. More recently, there has been a move to a less invasive surgery called <a href="https://www.vascularsociety.org.uk/patients/procedures/2/endovascular_aneurysm_repair_evar">endovascular aneurysm repair</a>. This sees a graft fed in through an artery in your groin and then moved into place to repair the aorta. This can only be done if the patient’s blood vessels are healthy enough. </p>
<p>Aneurysms are extremely dangerous if not caught early. The good news is their <a href="https://www.ncbi.nlm.nih.gov/books/NBK459176/">prevalence in men over 65</a> is falling – possibly due in part to healthier lifestyles and fewer people smoking. But it will be important to continue screening programmes, and possibly even begin screening men at younger ages to prevent tragedies like what happened to Grant Wahl.</p><img src="https://counter.theconversation.com/content/196683/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Adam Taylor is affiliated with The Anatomical Society. </span></em></p>Aortic aneurysms most commonly happen in men aged over 65.Adam Taylor, Professor and Director of the Clinical Anatomy Learning Centre, Lancaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1855932022-07-06T14:50:16Z2022-07-06T14:50:16ZHow hot is too hot for the human body? Our lab found heat + humidity gets dangerous faster than many people realize<figure><img src="https://images.theconversation.com/files/470854/original/file-20220624-12-2yp1w8.jpg?ixlib=rb-1.1.0&rect=0%2C22%2C3806%2C2769&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Long-term exposure to high heat can become lethal.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/construction-worker-stops-to-cool-off-in-the-water-news-photo/1162996602?adppopup=true">Mark Wilson/Getty Images</a></span></figcaption></figure><p>Heat waves are <a href="https://doi.org/10.1038/s41467-020-16970-7">becoming supercharged as the climate changes</a> – lasting longer, becoming more frequent and getting just plain hotter. One question a lot of people are asking is: “When will it get too hot for normal daily activity as we know it, even for young, healthy adults?”</p>
<p>The answer goes beyond the temperature you see on the thermometer. It’s also about humidity. <a href="https://scholar.google.com/citations?user=zsXN72cAAAAJ&hl=en">Our</a> <a href="https://scholar.google.com/citations?user=xuBw4jQAAAAJ&hl=en">research</a> shows the combination of the two can <a href="https://doi.org/10.1152/japplphysiol.00738.2021">get dangerous faster</a> than scientists previously believed.</p>
<p>Scientists and other observers have become alarmed about the increasing frequency of extreme heat paired with high humidity, measured as “wet-bulb temperature.” During the heat waves that overtook South Asia in May and June 2022, Jacobabad, Pakistan, recorded a <a href="https://www.telegraph.co.uk/global-health/climate-and-people/hotter-human-body-can-handle-pakistan-city-broils-worlds-highest/">maximum wet-bulb temperature</a> of 33.6 C (92.5 F) and <a href="https://www.indiatimes.com/news/india/at-400c-delhis-real-feel-was-above-500c-on-tuesday-573438.html">Delhi topped that</a> – close to the theorized upper limit of human adaptability to humid heat.</p>
<p>People often point to a <a href="https://doi.org/10.1073/pnas.0913352107">study published in 2010</a> that estimated that a wet-bulb temperature of 35 C – equal to 95 F at 100% humidity, or 115 F at 50% humidity – would be the upper limit of safety, beyond which the human body can no longer cool itself by evaporating sweat from the surface of the body to maintain a stable body core temperature.</p>
<p>It was not until recently that this limit was tested on humans in laboratory settings. The results of these tests show an even greater cause for concern.</p>
<h2>The PSU H.E.A.T. Project</h2>
<p>To answer the question of “how hot is too hot?” we brought young, healthy men and women into the <a href="https://hhd.psu.edu/kines/get-started/research-labs-and-initiatives">Noll Laboratory at Penn State University</a> to experience heat stress in a controlled environment.</p>
<p>These experiments provide insight into which combinations of temperature and humidity begin to become harmful for even the healthiest humans.</p>
<figure class="align-center ">
<img alt="A young man in shorts walks on a treadmill with a towel beside him in a glass-enclosed room while a scientist monitors his body temperature and other conditions on computer screens on the other side of the glass." src="https://images.theconversation.com/files/470808/original/file-20220624-17-za2vp8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/470808/original/file-20220624-17-za2vp8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/470808/original/file-20220624-17-za2vp8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/470808/original/file-20220624-17-za2vp8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/470808/original/file-20220624-17-za2vp8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/470808/original/file-20220624-17-za2vp8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/470808/original/file-20220624-17-za2vp8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">S. Tony Wolf, a postdoctoral researcher in kinesiology at Penn State and co-author of this article, conducts a heat test in the Noll Laboratory as part of the PSU Human Environmental Age Thresholds project.</span>
<span class="attribution"><a class="source" href="https://www.psu.edu/news/research/story/humans-cant-endure-temperatures-and-humidities-high-previously-thought/">Patrick Mansell / Penn State</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span>
</figcaption>
</figure>
<p>Each participant swallowed a small telemetry pill, which monitored their deep body or core temperature. They then sat in an environmental chamber, moving just enough to simulate the minimal activities of daily living, such as cooking and eating. Researchers slowly increased either the temperature in the chamber or the humidity and monitored when the subject’s core temperature started to rise.</p>
<p>That combination of temperature and humidity whereby the person’s core temperature starts to rise is called the “<a href="https://doi.org/10.1152/japplphysiol.00738.2021">critical environmental limit</a>.” Below those limits, the body is able to maintain a relatively stable core temperature over time. Above those limits, core temperature rises continuously and risk of heat-related illnesses with prolonged exposures is increased.</p>
<p>When the body overheats, the heart has to work harder to pump blood flow to the skin to dissipate the heat, and when you’re also sweating, that decreases body fluids. In the direst case, prolonged exposure can result in heat stroke, a life-threatening problem that requires immediate and rapid cooling and medical treatment. </p>
<p>Our studies on young healthy men and women show that this upper environmental limit <a href="https://doi.org/10.1152/japplphysiol.00738.2021">is even lower</a> than the theorized 35 C. It’s more like a wet-bulb temperature of 31 C (88 F). That would equal 31 C at 100% humidity or 38 C (100 F) at 60% humidity.</p>
<figure class="align-center ">
<img alt="A chart allows users to see when the combination of heat and humidity becomes dangerous at each degree and percentage." src="https://images.theconversation.com/files/470813/original/file-20220624-14-jt7lbq.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/470813/original/file-20220624-14-jt7lbq.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=516&fit=crop&dpr=1 600w, https://images.theconversation.com/files/470813/original/file-20220624-14-jt7lbq.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=516&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/470813/original/file-20220624-14-jt7lbq.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=516&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/470813/original/file-20220624-14-jt7lbq.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=648&fit=crop&dpr=1 754w, https://images.theconversation.com/files/470813/original/file-20220624-14-jt7lbq.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=648&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/470813/original/file-20220624-14-jt7lbq.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=648&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Similar to the National Weather Service’s heat index chart, this chart translates combinations of air temperature and relative humidity into critical environmental limits, above which core body temperature rises. The border between the yellow and red areas represents the average critical environmental limit for young men and women at minimal activity.</span>
<span class="attribution"><span class="source">W. Larry Kenney</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<h2>Dry vs. humid environments</h2>
<p>Current heat waves around the globe are approaching, if not exceeding, these limits.</p>
<p>In hot, dry environments the critical environmental limits aren’t defined by wet-bulb temperatures, because almost all the sweat the body produces evaporates, which cools the body. However, the amount humans can sweat is limited, and we also gain more heat from the higher air temperatures.</p>
<p>Keep in mind that these cutoffs are based solely on keeping your body temperature from rising excessively. Even lower temperatures and humidity can place stress on the heart and other body systems. And while eclipsing these limits does not necessarily present a worst-case scenario, prolonged exposure may become dire for vulnerable populations such as the elderly and those with chronic diseases. </p>
<p>Our experimental focus has now turned to testing older men and women, since even healthy aging makes people less heat tolerant. Adding on the increased prevalence of heart disease, respiratory problems and other health problems, as well as certain medications, can put them at even higher risk of harm. People over the age of 65 comprise some <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1380980/pdf/amjph00508-0117.pdf">80%-90% of heat wave casualties</a>.</p>
<h2>How to stay safe</h2>
<p>Staying well hydrated and seeking areas in which to cool down – even for short periods – are important in high heat.</p>
<p>While more cities in the United States are expanding <a href="https://www.cdc.gov/climateandhealth/docs/UseOfCoolingCenters.pdf">cooling centers</a> to help people escape the heat, there will still be many people who will experience these dangerous conditions with <a href="https://www.latimes.com/world-nation/story/2022-06-20/sweltering-streets-hundreds-of-homeless-die-in-extreme-heat-each-year">no way to cool themselves</a>. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/vo93rjdHXVo?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The lead author of this article, W. Larry Kenney, discusses the impact of heat stress on human health with PBS NewsHour.</span></figcaption>
</figure>
<p>Even those with access to air conditioning might not turn it on because of the <a href="https://www.cdc.gov/mmwr/volumes/71/wr/pdfs/mm7124a1-H.pdf">high cost of energy</a> – a common occurrence in Phoenix, Arizona – or because of <a href="https://apnews.com/article/climate-change-government-and-politics-business-environment-and-nature-6a66be20ed86ad18ed131156c9f7a517">large-scale power outages</a> during heat waves or wildfires, as is becoming more common in the western U.S.</p>
<p>A recent study focusing on <a href="https://doi.org/10.1007/s00484-022-02295-1">heat stress in Africa</a> found that future climates will not be conducive to the use of even low-cost cooling systems such as “swamp coolers” as the tropical and coastal parts of Africa become more humid. These devices, which require far less energy than air conditioners, use a fan to recirculate the air across a cool, wet pad to lower the air temperature, but they become ineffective at high wet-bulb temperatures above 21 C (70 F).</p>
<p>All told, the evidence continues to mount that climate change is not just a problem for the future. It is one that humanity is currently facing and must tackle head-on.</p><img src="https://counter.theconversation.com/content/185593/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>W. Larry Kenney receives research grant funding from the National Institutes of Health/National Institute on Aging.</span></em></p><p class="fine-print"><em><span>Daniel Vecellio is supported by a training grant from the National Institute on Aging through the Penn State Center for Healthy Aging. </span></em></p><p class="fine-print"><em><span>Rachel Cottle is supported by a training grant from the National Institute on Aging through the Penn State Center for Healthy Aging.</span></em></p><p class="fine-print"><em><span>S. Tony Wolf is supported by the National Institutes of Health. </span></em></p>New research on young, healthy humans found the body begins overheating when exposed to temperatures and humidity lower than previously believed.W. Larry Kenney, Professor of Physiology, Kinesiology and Human Performance, Penn StateDaniel Vecellio, Geographer-climatologist and Postdoctoral Fellow, Penn StateRachel Cottle, Ph.D. Candidate in Exercise Physiology, Penn StateS. Tony Wolf, Postdoctoral Researcher in Kinesiology, Penn StateLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1860642022-06-30T10:39:16Z2022-06-30T10:39:16ZDepeche Mode keyboardist Andrew Fletcher died of an aortic dissection – here’s what it is<p>It was revealed this week that <a href="https://www.rollingstone.com/music/music-news/depeche-mode-andy-fletcher-cause-of-death-aortic-dissection-1375076/">Depeche Mode</a> keyboardist Andrew “Fletch” Fletcher, died in May from an aortic dissection. Aortic dissections are relatively uncommon compared to other cardiovascular conditions such as heart attacks – but their outcomes are <a href="https://www.ncbi.nlm.nih.gov/books/NBK441963/">often very poor</a>. </p>
<p>The aorta is the body’s main artery. It carries oxygen and nutrient rich blood from the heart to the rest of the body, providing our tissues with everything they need to function properly. An aortic dissection is a tear of the innermost lining of the aorta. The inner lining, known as the intima or tunica intima, is a single layer of highly specialised cells called <a href="https://www.ncbi.nlm.nih.gov/books/NBK26848/">endothelial cells</a>, which ensure that the blood stays in its liquid form as it flows around through the body’s blood vessels.</p>
<p>When damage to the endothelial layer occurs, the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5949592/">high-pressure blood</a> tears through the intima layer and into the next layer, the media – literally “dissecting” a pathway into the outer layers of the aorta. If not diagnosed and treated, this can lead to complete failure of the aorta wall and blood escaping out of the vessel and into neighbouring structures and tissues. This stretches the aorta and changes its <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6851434/">biomechanical function</a>, which can further contribute to the disease process. As blood is diverted into the tear, it can remove flow from the organs downstream – in some instances completely preventing supply to some of them. The tear also changes the flow of blood through the vessel, which can cause further damage to the specialised endothelial lining cells.</p>
<h2>Uncommon condition</h2>
<p><a href="https://heartresearch.org.uk/aortic-dissection/#:%7E:text=Aortic%20dissection%20is%20a%20rare,surgery%20to%20repair%20the%20aorta.">In the US and UK</a>, aortic dissections affect <a href="https://pubmed.ncbi.nlm.nih.gov/10807810/">approximately three</a> to <a href="https://pubmed.ncbi.nlm.nih.gov/14959911/">four people</a> per 100,000. Aortic dissections are twice as common in the <a href="https://pubmed.ncbi.nlm.nih.gov/29989600/">ascending part</a> of the aorta compared to the descending part. </p>
<p>It’s important to know <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2672467/">where an aortic dissection happens</a>, as this can impact how a person is affected, how the condition is treated and their likelihood of survival. Tears which affect the ascending aorta are known as type A while those which affect the descending aorta are type B.</p>
<p>A person’s sex also affects the type of aortic dissection they may develop, alongside their likelihood of ever developing one. For men, aortic dissection tends to happen <a href="https://pubmed.ncbi.nlm.nih.gov/31926709/">around age 60</a>, for women it’s usually later, around age 65. Type A dissections are twice as likely to happen in men than women.</p>
<p>Aortic dissections are linked primarily to two things: genetic conditions and <a href="https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.056546">lifestyle factors</a> that affect the heart and blood vessels. For example, poor diet and smoking may lead to <a href="https://www.nhs.uk/conditions/high-blood-pressure-hypertension/">hypertension</a> (high blood pressure) which increases the likelihood of damage to the specialised cells that line the blood vessels. This makes it far more likely for a person to develop an aortic dissection.</p>
<figure class="align-center ">
<img alt="A digital illustration of an aortic dissection, which happens when the lining of the blood vessel develops a tear." src="https://images.theconversation.com/files/471819/original/file-20220630-11-qm06dv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/471819/original/file-20220630-11-qm06dv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/471819/original/file-20220630-11-qm06dv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/471819/original/file-20220630-11-qm06dv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/471819/original/file-20220630-11-qm06dv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/471819/original/file-20220630-11-qm06dv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/471819/original/file-20220630-11-qm06dv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">An aortic dissection happens when a tear develops in the aorta’s innermost lining.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/artery-dissection-3d-illustration-451619497">sciencepics/Shutterstock</a></span>
</figcaption>
</figure>
<p>Another significant lifestyle factor that makes a person more likely to develop an aortic dissection is <a href="https://pubmed.ncbi.nlm.nih.gov/20233907/">cocaine use</a>. This increases <a href="https://www.ahajournals.org/doi/10.1161/circulationaha.110.940569">heart rate and blood pressure</a>, while simultaneously decreasing the amount of blood passing through the arteries that supply the heart. Cocaine use not only makes a person more likely to develop an aortic dissection later in life, but it may also <a href="https://pubmed.ncbi.nlm.nih.gov/17826227/">trigger an aortic dissection</a>. </p>
<p>A number of genetic conditions are associated with an increased risk of aortic dissection too. The most common of these is a condition called <a href="https://www.nhs.uk/conditions/marfan-syndrome/symptoms/">Marfan syndrome</a>, affecting about <a href="https://www.cdc.gov/heartdisease/marfan_syndrome.htm#:%7E:text">one in 5000</a> people. This prevents people from properly producing enough of a key protein which helps give blood vessel walls their structure and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3075583/">elasticity</a>. Without enough of this protein, the blood vessel walls are weakened and at an increased risk of dissection or rupture. People with Marfan syndrome are also more likely to develop an aortic dissection at a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5721116/">younger age</a> – usually around 38.</p>
<p>Trauma can also cause a dissection, with <a href="https://www.sciencedirect.com/science/article/pii/S0741521497702258">road traffic accidents</a> a major cause. They can either <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6634278/">cause a dissection to start</a>, or a spontaneous rupture of the aorta. </p>
<h2>Possible treatments</h2>
<p>Symptoms of aortic dissection include pain, described often as ripping or tearing in the chest, abdomen or back. Where people are known to have predisposing conditions, they are <a href="https://www.ahajournals.org/doi/10.1161/circulationaha.107.693523">monitored or medically managed</a>, usually with drugs such as betablockers and anti-hypertensives, which reduce blood pressure and decrease risk of damage to the endothelial lining. This <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4128933/">type of management</a> is only really appropriate for type B dissections. Type A almost always requires immediate surgical intervention.</p>
<p>In people with suspected or known aortic dissection, catching it early is key. A CT scan will typically be used to <a href="https://www.ahajournals.org/doi/10.1161/HCI.0000000000000075#:%7E:text">diagnose the condition</a>. Usually, the end stage of treatment is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4893532/">surgical repair or replacement</a> of the defective part of the aorta. But outcomes from this procedure are mixed, with survival from surgery for a type A dissection usually <a href="https://www.ahajournals.org/doi/10.1161/circulationaha.105.000497">around 52-94% at one-year</a> after an operation and 45-88% at five years. For type B, there’s a similar <a href="https://www.ahajournals.org/doi/10.1161/circulationaha.106.622340">variation in survival</a>, at year one (around 56-92%) and year 5 (48%-82%).</p>
<p>In type B dissections, sometimes the anti-hypertensive medications may be used to <a href="https://jintensivecare.biomedcentral.com/articles/10.1186/s40560-018-0287-7">stabilise the patient</a> before surgery, but this is not always possible. A dissection is a serious condition and will not repair itself. </p>
<p>Due to the seriousness and potentially poor outcomes from aortic dissection, it’s important to modify any lifestyle factors that may contribute to an increased risk – such as exercising, eating a healthy and balanced diet and giving up smoking. It’s also important to ensure any underlying health conditions that may put you at greater risk (such as hypertension) are medically managed.</p><img src="https://counter.theconversation.com/content/186064/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Adam Taylor is affiliated with the Anatomical Society. </span></em></p>Aortic dissection is an uncommon condition – affecting only three or four people per 100,000.Adam Taylor, Professor and Director of the Clinical Anatomy Learning Centre, Lancaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1826242022-05-10T18:25:19Z2022-05-10T18:25:19ZPig-human transplants may be a misguided attempt to address the organ shortage<figure><img src="https://images.theconversation.com/files/461887/original/file-20220509-20-agjzud.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6000%2C4500&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Cross-species transplants require us to examine the relationships between humans and animals.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/pig-human-transplants-may-be-a-misguided-attempt-to-address-the-organ-shortage" width="100%" height="400"></iframe>
<p>At the end of 2021, 57-year old David Bennett Sr. was bedridden and on life-support with irreversible heart failure. He was not eligible for a human heart transplant or an implanted mechanical heart pump because of his underlying health condition and, allegedly, “<a href="https://www.technologyreview.com/2022/05/04/1051725/xenotransplant-patient-died-received-heart-infected-with-pig-virus/">a history of disregarding medical advice</a>.”</p>
<p>Certain death was on the horizon and this fatal prognosis made Bennett a candidate for a highly experimental and never-before-attempted surgical procedure involving the transplantation of a heart from a genetically modified pig.</p>
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Read more:
<a href="https://theconversation.com/pig-heart-transplant-was-david-bennett-the-right-person-to-receive-groundbreaking-surgery-174991">Pig heart transplant: was David Bennett the right person to receive groundbreaking surgery?</a>
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<p>The pig-to-human cardiac transplant — or xenotransplant — was <a href="https://www.technologyreview.com/2022/01/11/1043374/gene-edited-pigs-heart-transplant/">authorized by the U.S. Food and Drug Administration on compassionate grounds on New Year’s Eve 2021</a> and the surgery was performed on Jan. 7, 2022.</p>
<p>Initial reports following the experimental surgery suggested that <a href="https://doi.org/10.1038/d41586-022-00111-9">the genetically modified, human-compatible pig heart was functioning well and infection was not a problem</a>. </p>
<p>Bennett died on March 8 — at the time, “no obvious cause” of death was identified. Now, it has been reported that the pig heart was <a href="https://www.newscientist.com/article/2319108-man-who-received-pig-heart-transplant-has-died-after-pig-virus-found/">infected with a virus called porcine cytomegalovirus and that this virus may have contributed to Bennett’s death</a>. </p>
<p>Though the cause of death remains unclear, infection has been implicated in previous xenotransplantation failures involving baboons as the recipients.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/42bwa85g1DM?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The BBC reports on the initial pig-to-human heart transplant surgery.</span></figcaption>
</figure>
<h2>More demand than supply</h2>
<p>There is an ongoing chronic <a href="https://hillnotes.ca/2021/04/16/organ-donation-in-canada-2/">shortage of suitable human organs for life-saving transplantation</a>. Indeed, many <a href="https://www.cihi.ca/en/organ-transplants-in-canada-2020-donations-and-need-infographic">Canadian transplant candidates die waiting for an organ donation</a>.</p>
<p>Attempts to increase the limited supply of human organs have included changes to consent rules: <a href="https://doi.org/10.1016/S2468-1253(17)30037-7">moving to an opt-out system</a>, <a href="https://doi.org/10.1016/S0140-6736(18)31870-1">introducing directed living donation and deceased donor-initiated chains</a> and, in some countries, <a href="https://doi.org/10.1097/MOT.0000000000000617">offering financial compensation</a>. </p>
<p>Still, patients die on transplant waiting lists. For this reason, there is ever increasing interest in xenotransplantation — an ethically controversial practice. </p>
<h2>Nonhuman primates and pigs</h2>
<p>In 1984, <a href="https://time.com/4086900/baby-fae-history/">the heart of a young baboon was transplanted into Baby Fae</a>, an infant born with a fatal heart defect called <a href="https://www.mayoclinic.org/diseases-conditions/hypoplastic-left-heart-syndrome/symptoms-causes/syc-20350599">hypoplastic left heart syndrome</a>. Baby Fae lived for three weeks, but eventually died of heart failure caused by rejection of the transplanted baboon heart.</p>
<p>Prior to this, there had been three other experimental nonhuman heart transplants, <a href="https://dx.doi.org/10.1080/08998280.2012.11928783">the earliest in 1964 using a chimpanzee heart</a>.</p>
<p>More recent efforts at xenotransplantation have involved the <a href="https://www.uab.edu/news/campus/item/12566-uab-announces-first-clinical-grade-transplant-of-gene-edited-pig-kidneys-into-brain-dead-human">transplantation of pig kidneys into brain-dead humans</a>. The most dramatic recent example, however, remains Bennett’s first-in-human cardiac xenotransplant using a genetically modified pig heart.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/462150/original/file-20220510-17-ol00fx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="a baboon behind a cage" src="https://images.theconversation.com/files/462150/original/file-20220510-17-ol00fx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/462150/original/file-20220510-17-ol00fx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/462150/original/file-20220510-17-ol00fx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/462150/original/file-20220510-17-ol00fx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/462150/original/file-20220510-17-ol00fx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/462150/original/file-20220510-17-ol00fx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/462150/original/file-20220510-17-ol00fx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">One of the earliest xenotransplants involved a baboon heart transplanted into an infant.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>For some, the use of pig hearts for xenotransplantation may be ethically preferable to the use of nonhuman primate hearts because pigs are already used for medicine: for example, <a href="https://www.npr.org/2021/10/20/1047560631/in-a-major-scientific-advance-a-pig-kidney-is-successfully-transplanted-into-a-h">pig heart valves, corneas and skin are used in various treatments</a>.</p>
<p>Or it could be that pigs are preferable “organ donors” because they are already used for food. When it comes to food animals — those who are consumed by humans — people can be biased against accurately seeing the subjectivity of the animal. This is referred to as the “<a href="https://dx.doi.org/10.3390/ani9121125">meat paradox</a>,” where people perceive food animals as “<a href="https://www.bbc.com/future/article/20190206-what-the-meat-paradox-reveals-about-moral-decision-making">objects and thereby avoid the discomfort caused by knowing about the suffering behind consumer goods</a>.”</p>
<p>A third reason to prefer killing pigs for human benefit instead of killing nonhuman primates is that pigs are biologically less similar to humans.</p>
<h2>Prioritizing humans</h2>
<p>Moral worth — <a href="https://impactethics.ca/2014/09/05/which-lives-are-you-pro/">the value assigned to others in ways that affect how we treat them</a> — is not species specific. Rather, it is associated with specific capacities such as the ability to think, make choices, experience pain, communicate and have social relationships.</p>
<p>Because a human zygote lacks such capacities, not many believe that they have the same moral worth as a human two-year old, and there is nothing obviously irrational about this belief. Though a zygote may have the potential to reach a comparable level of development as a two-year old, they are not yet comparable. Their shared human identity is beside the point. </p>
<p>On occasion, humans may choose to prioritize the interests of their companion animals without doing something obviously wrong. For example, it is not irrational to spend money on the care of pets, even if that money could have gone towards helping fellow humans. This choice may reflect a shared social relationship and the emotional bonds that come with it. It may also reflect a sense of duty toward nonhuman animals that are dependent on the care provided by humans. </p>
<p>Having said this, clearly, there are times when it is appropriate to prioritize the interests of humans over other animals; it is just that <a href="https://aeon.co/essays/human-exceptionalism-is-a-danger-to-all-human-and-nonhuman">this perspective shouldn’t be the default position</a>. In any case, it is not clear, nor is it easy to determine, that Bennett’s extraordinary xenotransplant falls into this category.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/462152/original/file-20220510-16-xxiv1e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="pigs standing at a trough in a shed" src="https://images.theconversation.com/files/462152/original/file-20220510-16-xxiv1e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/462152/original/file-20220510-16-xxiv1e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/462152/original/file-20220510-16-xxiv1e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/462152/original/file-20220510-16-xxiv1e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/462152/original/file-20220510-16-xxiv1e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/462152/original/file-20220510-16-xxiv1e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/462152/original/file-20220510-16-xxiv1e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The killing and consumption of pigs is normalized as they are produced for food.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<h2>Animal welfare</h2>
<p>In Canada, support for animal-based research is anchored in a commitment to <a href="https://www.ccac.ca/Documents/2013_National_Survey.pdf">prevent — or at the very least reduce — unnecessary suffering</a>. The problem with this stance is that current animal welfare considerations do not typically support strong constraints on the scientific use of animals. </p>
<p>Notably, there are pressures to limit, but <a href="https://ccac.ca/en/facts-and-legislation/animal-data/annual-animal-data-reports.html">not to eliminate</a>, the use of animals in research likely to have severe welfare impacts. Also, common animal welfare considerations do not prohibit killing the animals, they just constrain how they are killed. </p>
<p>Part of the problem here is that there are <a href="https://doi.org/10.1017/S0963180119000732">no substantive ethical principles governing animal use in science</a>. The three Rs, which are pervasive in regulated animal use in science, emphasize <em>replacing</em> sentient animals (animals capable of experiencing pain and pleasure) where possible, <em>reducing</em> the number of sentient animals used in studies to a “bare minimum” and <em>refining</em> their experiences of use to minimize suffering. </p>
<p>As such, the three Rs seem to assume something like a principled commitment to non-maleficence — <a href="https://doi.org/10.1093/ilar/ilaa014">avoiding unnecessary harm</a>. However, the continued dependency on harmful animal-based research that almost always ends with the killing of the animals belies this claim, given the known <a href="https://www.cbc.ca/radio/quirks/may-7-endangered-tiny-porpoise-mars-quakes-thermal-batteries-and-more-1.6443011/meet-the-canadian-researcher-determined-to-take-the-animals-out-of-lab-testing-1.6443917">significant problems of extrapolation of research findings</a>.</p>
<p>Given the ethical challenges with animal-based research in general and more specifically the ethical challenges with animal-to-human xenotransplantation, there is good reason to look for <a href="https://www.thehastingscenter.org/xenotransplantation-three-areas-of-concern/">other strategies to increase the supply of organs</a> for transplantation.</p><img src="https://counter.theconversation.com/content/182624/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew Fenton is a member of the (Canadian) Society for Humane Science and is currently serving on a subcommittee for the Canadian Council on Animal Care (revising their core ethics document) and a panel on nonhuman primate research for the National Anti-Vivisection Society. </span></em></p><p class="fine-print"><em><span>Françoise Baylis does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The heart used in the first pig-human transplant was infected with a pig virus. This reveals that using other species as organ donors may not provide a solution for organ shortages.Françoise Baylis, University Research Professor, Philosophy, Dalhousie UniversityAndrew Fenton, Associate Professor, Philosophy, Dalhousie UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1752902022-02-27T13:08:39Z2022-02-27T13:08:39ZOrgan transplants from pigs: Medical miracle or pandemic in the making?<figure><img src="https://images.theconversation.com/files/447227/original/file-20220218-3064-xtzvrp.jpg?ixlib=rb-1.1.0&rect=422%2C35%2C4922%2C3332&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Xenotransplantation is the transplanting of cells, tissues or organs from animals to humans. Pre-clinical trials of organ transplant from pigs have addressed some of the technical barriers.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Three out of four <a href="https://www.cdc.gov/onehealth/basics/zoonotic-diseases.html">new diseases are zoonotic</a>, meaning they have evolved to infect new host species. For example, a mutated <a href="https://www.cdc.gov/flu/avianflu/virus-transmission.htm">bird-flu virus</a> may jump from wild birds to free-range domestic poultry and then to humans who are in contact with poultry. Similar pathways have led to infection by the pathogens that cause <a href="https://doi.org/10.1038/nrmicro.2017.45">Ebola, Zika, HIV, Lyme disease and likely COVID-19</a>.</p>
<p>If a new medical technology increased the risk of a new zoonotic pandemic — however marginally — how would society decide the balance of risk and benefit? If you needed new lungs that were only available in another country, would a health prohibition on the transplant in your own country stop you? </p>
<p>New developments in organ transplant technology may have streamlined a pathway for new zoonotic diseases, but the biotechnology innovators and medical research institutes have not engaged the public on the risks. Failing to do so may jeopardize the potential of a promising therapy.</p>
<h2>Xenotransplantation</h2>
<p>Over 4,400 Canadians are waitlisted for the lifesaving transplant of a new kidney, liver or lung. In 2019, <a href="https://www.blood.ca/en/stories/data-offers-hope-patients-waiting-organ-transplant">250 died waiting</a>. In the United States and elsewhere, <a href="https://www.organdonor.gov/learn/organ-donation-statistics">the supply gap is more extreme</a> and high hopes ride on xenotransplantation: the transplanting of cells, tissues or organs from animals. </p>
<p>Pre-clinical trials of organ transplants from pigs have addressed the technical barriers to xenotransplantation, reducing the likelihood of rejection. Last summer, Maryland School of Medicine surgeons reported the 31-day survival of a baboon after receiving a <a href="https://doi.org/10.1111/ajt.16809">lung from a genetically modified pig</a>. </p>
<p>Weeks later, a team at New York University transplanted a kidney from a genetically modified pig into a <a href="https://doi.org/10.1111/xen.12718">brain-dead person</a>. In December 2021, surgeons at Maryland School of Medicine transplanted a genetically modified pig heart into a <a href="https://doi.org/10.1038/d41586-022-00111-9">living 57-year-old man</a>. </p>
<p>All projects were approved under U.S. Food and Drug Administration (FDA) regulations, and corporate funding was supplemented by the U.S. National Institutes of Health. The next step with the FDA is to approve clinical trials. Normalization of xenotransplantation could happen before there is informed public acceptance of the benefits and risks.</p>
<h2>A potential zoonotic pathway</h2>
<p>As a developmental geneticist, it has been exciting to track these advances. The revolution in designer gene editing (known as CRISPR-Cas9) makes this stunning progress possible. <a href="https://doi.org/10.1126/science.aan4187">CRISPR allows molecules on the surface of pig cells to be modified</a> so the human immune system will not trigger tissue rejection.</p>
<figure class="align-center ">
<img alt="Illustration in blue tones of a human torso with respiratory tract and lungs in red" src="https://images.theconversation.com/files/447231/original/file-20220218-13070-hep7im.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/447231/original/file-20220218-13070-hep7im.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=465&fit=crop&dpr=1 600w, https://images.theconversation.com/files/447231/original/file-20220218-13070-hep7im.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=465&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/447231/original/file-20220218-13070-hep7im.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=465&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/447231/original/file-20220218-13070-hep7im.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=585&fit=crop&dpr=1 754w, https://images.theconversation.com/files/447231/original/file-20220218-13070-hep7im.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=585&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/447231/original/file-20220218-13070-hep7im.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=585&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Zoonotic bacteria and viruses enter most readily through the delicate surfaces of the respiratory tract.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>To prevent human transplant recipients from being infected with pig <a href="https://www.genome.gov/genetics-glossary/Retrovirus">retroviruses</a> (viruses that can integrate their genetic material into the host’s cells), the retroviruses hiding in the pig genome have been <a href="https://doi.org/10.1111/xen.12595">removed by CRISPR editing</a>. The risk of transferring a disease directly from a genetically modified donor pig to the human host is negligible.</p>
<p>However, disease-free transplanted pig organs could become infected after transplantation. Zoonotic bacteria and viruses enter hosts most readily through the <a href="https://doi.org/10.1051/vetres:2006062">delicate surfaces of the respiratory tract</a>, as with COVID-19. Living pig cells in a transplanted lung could readily be infected by an inhaled pig virus, including a novel virus from a wild animal host that has evolved to infect pigs. </p>
<p>After entering the human body, a replicating zoonotic virus could generate millions of mutations a day, because their mechanism for gene copying <a href="https://doi.org/10.3390/v13091882">is naturally error prone</a>. A pig virus replicating in a lung transplanted into a human could <a href="https://theconversation.com/how-do-viruses-mutate-and-jump-species-and-why-are-spillovers-becoming-more-common-134656">produce variants</a> that may be capable of recognizing and infecting human cells. Although likely a rare event, it is not impossible that this could trigger a new zoonotic pandemic.</p>
<h2>Risk, fear and polarization</h2>
<p>The scenario described above could evoke risk and fear from a complex new medical technology. It parallels the thinking involved in <a href="https://doi.org/10.1038/s41591-021-01459-7">vaccine hesitancy</a> or the <a href="https://www.scientificamerican.com/article/why-people-oppose-gmos-even-though-science-says-they-are-safe/">distrust of genetically modified foods</a>. Both are well anchored in today’s political culture. In both cases, citizens increasingly demand prior consent and the choice to opt out — despite possible risks to public health. <a href="https://doi.org/10.1038/s41598-022-05498-z">Vaccine hesitancy</a> has increased the death toll from COVID-19 and delayed economic recovery from the pandemic.</p>
<p>In contrast, distrust of the industrialization of food has discouraged introduction of genetically modified foods that <a href="https://doi.org/10.4161/21645698.2014.967570">enhance nutrition or sustain agricultural productivity</a> in a warming climate. Consumers question whether genetically modified organisms (GMOs) exist for public benefit or for corporate profit.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/447229/original/file-20220218-19-vy6cvf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A protester wearing a winter hat with their face covered with a scarf, hold a paper plate that says 'No GMOs on my plate'" src="https://images.theconversation.com/files/447229/original/file-20220218-19-vy6cvf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/447229/original/file-20220218-19-vy6cvf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=798&fit=crop&dpr=1 600w, https://images.theconversation.com/files/447229/original/file-20220218-19-vy6cvf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=798&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/447229/original/file-20220218-19-vy6cvf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=798&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/447229/original/file-20220218-19-vy6cvf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1003&fit=crop&dpr=1 754w, https://images.theconversation.com/files/447229/original/file-20220218-19-vy6cvf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1003&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/447229/original/file-20220218-19-vy6cvf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1003&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Distrust of the industrialization of food has discouraged introduction of GMO foods.</span>
<span class="attribution"><span class="source">(CP PHOTO/Paul Chiasson)</span></span>
</figcaption>
</figure>
<p>Increasingly, health issues such as <a href="https://theconversation.com/politicizing-covid-19-vaccination-efforts-has-fuelled-vaccine-hesitancy-175416">vaccination</a>, vaping or genetic testing generate highly polarized <a href="https://doi.org/10.1093/ntr/ntaa276">platforms for misinformation</a>, debate and political leverage. <a href="https://thedecisionlab.com/insights/society/social-media-and-moral-outrage/">Social media algorithms amplify extreme positions and elicit strong emotional reactions</a> at the <a href="http://dx.doi.org/10.1177/1461444818822813">expense of the middle ground</a>. When communications from the scientific community are reactive, poorly targeted or <a href="https://doi.org/10.1080/02691728.2020.1739778">unintelligible to the average person</a>, the influence of science in the policy process is diminished.</p>
<p>In 2022, progress in xenotransplant technology makes <a href="https://edition.cnn.com/2022/01/15/opinions/pig-heart-transplant-big-deal-reiner/index.html">good news stories</a>. Immense pressure to resolve the growing organ shortage for transplantation may tempt the biotechnology business and public regulators to be insufficiently critical as they seek permission to proceed with clinical studies. They must prepare for the nature and scale of backlash from those tired of experts and mistrustful of corporate motivation and institutional authority. </p>
<p>Concern about zoonosis from transplants was <a href="https://www.nuffieldbioethics.org/publications/xenotransplantation">voiced over twenty years ago</a>, long before CRISPR transformed the field. <a href="https://www.fda.gov/regulatory-information/search-fda-guidance-documents/phs-guideline-infectious-disease-issues-xenotransplantation">Since then</a>, there appear to be no hard facts or even a call for research on zoonotic infection through xenotransplants after transplantation. Bioethicists are <a href="https://www.thehastingscenter.org/xenotransplantation-three-areas-of-concern/">flagging the issue now</a>, but the silence about xenotransplant zoonosis from biotechnology corporations and their affiliated preclinical research institutes leaves an open door to a narrative motivated by skepticism and distrust. It is incumbent on them to lead a public dialogue on managing the risk of novel zoonotic diseases arising from infection after transplantation.</p><img src="https://counter.theconversation.com/content/175290/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>J Roger Jacobs receives funding from the Natural Sciences and Engineering Research Council of Canada.</span></em></p>New developments in organ transplants from animals show promise. However, there has been no public engagement about a potential risk. It may streamline a pathway to humans for new zoonotic diseases.J Roger Jacobs, Professor, Department of Biology, McMaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1765372022-02-13T18:49:12Z2022-02-13T18:49:12ZIs this love … or an arrhythmia? Your heart really can skip a beat when you’re in love<figure><img src="https://images.theconversation.com/files/445828/original/file-20220210-23-s1oys3.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C9156%2C6328&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>We’ve seen it in our favourite romantic comedy – and for many of us, we’ve even felt it in real life. The door of the café swings open, in walks the person of your dreams. Momentarily you’re paralysed. Temporarily overwhelmed. And then you feel it, in your chest. </p>
<p>Is it love at first sight? Is your heart really beating faster than normal? Does it feel – even just for a second – like it’s skipped a beat? </p>
<p>It turns out the movie scenes, songs and poems are right to some extent. Feelings of love and attraction do affect the heart. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/friday-essay-3-ways-philosophy-can-help-us-understand-love-155374">Friday essay: 3 ways philosophy can help us understand love</a>
</strong>
</em>
</p>
<hr>
<h2>A heartful of feelings … also blood affected by hormones</h2>
<p>It’s actually quite normal for your heart to beat faster (or race) – and can happen when you are <a href="https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/racing-heart-beat-heart-arrhythmia-101">excited</a>, <a href="https://www.medicalnewstoday.com/articles/anxiety-with-heart-palpitations">nervous</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/35006474/">angry</a> or even if you’ve had <a href="https://pubmed.ncbi.nlm.nih.gov/19083466/">too many coffees</a>. </p>
<p>You’ve probably heard of the <a href="https://theconversation.com/global/topics/fight-or-flight-28153">fight or flight response</a>. Well, that also explains the feeling of your heart racing during a romantic moment. </p>
<p>Your brain sends a signal to your adrenal glands, two little hormone-producing organs that sit on top of your kidneys. This produces a small boost of the hormone <a href="https://www.endocrineweb.com/adrenaline">adrenaline</a>. It moves via your bloodstream directly to your heart, where its action is to temporarily make your heart beat faster. </p>
<p>The body appears to react this way, even though you’re not necessarily in danger. If you were running away from a bear, the increased heart rate would prepare your muscles to run. When love or attraction strikes, this might be your body’s way of preparing you to run into the arms of your perfect match.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/2REkk9SCRn0?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The heart wants what the heart wants.</span></figcaption>
</figure>
<h2>Phew! So, it’s not life threatening?</h2>
<p>Probably not. Particularly if you don’t notice it happening frequently and are otherwise in good health. </p>
<p>In response to a surge of adrenaline, your heart racing is almost certainly due to sinus tachycardia. This is when your heart is still beating in a normal rhythm, but faster – like what happens during a good gym session or a run around the block. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/445827/original/file-20220210-41044-wdggrp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two women cuddle in a kitchen." src="https://images.theconversation.com/files/445827/original/file-20220210-41044-wdggrp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/445827/original/file-20220210-41044-wdggrp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/445827/original/file-20220210-41044-wdggrp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/445827/original/file-20220210-41044-wdggrp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/445827/original/file-20220210-41044-wdggrp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/445827/original/file-20220210-41044-wdggrp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/445827/original/file-20220210-41044-wdggrp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">In response to a surge of adrenaline, your heart racing is almost certainly due to sinus tachycardia.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>There are other conditions which can cause someone to feel their heart is racing. Supraventricular tachycardia (SVT) is a condition which results from someone having an <a href="https://www.mja.com.au/journal/2009/190/5/supraventricular-tachycardia">extra electrical circuit</a> in the heart. We are all born with natural electrical circuits, but some people have an extra circuit. In certain situations, that circuit activates and causes palpitations. While the symptoms of SVT can be disconcerting, it is usually benign and can be easily treated with a <a href="https://pubmed.ncbi.nlm.nih.gov/33855753/">small surgical procedure</a>. </p>
<p>Another condition is atrial fibrillation (AF), which results in an irregular and sometimes very rapid heart rhythm. AF is the most common arrhythmia seen in clinical practice by cardiologists and its prevalence increases with age. </p>
<p>Approximately <a href="https://pubmed.ncbi.nlm.nih.gov/25588442/">5-10% of Australians</a> will develop AF in their lifetimes. AF can vary in severity, from occasional episodes of electrical disturbance, to a more serious condition that can result in impairment of how the heart pumps, leading to poorer quality of life and a risk of stroke or heart failure. Some AF is <a href="https://www.mayoclinic.org/diseases-conditions/atrial-fibrillation/diagnosis-treatment/drc-20350630">effectively managed with medication</a>, while other people may require cardioversion (delivering a small shock to the heart) or ablation (a procedure which deactivates cells in the heart that cause AF). </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/445831/original/file-20220210-26283-ne7nkc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="two hands make love heart" src="https://images.theconversation.com/files/445831/original/file-20220210-26283-ne7nkc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/445831/original/file-20220210-26283-ne7nkc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/445831/original/file-20220210-26283-ne7nkc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/445831/original/file-20220210-26283-ne7nkc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/445831/original/file-20220210-26283-ne7nkc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/445831/original/file-20220210-26283-ne7nkc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/445831/original/file-20220210-26283-ne7nkc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The best thing you can do for your love life is stay heart healthy.</span>
<span class="attribution"><a class="source" href="https://images.unsplash.com/photo-1586807480822-0e95ba6666ad?ixlib=rb-1.2.1&ixid=MnwxMjA3fDB8MHxzZWFyY2h8MjN8fGxvdmUlMjBoZWFydHxlbnwwfHwwfHw%3D&auto=format&fit=crop&w=800&q=60">Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-write-a-love-poem-155161">How to write a love poem</a>
</strong>
</em>
</p>
<hr>
<h2>That explains the electricity. But can it actually skip a beat?</h2>
<p>Yes. It’s absolutely possible for the heart to skip a beat. That can be <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/heart-arrhythmias-and-palpitations">triggered</a> by the same things that make your heart race – stress, anxiety, dehydration and a range of other things. These premature beats are almost always benign, meaning they aren’t life-threatening or the sign of a heart attack in the making. </p>
<p>So, whether it’s love, or the excited thrill in anticipation of love – your heart really does behave differently when romance walks in the door. The best thing we can do for our hearts is <a href="https://www.heartfoundation.org.au/heart-health-education/keeping-your-heart-healthy">maintain a healthy lifestyle</a>. That means exercising regularly, quitting smoking and checking in with your doctor for a heart health screen to make sure it’s just love, and nothing more sinister.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/445835/original/file-20220210-25-1vicpg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman clutches her heart while smiling." src="https://images.theconversation.com/files/445835/original/file-20220210-25-1vicpg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/445835/original/file-20220210-25-1vicpg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/445835/original/file-20220210-25-1vicpg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/445835/original/file-20220210-25-1vicpg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/445835/original/file-20220210-25-1vicpg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/445835/original/file-20220210-25-1vicpg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/445835/original/file-20220210-25-1vicpg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Your heart really does behave differently when love walks in the door.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure><img src="https://counter.theconversation.com/content/176537/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>It’s a love song cliché and a Hollywood staple, but your heart really might race or skip a beat when you feel love and attraction.Hannah Brown, Science Strategy and Operations Manager, Victorian Heart Institute, Monash UniversityHui-Chen Han, Research affiliate, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1745802022-01-17T17:34:19Z2022-01-17T17:34:19ZMyocarditis: COVID-19 is a much bigger risk to the heart than vaccination<figure><img src="https://images.theconversation.com/files/440923/original/file-20220114-19-c1e1zo.jpg?ixlib=rb-1.1.0&rect=91%2C51%2C6244%2C4469&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Myocarditis is an inflammation of the heart muscle most commonly caused by a virus.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 175px; border: none; position: relative; z-index: 1;" allowtransparency="" src="https://narrations.ad-auris.com/widget/the-conversation-canada/myocarditis--covid-19-is-a-much-bigger-risk-to-the-heart-than-vaccination" width="100%" height="400"></iframe>
<p>The <a href="https://doi.org/10.1161/CIRCRESAHA.121.317997">heart has played a central role</a> in COVID-19 since the beginning. Cardiovascular conditions are among the highest risk factors for hospitalization. A significant number of patients hospitalized with SARS-CoV-2 infections have signs of heart damage, and many recover from infection with lasting cardiovascular injury.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://theconversation.com/ca/topics/vaccine-confidence-in-canada-107061">Click here for more articles in our series about vaccine confidence.</a></span>
</figcaption>
</figure>
<p>It’s not surprising that debates over COVID-19 vaccines frequently centre around issues involving cardiovascular health. The high-profile <a href="https://theathletic.com/news/christian-eriksen-hospital-collapse-euro-2020/Jtev3AXbH8H4/">collapse of Danish soccer player Christian Eriksen in June</a> initiated a myth about the link between <a href="https://www.science20.com/w_glen_pyle/a_false_start_for_sudden_cardiac_death_in_athletes_and_covid19_vaccines-255817">sudden cardiac death and vaccination among athletes</a> that persists several months later. </p>
<p>Perhaps the <a href="https://montrealgazette.com/opinion/columnists/christopher-labos-how-worried-should-we-be-about-myocarditis">most common point of conflict concerning COVID-19 vaccines</a> is the risk of myocarditis following immunization, particularly among young people.</p>
<p>What do the numbers tell us about COVID-19, vaccines and myocarditis?</p>
<h2>What is myocarditis?</h2>
<p>Myocarditis is an inflammation of the heart muscle most commonly caused by a virus like <a href="https://doi.org/10.1038/s41569-020-00435-x">influenza, coxsackie, hepatitis or herpes</a>. Other causes include bacteria, fungi, toxins, chemotherapy and autoimmune conditions.</p>
<p>Some viruses infect heart muscle and cause direct injury to the heart, while others cause heart damage indirectly through the immune system. Activation of the immune system in response to an infection triggers the release of chemicals in the body called <a href="https://www.livescience.com/what-are-cytokines.html">cytokines</a>, which help clear infections. In some cases, the levels of cytokines rise to unusually high levels to produce a “cytokine storm” that causes damage to heart muscle.</p>
<h2>Myocarditis by the numbers</h2>
<figure class="align-center ">
<img alt="A soccer player on the field in a red uniform" src="https://images.theconversation.com/files/440920/original/file-20220114-28-6aopnv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/440920/original/file-20220114-28-6aopnv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/440920/original/file-20220114-28-6aopnv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/440920/original/file-20220114-28-6aopnv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/440920/original/file-20220114-28-6aopnv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/440920/original/file-20220114-28-6aopnv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/440920/original/file-20220114-28-6aopnv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Soccer player Alphonso Davies, 21, of Canada’s national men’s team, was sidelined by heart inflammation after having COVID-19.</span>
<span class="attribution"><span class="source">(AP Photo/Efrem Lukatsky)</span></span>
</figcaption>
</figure>
<p>Before COVID-19 the incidence of myocarditis was between <a href="https://doi.org/10.1016/j.jacc.2016.09.937">one and 10 cases per 100,000 people per year</a>. Rates are highest in males between 18 and 30 years old. Interestingly, most cases of myocarditis in the <a href="https://www.myocarditisfoundation.org/about-myocarditis/">highest risk group are in otherwise healthy and active people</a>. </p>
<p>According to the <a href="https://www.cdc.gov/mmwr/volumes/70/wr/mm7035e5.htm">U.S. Centers for Disease Control and Prevention</a>, the risk of myocarditis after infection with COVID-19 is much higher, at 146 cases per 100,000. The risk is higher for males, older adults (ages 50+) and children under 16 years old. Soccer player Alphonso Davies, 21, of Canada’s national men’s team, was sidelined by heart inflammation after having COVID-19.</p>
<h2>Post-vaccination myocarditis</h2>
<p>Myocarditis following COVID-19 vaccination is rare and the risk is much smaller than the risks of cardiac injury linked to COVID-19 itself. </p>
<p>Based on <a href="http://doi.org/10.1056/NEJMoa2110737">a study out of Israel</a>, the risk of post-vaccine myocarditis is 2.13 cases per 100,000 vaccinated, which is within the range usually seen in the general population. This study is consistent with others in the United States and Israel which put the <a href="https://doi.org/10.1038/s41569-021-00662-w">overall incidence of post-vaccine myocarditis between 0.3 and five cases per 100,000 people</a>.</p>
<figure class="align-center ">
<img alt="A young person wearing a face mask getting a vaccination" src="https://images.theconversation.com/files/440922/original/file-20220114-22-icdnc7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/440922/original/file-20220114-22-icdnc7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/440922/original/file-20220114-22-icdnc7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/440922/original/file-20220114-22-icdnc7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/440922/original/file-20220114-22-icdnc7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/440922/original/file-20220114-22-icdnc7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/440922/original/file-20220114-22-icdnc7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">In the rare cases of myocarditis following COVID-19 vaccination, the vast majority are mild and resolve quickly.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<h2>The kids are alright</h2>
<p>The highest incidence of myocarditis after vaccination with mRNA vaccines has occurred within three to four days after the second vaccination in <a href="http://doi.org/10.1056/NEJMoa2109730">males who are under age 30</a>. In <a href="https://doi.org/10.1161/CIRCULATIONAHA.121.056583">pediatric data</a>, the median age is 15.8 years, with most patients being male (90.6 per cent) and white (66.2 per cent) or Hispanic (20.9 per cent). Reliable data on booster shots in this age group is not yet available.</p>
<p>Most studies show a clear benefit of COVID-19 mRNA vaccination with respect to myocarditis. Only <a href="https://doi.org/10.1038/s41591-021-01630-0">one study by Martina Patone, from the University of Oxford, and colleagues</a> found more ambiguous results for those under 40 years of age based on myocarditis rates alone. However, if considering the other ill effects of infection with SARS-CoV-2 — both cardiac and not — there was still a strong benefit in immunizing younger people with COVID-19 vaccines other than Moderna, <a href="https://doi.org/10.1136/bmj-2021-068665">which research suggests has a higher risk for myocarditis than Pfizer’s vaccine</a>.</p>
<h2>Repairing the damage</h2>
<p>The <a href="https://doi.org/10.1161/CIRCRESAHA.118.313578">treatment for myocarditis</a> varies depending on its severity. Adults with mild forms of myocarditis typically need only rest and non-steroidal anti-inflammatory drugs (NSAIDS) like ibuprofen. More severe cases require medications or even mechanical circulatory supports like left ventricular assist devices to support heart function. In some cases when treatment is no longer effective, a heart transplant is required.</p>
<p>In a <a href="https://doi.org/10.1161/CIRCULATIONAHA.121.056583">multicentre series of patients under 21 years old</a>, those with mild symptoms received only NSAIDs or no anti-inflammatory therapy at all. Patients with more severe symptoms can receive stronger therapies including intravenous immunoglobulin, glucocorticoids or colchicine in addition to NSAIDs.</p>
<h2>How serious is it?</h2>
<figure class="align-right ">
<img alt="Illustration of a heart" src="https://images.theconversation.com/files/440924/original/file-20220114-28-2c4vs6.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/440924/original/file-20220114-28-2c4vs6.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=720&fit=crop&dpr=1 600w, https://images.theconversation.com/files/440924/original/file-20220114-28-2c4vs6.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=720&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/440924/original/file-20220114-28-2c4vs6.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=720&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/440924/original/file-20220114-28-2c4vs6.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=905&fit=crop&dpr=1 754w, https://images.theconversation.com/files/440924/original/file-20220114-28-2c4vs6.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=905&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/440924/original/file-20220114-28-2c4vs6.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=905&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Adults who develop myocarditis from COVID-19 have poorer outcomes than non-myocarditis COVID-19 cases, including a higher risk of death.</span>
<span class="attribution"><span class="source">(Pixabay)</span></span>
</figcaption>
</figure>
<p>Over 80 per cent of <a href="https://doi.org/10.1161/JAHA.119.015351">myocarditis cases</a> not related to COVID-19 or COVID-19 vaccination resolve spontaneously, while five per cent of patients die or require a heart transplant within one year of diagnosis. </p>
<p>Adults who develop <a href="https://doi.org/10.1111/eci.13679">myocarditis from COVID-19 have poorer outcomes</a> than non-myocarditis COVID-19 cases, including a higher risk of death. It should be noted that myocarditis associated with SARS-CoV-2 infection is just one of several heart conditions linked to COVID-19 with outcomes that are worse than non-COVID-19 cases.</p>
<p>In cases of myocarditis following COVID-19 vaccination, the vast majority of cases are mild and resolve quickly. In adults, <a href="http://doi.org/10.1056/NEJMoa2109730">95 per cent of cases were deemed to be mild</a>. Similarly, in children, <a href="https://doi.org/10.1161/CIRCULATIONAHA.121.056583">98.6 per cent are mild</a>, and there has not been any reported need for mechanical heart support (extracorporeal membrane oxygenation, when blood is pumped outside the body to a heart-lung machine) or deaths. All children who had heart weakness had complete normalization of their heart function on followup.</p>
<h2>Take-home message</h2>
<p>The dynamic changes in the global pandemic, combined with rapid developments in research, make it challenging for the public to take in all the information about the risks and benefits of COVID-19 vaccines. In cases like this it is useful to turn to the guidance of medical organizations whose mandates are to protect the health and welfare of society. </p>
<p>Considering all of the available research, organizations including the <a href="https://www.heart.org/en/coronavirus/coronavirus-questions/questions-about-covid-19-vaccination">American Heart Association</a>, <a href="https://ccs.ca/app/uploads/2021/05/CCS_Vaccine_Info_May2021_v2.pdf">Canadian Cardiovascular Society</a>, <a href="https://www.heartandstroke.ca/how-you-can-help/advocate/covid19-vaccines-what-we-are-doing">Heart and Stroke Foundation of Canada</a>, <a href="https://cps.ca/en/documents/position/covid-19-vaccine-for-children">Canadian Paediatric Society</a> and the <a href="https://www.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/children-and-covid-19-vaccination-trends/">American Academy of Pediatrics</a> encourage all who are eligible to be vaccinated against COVID-19.</p>
<p>That’s a message we should all take to heart.</p>
<p><em>This is an updated version of a story originally published on Jan. 17, 2022. It clarifies that a study found patients with myocarditis from COVID-19 had poorer outcomes compared to COVID-19 patients who did not develop myocarditis.</em></p>
<p><em>Do you have a question about COVID-19 vaccines? Email us at <a href="mailto:ca-vaccination@theconversation.com">ca-vaccination@theconversation.com</a> and vaccine experts will answer questions in upcoming articles.</em></p><img src="https://counter.theconversation.com/content/174580/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Glen Pyle receives funding from the Canadian Institutes of Health Research, the Heart and Stroke Foundation of Canada, and the Natural Sciences and Engineering Research Council of Canada. He is the co-lead for COVID-19 Resources Canada "Science Explained", a member of Science Up First, and is part of the advisory council for Royal City Science.</span></em></p><p class="fine-print"><em><span>Jennifer H. Huang does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Myocarditis following COVID-19 vaccination is rare, and the risk is much smaller than the risks of cardiac injury linked to COVID-19 itself.Glen Pyle, Professor, Laboratory of Molecular Cardiology, University of GuelphJennifer H. Huang, Associate Professor of Pediatric Cardiology, Oregon Health & Science UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1734842021-12-21T13:43:21Z2021-12-21T13:43:21ZMechanical forces in a beating heart affect its cells’ DNA, with implications for development and disease<figure><img src="https://images.theconversation.com/files/436506/original/file-20211208-23-3udfl3.png?ixlib=rb-1.1.0&rect=0%2C0%2C764%2C459&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Contracting heart cells exert forces on their genetic material that affect how they develop.</span> <span class="attribution"><a class="source" href="https://doi.org/10.1038/s41551-021-00823-9">Benjamin Seelbinder</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span></figcaption></figure><p>Sometimes cells can forget what type of cell they are and stop functioning correctly. This commonly happens in <a href="https://doi.org/10.1016/j.devcel.2015.12.001">cancer</a>, in which mature cells lose aspects of their identity and become more susceptible to begin dividing uncontrollably.</p>
<p>Heart conditions like <a href="https://www.mayoclinic.org/diseases-conditions/cardiomyopathy/symptoms-causes/syc-20370709">cardiomyopathy</a>, a disease that makes it harder to pump blood, affect the shape and function of affected heart cells. These changes can also occur in the nucleus of the cell, which houses genetic material that tells a cell how to function.</p>
<p>Because certain changes to nuclear structure can be early warning signals for heart problems, monitoring for such changes could help clinicians diagnose and treat disease before it gets worse. Researchers know that certain <a href="https://dx.doi.org/10.1172%2FJCI87491">changes in the physical forces exerted on heart cells</a>, including from their own contraction, can lead the cells to lose their heart cell identity and function poorly. But exactly how these physical forces work to change heart cell identity was unclear. </p>
<p>In <a href="https://doi.org/10.1038/s41551-021-00823-9">a 2021 study</a> my colleagues and I published in the journal Nature Biomedical Engineering, we found that mechanical forces can reorganize the genetic material inside the nucleus of heart cells and affect how they develop and function. Better understanding of how cells claim and maintain their identities may help advance treatments to repair heart damage from cardiovascular disease and create new prosthetic tissues.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/AONaH_oi3wQ?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Heart cells in a petri dish change the structure of their nuclei with each beat.</span></figcaption>
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<h2>Pushing cell development in another direction</h2>
<p>Early in human development, the external pressures surrounding immature cells influence what type of cell they eventually become when they <a href="https://doi.org/10.1016/j.cell.2006.06.044">differentiate</a>, or fully mature. These external forces also help maintain <a href="https://doi.org/10.1146/annurev-bioeng-071114-040829">tissue health as people age</a>. </p>
<p>During differentiation, cells move around and restructure a mixture of proteins and DNA called <a href="https://www.genome.gov/genetics-glossary/Chromatin">chromatin</a> that’s located in their nuclei. Cells use chromatin as a way to package and organize their genetic code. Knowing that external physical pressures can affect how cells mature, <a href="https://www.colorado.edu/lab/neulab/">my research lab</a> and I wanted to explore how mechanical forces can reorganize chromatin and what that might tell us about how heart cells develop and sometimes stop working.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/438277/original/file-20211217-27-ca80jb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Diagram of chromosome unwinding to show chromatin, histones and DNA" src="https://images.theconversation.com/files/438277/original/file-20211217-27-ca80jb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/438277/original/file-20211217-27-ca80jb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=515&fit=crop&dpr=1 600w, https://images.theconversation.com/files/438277/original/file-20211217-27-ca80jb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=515&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/438277/original/file-20211217-27-ca80jb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=515&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/438277/original/file-20211217-27-ca80jb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=648&fit=crop&dpr=1 754w, https://images.theconversation.com/files/438277/original/file-20211217-27-ca80jb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=648&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/438277/original/file-20211217-27-ca80jb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=648&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Chromatin consists of DNA tightly coiled around proteins called histones.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/illustration/chromation-biological-diagram-vector-royalty-free-illustration/1205309579">VectorMine/iStock via Getty Images Plus</a></span>
</figcaption>
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<p>To do this, we looked at adult heart cells as they contracted under a microscope to see how their nuclei change shape. We then compared these images with the nuclei of embryonic heart cells as they normally change during early development. We found that areas in the nucleus with high tension tended to organize chromatin into specific shapes known to influence cell behavior. When we changed the tension in those areas of the nucleus, we were able to prevent cells from developing into normal heart cells. This meant that tension may play a key role in guiding heart cells on how to develop.</p>
<p>We then examined how mechanical stress changed the chromatin structure of heart cells from patients with cardiovascular disease and mice with reduced heart performance. Compared with healthy cells, heart cells from both patients and mice lost their chromatin organization and identity as heart cells. This meant that mechanical tension could influence how well mature cells function and their likelihood of developing into cardiovascular disease.</p>
<h2>Mechanical forces matter in medicine</h2>
<p>While our study explores the role that chromatic reorganization plays in early development, additional research is needed to understand exactly what triggers cells to develop into specific cell types. Further insight into how the mechanical environment surrounding a cell affects how it matures will help researchers better understand the process of human development.</p>
<p>Understanding what triggers a collection of cells to transition to a fully functional organ may also help researchers learn how to mimic these developmental processes and create new prosthetic devices. For example, accounting for the mechanical forces that affect how well <a href="https://doi.org/10.1038/nm1394">tissue grafts for failing hearts</a> and <a href="https://doi.org/10.1073/pnas.1402723111">muscles</a> work may help biomedical engineers design even more effective artificial implants. It may also set the stage for more <a href="https://doi.org/10.1038/s41573-020-0079-3">organ-on-chip models</a> that can be used instead of animals to screen potential drugs.</p><img src="https://counter.theconversation.com/content/173484/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Corey Neu receives funding from the National Institutes of Health, National Science Foundation, and the Department of Defense. </span></em></p>Heart disease can change the genetic structure of heart cells. Understanding the role that mechanical forces play in these changes could lead to improvements in artificial tissue design.Corey Neu, Professor of Mechanical and Biomedical Engineering, University of Colorado BoulderLicensed as Creative Commons – attribution, no derivatives.