Gateway Gazette

New Clinic Helps Heart Patients Who Can’t Stand To Stand Up

Libin Institute backs new clinic and research for sufferers of orthostatic intolerance

Dr. Satish Raj,  an alumnus from the clinical cardiac electrophysiology fellowship program at the University of Calgary, is leading the development of the new Calgary Autonomic and Syncope Clinic at South Health Campus.
Dr. Satish Raj, an alumnus from the clinical cardiac electrophysiology fellowship program at the University of Calgary, is leading the development of the new Calgary Autonomic and Syncope Clinic at South Health Campus.

Dr. Satish Raj is a cardiac electrophysiologist with big plans to help patients with a hard-to-treat condition called orthostatic intolerance.

“Basically these patients do not deal well with gravity,” says Dr. Raj,  an alumnus from the clinical cardiac electrophysiology fellowship program at the University of Calgary, an associate professor in cardiac sciences in the Cumming School of Medicine, and an electrophysiologist of the Libin Cardiovascular Institute of Alberta.

“When they stand up, their blood pressure may fall precipitously or their heart rates may go up excessively, and they usually do not feel well. Many patients have trouble concentrating, fatigue, mental clouding, and feel worn out. This world is designed for people to be upright such as working at a desk or standing up to walk around, so it is tough when lying down is their only option to feel better.”

Raj is developing the Calgary Autonomic and Syncope Clinic, along with a matching clinical research program, to better understand three orthostatic intolerance conditions: vasovagal syncope, orthostatic hypotension, and postural tachycardia syndrome.

International expertise supported by Libin Institute

The clinical testing laboratory is the only clinic in the region specializing in autonomic cardiovascular disorders and is based at South Health Campus.

“Dr. Raj is an international expert in the study of fainting and abnormalities of the regulation of blood pressure leading to symptoms while people stand,” says Dr. Todd Anderson, director, Libin Institute. “This is a common problem that will be addressed with the new clinic being developed within the Libin Institute. The work of his team will provide novel insights into these problems improving patient care for southern Albertans,” he says.

Two types of testing

When the clinical laboratory opens, two types of tests will be available: autonomic reflex testing and tilt table testing.

Tilt table testing involves prolonged standing while continuously monitoring heart rate and blood pressure. This can bring out a predisposition to reflex fainting (an abnormally sensitive reflex that senses the heart is beating too hard, sending a signal the brain to decrease blood vessel tone and/or to decrease heart rate fainting), as well as help researchers understand the blood pressure dynamics and their relationship to symptoms while upright.

Autonomic reflex testing involves a brief tilt test (tilting patients at various lengths of time to see if they faint), and a series of breathing manoeuvres while continuously monitoring heart rate and blood pressure. These can be used to look for problems with the sympathetic (“fight or flight”) nervous system, as well as the parasympathetic (“rest and digest”) nervous system.

While there is no start date set for the clinical testing laboratory, Dr. Raj and his team are currently completing orthostatic vital tests and taking thorough medical histories from these patients.

Careful analysis not available elsewhere in Calgary

“When patients come to the clinic, we get their lying down blood pressure and heart rates and then stand them up for 10 minutes to see the difference in blood pressures and heart rates. While this clinical assessment may sound simple, the reality is that this type of careful analysis regarding these conditions is not done in any other clinic in Calgary,” says Raj.

Careful and detailed medical histories are also collected to try to understand how the patients problems started and how their symptoms are impacting their lives, all in an effort to customize treatment to better help their condition and their quality of life.

The Calgary Autonomic and Syncope Clinic opened just three weeks ago at the South Health Campus. Besides Calgarians, there have also been multiple referrals and strong interests from patients all across western Canada.

Referrals from across western Canada

“Even before we were up and running as a clinic, people were reaching out to me to try to get into the clinic from areas ranging from Vancouver, British Columbia to Saskatchewan. A lot of these patients have difficulty in finding physicians with the expertise to guide their care and help their family doctors. It is great that we have care teams in Calgary that can be a resource for so many patients in western Canada,” says Raj. He anticipates the clinical testing laboratory to be up and running in the next few months.

“My ultimate goal is to provide the best care for these patients; to try to develop newer and more effective therapies; serve as a strong educational base to train other physicians to care for these patients; and to develop a strong national network of autonomic specialty clinics to accelerate improvements in care for these patients.”

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