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Guerra PG, Simpson CS, Van Spall HGC, Asgar AW, Billia P, Cadrin-Tourigny J, Chakrabarti S, Cheung CC, Dore A, Fordyce CB, Gouda P, Hassan A, Krahn A, Luc JGY, Mak S, McMurtry S, Norris C, Philippon F, Sapp J, Sheldon R, Silversides C, Steinberg C, Wood DA. Canadian Cardiovascular Society 2023 Guidelines on the Fitness to Drive. Can J Cardiol 2024; 40:500-523. [PMID: 37820870 DOI: 10.1016/j.cjca.2023.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/26/2023] [Accepted: 09/29/2023] [Indexed: 10/13/2023] Open
Abstract
Cardiovascular conditions are among the most frequent causes of impairment to drive, because they might induce unpredictable mental state alterations via diverse mechanisms like myocardial ischemia, cardiac arrhythmias, and vascular dysfunction. Accordingly, health professionals are often asked to assess patients' fitness to drive (FTD). The Canadian Cardiovascular Society previously published FTD guidelines in 2003-2004; herein, we present updated FTD guidelines. Because there are no randomized trials on FTD, observational studies were used to estimate the risk of driving impairment in each situation, and recommendations made on the basis of Canadian Cardiovascular Society Risk of Harm formula. More restrictive recommendations were made for commercial drivers, who spend longer average times behind the wheel, use larger vehicles, and might transport a larger number of passengers. We provide guidance for individuals with: (1) active coronary artery disease; (2) various forms of valvular heart disease; (3) heart failure, heart transplant, and left ventricular assist device situations; (4) arrhythmia syndromes; (5) implantable devices; (6) syncope history; and (7) congenital heart disease. We suggest appropriate waiting times after cardiac interventions or acute illnesses before driving resumption. When short-term driving cessation is recommended, recommendations are on the basis of expert consensus rather than the Risk of Harm formula because risk elevation is expected to be transient. These recommendations, although not a substitute for clinical judgement or governmental regulations, provide specialists, primary care providers, and allied health professionals with a comprehensive list of a wide range of cardiac conditions, with guidance provided on the basis of the level of risk of impairment, along with recommendations about ability to drive and the suggested duration of restrictions.
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Affiliation(s)
- Peter G Guerra
- Université de Montréal, Institut de Cardiologie de Montréal, Montréal, Québec, Canada.
| | | | - Harriette G C Van Spall
- McMaster University, Hamilton Health Sciences Centre, Hamilton, Ontario, Canada, and Baim Institute for Clinical Research, Boston, Massachusetts, USA
| | - Anita W Asgar
- Université de Montréal, Institut de Cardiologie de Montréal, Montréal, Québec, Canada
| | - Phyllis Billia
- University of Toronto, University Health Network, Toronto, Ontario, Canada
| | - Julia Cadrin-Tourigny
- Université de Montréal, Institut de Cardiologie de Montréal, Montréal, Québec, Canada
| | - Santabhanu Chakrabarti
- Division of Cardiology and Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher C Cheung
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Annie Dore
- Université de Montréal, Institut de Cardiologie de Montréal, Montréal, Québec, Canada
| | - Christopher B Fordyce
- Division of Cardiology and Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Pishoy Gouda
- University of Alberta, Edmonton, Alberta, Canada
| | - Ansar Hassan
- Mitral Center of Excellence, Maine Medical Center, Portland, Maine, USA
| | - Andrew Krahn
- Division of Cardiology and Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jessica G Y Luc
- Division of Cardiology and Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Susanna Mak
- University of Toronto, Sinai Health, Toronto, Ontario, Canada
| | | | | | - Francois Philippon
- Institut Universitaire de Cardiologie et Pneumologie de Québec, Hôpital Laval, Laval, Québec, Canada
| | - John Sapp
- Dalhousie University, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | | | | | - Christian Steinberg
- Institut Universitaire de Cardiologie et Pneumologie de Québec, Hôpital Laval, Laval, Québec, Canada
| | - David A Wood
- Division of Cardiology and Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
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2
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Van Damme A, McDermott S, McMurtry S, Kung JY, Gyenes G, Norris C. Secondary Prevention and Rehabilitation for Spontaneous Coronary Artery Dissection: A Systematic Review. Can J Cardiol 2023; 39:S395-S411. [PMID: 37604409 DOI: 10.1016/j.cjca.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/15/2023] [Accepted: 08/15/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Spontaneous coronary artery dissection (SCAD) is a serious, noniatrogenic and nontraumatic cardiac event that predominantly affects women, with a high risk of recurrence. Secondary prevention strategies are not well understood in this population. Therefore, the aim of this systematic review is to determine the current evidence on secondary prevention strategies and their effect on recurrent cardiac events and quality of life (QOL). METHODS A literature search was conducted on August 21, 2021, of Ovid MEDLINE, Ovid Embase, CINAHL, Cochrane Library (via Wiley), Google Scholar, and ProQuest Dissertations & Theses Global. Literature on adult SCAD survivors who underwent secondary prevention measures with reported outcomes on major adverse cardiovascular events or QOL were included. Articles solely on pregnancy-associated SCAD or fibromuscular dysplasia were excluded. RESULTS Thirty studies were included in this review. A variety of research methodologies were explored. There were no randomized controlled trials. Overall, the quality of the evidence was moderate. Although evidence on secondary prevention was limited, tailored medical management was shown to have the most effect on decreasing recurrent events. Cardiac rehabilitation (CR) was supported as a safe and effective program for SCAD patients, with no reported associations with recurrent SCAD events or major adverse cardiovascular events. CR along with psychosocial interventions showed promise in improving QOL in SCAD survivors. CONCLUSIONS Medical management has the most effect in reducing recurrent events. CR, as a secondary prevention program, can provide interventions that might improve QOL. Randomized trial evidence on therapies for patients with SCAD are needed.
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Affiliation(s)
- Andrea Van Damme
- Faculty of Medicine and Dentistry, University of Alberta, Walter C. MacKenzie Health Sciences Centre, Edmonton, Alberta, Canada.
| | - Susanna McDermott
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, Alberta, Canada
| | - Sean McMurtry
- Faculty of Medicine and Dentistry, University of Alberta, Walter C. MacKenzie Health Sciences Centre, Edmonton, Alberta, Canada
| | - Janice Y Kung
- University of Alberta, John W. Scott Health Sciences Library, Walter C. Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada
| | - Gabor Gyenes
- Faculty of Medicine and Dentistry, University of Alberta, Walter C. MacKenzie Health Sciences Centre, Edmonton, Alberta, Canada
| | - Colleen Norris
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, Alberta, Canada
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Kajtaz E, Montgomery LR, McMurtry S, Howland DR, Nichols TR. Non-uniform upregulation of the autogenic stretch reflex among hindlimb extensors following lateral spinal lesion in the cat. Exp Brain Res 2021; 239:2679-2691. [PMID: 34218298 PMCID: PMC9805805 DOI: 10.1007/s00221-020-06016-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 12/09/2020] [Indexed: 01/04/2023]
Abstract
Successful propagation throughout the step cycle is contingent on adequate regulation of whole-limb stiffness by proprioceptive feedback. Following spinal cord injury (SCI), there are changes in the strength and organization of proprioceptive feedback that can result in altered joint stiffness. In this study, we measured changes in autogenic feedback of five hindlimb extensor muscles following chronic low thoracic lateral hemisection (LSH) in decerebrate cats. We present three features of the autogenic stretch reflex obtained using a mechanographic method. Stiffness was a measure of the resistance to stretch during the length change. The dynamic index documented the extent of adaptation or increase of the force response during the hold phase, and the impulse measured the integral of the response from initiation of a stretch to the return to the initial length. The changes took the form of variable and transient increases in the stiffness of vastus (VASTI) group, soleus (SOL), and flexor hallucis longus (FHL), and either increased (VASTI) or decreased adaptation (GAS and PLANT). The stiffness of the gastrocnemius group (GAS) was also variable over time but remained elevated at the final time point. An unexpected finding was that these effects were observed bilaterally. Potential reasons for this finding and possible sources of increased excitability to this muscle group are discussed.
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Affiliation(s)
- E Kajtaz
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, 30318, USA
| | - L R Montgomery
- Kentucky Spinal Cord Injury Research Center, Department of Neurological Surgery, The University of Louisville, Louisville, KY, USA
- Research Service, Robley Rex VA Medical Center, Louisville, KY, USA
| | - S McMurtry
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, 30318, USA
| | - D R Howland
- Kentucky Spinal Cord Injury Research Center, Department of Neurological Surgery, The University of Louisville, Louisville, KY, USA
- Research Service, Robley Rex VA Medical Center, Louisville, KY, USA
| | - T Richard Nichols
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, 30318, USA.
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Banks L, Randhawa VK, Caterini J, Colella TJF, Dhanvantari S, McMurtry S, Connelly KA, Robinson L, Anand SS, Ouzounian M, Zieroth S, Mak S, Straus S, Graham MM. Sex, Gender, and Equity in Cardiovascular Medicine, Surgery, and Science in Canada : Challenges, Successes, and Opportunities for Change. CJC Open 2020; 2:522-529. [PMID: 33305212 PMCID: PMC7711008 DOI: 10.1016/j.cjco.2020.06.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/29/2020] [Indexed: 01/01/2023] Open
Abstract
Background A previous review of sex, gender, and equity within cardiovascular (CV) medicine, surgery, and science in Canada has revealed parity during medical and graduate school training. The purpose of this study was to explore sex and gendered experiences within the Canadian CV landscape, and their impact on career training and progression. Methods An environmental scan was conducted of the Canadian CV landscape, which included an equity survey using Qualtrics software. Results The environmental scan revealed that women remain underrepresented within CV training programs as trainees (12%–30%), program directors (33%), in leadership roles at the divisional level (21%), and in other professional or career-related activities (< 30%). Our analysis also showed improvements of career engagement at these levels of women at over time. The thematic analysis of the equity survey responses (n = 71 respondents; 83% female; 9.7% response rate among female Canadian Cardiovascular Society members) identified the following themes reported within the socio-ecological framework: desire to report inequities vs staying the course (individual level); desire for social support and mentorship and challenges of dual responsibilities (interpersonal level); concerns over exclusionary cliques and desire for respect and opportunity (organizational level); and increasing awareness and actions to overcome institutional barriers and accountability (societal level). Conclusions Although women face challenges and remain underrepresented in CV medicine, surgery, and science, this study highlights potential opportunities for improving access of female medical, surgical, and research trainees and professionals to specialized cardiovascular training, career advancement, leadership, and research.
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Affiliation(s)
- Laura Banks
- Cardiovascular Prevention and Rehabilitation Program, University Health Network, Toronto, Ontario, Canada.,Faculty of Health Sciences, Ontario Tech University, Ontario, Canada
| | - Varinder K Randhawa
- Department of Cardiovascular Medicine, Kaufman Center for Heart Failure and Recovery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Tracey J F Colella
- Cardiovascular Prevention and Rehabilitation Program, University Health Network, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Savita Dhanvantari
- Imaging Program, Lawson Health Research Institute, London, Ontario, Canada
| | - Sean McMurtry
- Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
| | - Kim A Connelly
- Department of Cardiology, St Michaels Hospital, Toronto, Ontario, Canada
| | - Lisa Robinson
- University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sonia S Anand
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Maral Ouzounian
- University of Toronto, Toronto, Ontario, Canada.,Department of Cardiothoracic Surgery, University Health Network, Toronto, Ontario, Canada
| | - Shelley Zieroth
- Section of Cardiology, St Boniface Hospital, and University of Manitoba, Winnipeg, Canada
| | - Susanna Mak
- University of Toronto, Toronto, Ontario, Canada.,Department of Cardiology, University Health Network, Toronto, Ontario, Canada
| | - Sharon Straus
- Department of Medicine, St Michaels Hospital, Toronto, Ontario, Canada
| | - Michelle M Graham
- Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
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Dobrzynski L, Akjouj A, Djafari-Rouhani B, Vasseur JO, Bouazaoui M, Vilcot JP, Beaurain A, McMurtry S. Directional photon transfer between two wires. Phys Rev E Stat Nonlin Soft Matter Phys 2003; 67:057603. [PMID: 12786331 DOI: 10.1103/physreve.67.057603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2003] [Indexed: 05/24/2023]
Abstract
The directional transfer of a single photon from one wire to another, leaving all other neighbor states unaffected, is of great importance. We present a simple coupling structure that makes such transfer possible, for any given photon wavelength and linewidth. We give closed-form expressions for the parameters necessary to build such a structure. An illustration of our analytic study is given for the directional transmission of a telecommunication signal between two lines.
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Affiliation(s)
- L Dobrzynski
- LDSMM, UMR 8024, UFR de Physique, Université de Lille 1, 59655 Villeneuve d'Ascq Cédex, France
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Archer SL, Gragasin FS, Wu X, Wang S, McMurtry S, Kim DH, Platonov M, Koshal A, Hashimoto K, Campbell WB, Falck JR, Michelakis ED. Endothelium-derived hyperpolarizing factor in human internal mammary artery is 11,12-epoxyeicosatrienoic acid and causes relaxation by activating smooth muscle BK(Ca) channels. Circulation 2003; 107:769-76. [PMID: 12578883 DOI: 10.1161/01.cir.0000047278.28407.c2] [Citation(s) in RCA: 215] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Left internal mammary arteries (LIMAs) synthesize endothelium-derived hyperpolarizing factor (EDHF), a short-lived K(+) channel activator that persists after inhibition of nitric oxide (NO) and prostaglandin synthesis. EDHF hyperpolarizes and relaxes smooth muscle cells (SMCs). The identity of EDHF in humans is unknown. We hypothesized that EDHF (1) is 11,12-epoxyeicosatrienoic acid (11,12-EET); (2) is generated by cytochrome P450-2C, CYP450-2C; and (3) causes relaxation by opening SMC large-conductance Ca(2+)-activated K(+) channels (BK(Ca)). METHODS AND RESULTS The identity of EDHF and its mechanism of action were assessed in 120 distal human LIMAs and 20 saphenous veins (SVs) obtained during CABG. The predominant EET synthesized by LIMAs is 11,12-EET. Relaxations to exogenous 11,12-EET and endogenous EDHF are of similar magnitudes. Inhibition of EET synthesis by chemically distinct CYP450 inhibitors (17-octadecynoic acid, N-methylsulfonyl-6-(2-propargyloxyphenyl)hexanamide), or a selective EET antagonist (4,15-epoxyeicosa-5(Z)-enoic acid) impairs EDHF relaxation. 11,12-EET activates a BK(Ca) current and hyperpolarizes LIMA SMCs. Inhibitors of BK(Ca) but not inward-rectifier or small-conductance K(Ca) channels abolish relaxation to endogenous EDHF and exogenous 11,12-EET. BK(Ca) and CYP450-2C mRNA and proteins are more abundant in LIMAs than in SVs, perhaps explaining the lack of EDHF activity of the SV. Laser capture microdissection and quantitative RT-PCR demonstrate that BK(Ca) channels are primarily in vascular SMCs, whereas the CYP450-2C enzyme is present in both the endothelium and SMCs. CONCLUSIONS In human LIMAs, EDHF is 11,12-EET produced by an EDHF synthase CYP450-2C and accounting for approximately 40% of net endothelial relaxation. 11,12-EET causes relaxation by activating SMC BK(Ca) channels.
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MESH Headings
- 8,11,14-Eicosatrienoic Acid/analogs & derivatives
- 8,11,14-Eicosatrienoic Acid/metabolism
- 8,11,14-Eicosatrienoic Acid/pharmacology
- Acetylcholine/pharmacology
- Biological Factors/metabolism
- Bradykinin/pharmacology
- Cytochrome P-450 Enzyme System/metabolism
- Humans
- In Vitro Techniques
- Large-Conductance Calcium-Activated Potassium Channels
- Mammary Arteries/drug effects
- Mammary Arteries/metabolism
- Muscle, Smooth, Vascular/cytology
- Muscle, Smooth, Vascular/drug effects
- Muscle, Smooth, Vascular/metabolism
- Nitric Oxide Synthase/metabolism
- Patch-Clamp Techniques
- Potassium Channel Blockers/pharmacology
- Potassium Channels, Calcium-Activated/antagonists & inhibitors
- Potassium Channels, Calcium-Activated/metabolism
- Prostaglandin-Endoperoxide Synthases/metabolism
- Signal Transduction/drug effects
- Signal Transduction/physiology
- Vasodilation/drug effects
- Vasodilation/physiology
- Vasodilator Agents/pharmacology
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Affiliation(s)
- Stephen L Archer
- Vascular Biology Group, Cardiology Surgery, University of Alberta, Edmonton, Canada.
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McMurtry S. Dealing with chronic illness. Lamp 1998; 55:24-5. [PMID: 9543998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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