Exploring Nature's Gifts to Medical Science

"This will not only help the hundreds of thousands of people who have a heart attack every year around the world, it could also increase the number and quality of donor hearts, which will give hope to those waiting on the transplant list."

"Usually, if the donor heart has stopped beating for more than 30 minutes before retrieval, the heart can't be used."

"Even if we can buy an extra ten minutes, that could make the difference between someone having a heart and someone missing out. For people who are literally on death's door, this could be life-changing."

Peter Macdonald, professor, Victor Chang Cardiac Research Institute, Australia

Australian scientists have developed a drug candidate from the venom of the Fraser Island funnel-web spider that may prevent heart attack damage in humans. Photograph: Samantha Nixon/PR IMAGE

 

Some of the most poisonous creatures on the planet can be found in Australia. Coincidentally, scientists in Australia discovered that spider venom may lead to a new class of drugs that would conceivably be of inestimable help to victims of heart attacks. Spider venom is used by spiders themselves for the purpose of immobilizing or killing their victims so they can be consumed with no fuss by their predator.

Scientists from University of Queensland and Sydney's Victor Chang Cardiac Research Institute are focusing on producing a potential drug candidate derived from spider venom. The drug's purpose for use in humans is to block the "death signal" the heart sends during a heart attack causing heart cells to die. No drugs are currently in clinical use to prevent the damage that heart attacks cause.

The protein to be used in a new drug is called Hila, identified originally in the funnel-web spider's venom found on Fraser Island. Researchers have full confidence it could be used as well in the treatment of donor hearts to increase the distance they can be transported, improving the likelihood of a successful transplant. The study that holds out this hope was recently published in the journal Circulation.

A new diagnostic drug currently in development makes use of the venom of the Israeli deathstalker scorpion along with an infrared dye meant to identify and illuminate tumours, so it isn't only spiders' deadly venom that researchers focus on to discover potential new drugs for the human pharmacopeia. The drug derived from the deathstalker scorpion has gone through safety testing and early clinical trials viewing brain tumours in children.

Some scientists regard the funnel-web spider as one of the most dangerous in the world. They possess fangs that are large, powerful, able to penetrate fingernails and soft shoes. While still in its early stages, the Australian heart research has seen scientists involved testing the drug candidate on beating human heart cells that have been exposed to heart attack stresses, to determine whether the drug improved their survival.

The researchers are now proposing to begin human clinical trials within the next two to three years. As the leading cause of death on a global scale, cardiovascular diseases are responsible for taking about 17.9 million lives annually, according to the World Health Organization. At least four of five cardiovascular deaths result from heart attacks and strokes.

A professor at the University of Queensland, Glenn King, earlier had identified a small protein in the venom of the funnel-web spider, demonstrating markedly improved recovery from stroke. The current Australian discovery uses that earlier work as a scaffolding upon which their more current research has been built.

The protein known as Hi1a has been found in the venom of the Fraser Island funnel-web spider. Photograph: Samantha Nixon/PR IMAGE

Trauma in Emergency Cardio Events and Among Responders

"We ask a lot of them [bystanders] to respond, and then we just say, 'thanks'. The ambulance comes and takes the patient away and they're [the bystander giving medical aid] sort of left standing there, like, 'What just happened'?"
"[CPR training on mannequins or "Annie", the CPR doll] is nothing, nothing like it is in real life. It can be just a completely chaotic and unpredictable environment [when a medical emergency outside a hospital occurs]."
"It's your husband, your wife, a loved one, it's happening in your home -- maybe you're doing CPR on your bed. That scene may play in your mind for the rest of your life."
"And if you don't react [paralyzed with inaction], then there's the trauma of not reacting."
Katie Dainty, Li Ka Shing Knowledge Institute, St.Michael's Hospital, Toronto

"It doesn't matter how well they [reacting bystanders] do it, or how perfect it is [their technique], just that they're doing something -- pushing that blood around to that heart and that brain and giving that person the chance of surviving."
"It's life or death [for the victim]. It's a highly emotional situation."
"We need to better understand that and better support people that are witnesses to that."
Dr. Farhan Bhanji, professor of pediatrics, McGill University, Montreal

"Tell them [911 operators] he's gasping."
"[I don't know whether he -- man in medical distress whom she responded to by using CPR -- survived] but I hope he did and, if he didn't, I hope his family knew he wasn't alone, that he wasn't not touched, and left on the street until the ambulance came."
"I didn't want to talk to anybody about it. I worried about his family. I was upset with myself and disappointed that I really didn't want to do it [CPR] at first, because I was afraid. But I'm so glad I did, I'm so glad I did."
"I still cry [thinking about it] and I shouldn't, right? I think we have to find new ways of talking about that."
Toronto woman trained in CPR

Paramedics and members of the Toronto Paramedic Services’ Safe City team demonstrated cardiopulmonary resuscitation (CPR) and the use of an automated external defibrillator (AED) to members of the public and City staff members today at Toronto City Hall. The event was part of Toronto Paramedic Services’ 2016 Heart Month activities. Toronto Paramedic Services

Research suggests the experience of a witness to someone suffering a medical emergency, who then intervenes in a desperate attempt to provide some measure of relief until paramedics arrive, suffers consequences as a result of their altruism; the irresistible urge to help someone survive a medical emergency, and to give comfort to someone in dire medical straits. The lay person attempting to administer emergency medical help can find the experience results in strong emotional reactions.

Nightmares, flashbacks and fearful thoughts that one cannot control may plague the volunteer for months and years after the event. One limited study published in BMJ Open last year concluded: "the main concern was whether their actions had led to severe injury, a vegetative state, or death". In other words, whether their amateur reaction turned out to be harmful to the survival of the person in distress, rather than helpful.

Each year in Canada an estimated 40,000 out-of-hospital cardiac arrests occur, and swift bystander CPR intervention can increase the opportunity of survival threefold. Yet, despite studies proving the indisputable value of such intervention, few researchers have undertaken studies to evaluate the outcome for "lay rescuers", onlookers to dire health events who react in the best interests of a positive outcome. And who may experience, while attempting to resuscitate someone, an event unfolding that leads nonetheless to death.

Canadian researchers have now launched a virtual support network (www.bystandernetwork.org) to enable the public to share their first-hand experiences after having responded to, or witnessed a cardiac arrest. This is an effort to examine and try to understand the psychological side-effects of cardio-pulmonary resuscitation. With the best of intentions people do want to do what they can to help others. And public entreaties for people to become familiar with the technique of CPR to enable the public to spring into action if and when needed makes the case for intervention as a public good.

The reality is that bystander CPR rates are low, with many cardiac arrests witnessed, but a mere third receiving bystander CPR. Though people sincerely do want to help, when they're faced with a sudden health emergency many tend to freeze; fear and panic immobilizes reaction; that in contemplating   how they would react, people may confidently visualize themselves doing so, but when the real thing occurs, they are frozen with indecision, polarized between need and fear.

The new guidelines that were publicized and published in 2010 now recommend that untrained bystanders witnessing an adult collapse, set aside the mouth-to-mouth breathing component of CPR and rather, focus simply on deep and rapid chest compressions solely. That simplification appears to have done little to help people feel a little more confident about their ability to do the necessary despite the mental strain they may be suffering. People still fear being the author of harm to others.

Yet, as medical scientist Katie Dainty stresses, it is always best to react and do something rather than stand back and commit to nothing. Doing nothing, the victim will likely die, while chest compressions double or triple the chances of survival through the circulation of oxygenated blood through the body, to ensure the brain and other organs can be kept alive.

Enhanced Health Services Equal Superior Health Outcomes

"In Canada, despite a universal health-care system, geographic variation in the supply of physician services is a policy concern and may contribute to regional disparities in health outcomes."
"Our study suggests that, even in a country with a universal health-insurance system, higher rates of preventive health care contribute to lower rates of cardiovascular disease events at a regional level."
"Ontario has long-standing challenges in recruiting and retaining primary care physicians to northern and more rural parts of the province, where wait times for urgent primary care visits are the longest and physician shortages the greatest."
Institute for Clinical Evaluative Sciences and Sunnybrook Schulich Heart Centre study

"There was a clear division between the healthiest and least-healthy LHINs [Local Health Integration Networks]."
"What we found were rather striking two-fold differences in the incidence of cardiovascular disease between Ontarians living in different parts of the province."
"Those living in the areas with the lowest burden of disease were the most likely to have received cardiovascular preventative services — such as having an annual physical, seeing their doctor to have their cholesterol and diabetes checked, and having their blood pressure controlled."
"The data suggests that there's a significant number of Ontarians who are not being fully assessed for cardiovascular risk in the middle-age range."  
"We think part of the difference is due to the availability and accessibility of primary care in different health regions across Ontario. I think part of it’s related to supply. In general, a lot of physicians prefer to live in the Toronto area and generally fewer physicians practise in rural areas of Ontario, paradoxically the areas where the need is the greatest."
"Almost all immigrant groups had lower cardiovascular disease... I don't think this is well recognized as an important contributor [to lower rates of cardiovascular disease]."
Dr. Jack Tu, cardiologist, senior scientist, Institute for Clinical Evaluative Sciences, Toronto

Toronto researchers found people in northern Ontario faced nearly double the levels of cardiovascular health issues of residents in and around Toronto.  (IStock)

This new study's conclusions -- which has been published in the Canadian Medical Association Journal -- were based data collected through researchers tracking 5.5 million middle-aged adults during the period of 2008 to 2012, specific to tracking heart attacks, strokes and deaths resulting from cardiovascular issues. The adults ranged in age from 40 to 79, and none had a history of cardiovascular disease at the onset of the study period.

The "striking variation" in heart attack, stroke and cardiovascular disease outcomes which were seen to be dependent on which LHIN people happened to be living in, was what impressed the study authors most particularly. Leading them to the conclusion that beyond genetic inheritance, lifestyle, including smoking and drinking, along with food choices, it was the issue of preventive medicine that was found to have a principal role in the differences.

Research undertaken previously had focused on smoking, obesity and other allied risk factors, including high blood pressure, seen to be more elevated in rural Ontario than what pertains in urban centres, linked to the variance in heart attack, stroke and cardiovascular disease rates. The current study, however, deviated from attributing outcomes to those key areas, to focus on what distinguished outcomes between rural northern areas of the province and centrally located cities.

What became clear as the study proceeded was that the geographic differences led to the reality that residents in the north had a diminished access to doctors, seeing them less frequently because of lack of availability. Leading to a situation where regions with the most elevated rates of cardiovascular disease were also the very regions where residents were least likely to receive preventive health care. These are regions known for the high rate of smoking and obesity along with the scarcest rates of fruits and vegetables consumption.


The key measure identified in the study was the frequency of people undergoing annual or periodic checkups; itself a subject of controversy given that where once annual medical checkups were routinely recommended, but latterly discouraged, as a result of provincial alterations in funding. While some research has found no compelling evidence to support yearly medical examinations, the finding of this study suggests those yearly events have needed significance in proactive, rather than reactive care.

The areas where people customarily receive the most annual physical checkups, according to Dr. Tu, the lead author of the study report, also happen to be the areas matching with the lowest rates of cardiovascular events. Improved screening for cardiovascular events is clearly required as a reaction to the study's conclusions, feels Dr. Tu. Emulating regular screening for some forms of cancer, for example.

He points out that in the United Kingdom and the United States there are national cardiovascular screening protocols. As well, the study pointed out that those parts of Ontario hosting the largest contingent of immigrants and the greatest non-white populations, also coincide with the lowest rates of cardiovascular disease. Dr. Tu labels this the 'healthy immigrant effect'. [Which appears to wear off, over time.]

The incidence of major cardiovascular events across health service regions, also known as Local Health Integration Networks, across Ontario throughout the five years of the study period. (CMAJ)

High Heart Risks in Men Shovelling Snow

"We didn't go to their homes to find out whether they were shovelling or not."
"We looked at the relationship between snowfall and risk of MI [myocardial infarction/heart attack]."
"It's the first study that looks at actual risk in population."
"We don't know why that is [that men appear at greater risk than women]. It's possible that men shovel more than women. Or that women do it in a way that's less risky or causes less exertion. Snow shovelling is a demanding cardiovascular exercise requiring more than 75 percent of the maximum heart rate, particularly with heavy loads."
"In the big picture, very few people who shovel will actually have a heart attack. [Those with risk factors should shovel] slowly and with less exertion."
Nathalie Auger, Quebec Public Health Institute

It has always been common knowledge that winter, plus snow shovelling is hazardous, in particular for older men. Older men in poor physical shape, likelier. Since such winter-time shovelling takes place in front of a house, to clear a driveway, it's also likely that a family lives in the house. A family where, given the age of an older man at risk, no longer has sons living at home. So if there are only two people in the home, a man and a woman, it is more habitual for the woman to remain indoors and the man to go out to do the shovelling; a division of household tasks across traditional gender-role lines.

So a male is out in the winter cold far more frequently than a female, shovelling snow. Little wonder there are more men who suffer dangerously adverse heart effects than women. Lead researcher, epidemiologist Nathalie Auger, in an affiliation with University of Montreal Hospital Research Center, spoke recently of her group's study for the Quebec Public Health Institute, which was published by the Canadian Medical Association Journal. A study that examined data collected over a 33-year period, on the connection between snowfall, heart failure and death.

The study took under consideration factors that would certainly impact on morbidity when snow and shovelling were combined; obesity, diabetes, a smoking habit and high blood pressure. The study obviously looked at hand shovelling, perhaps overlooking the fact that snow blowers or snow throwers are now in fairly universal use by many home owners. And people getting on in age and who can afford a now-common mechanical device to aid in clearing away snow, generally tend to use them. Even with their use, it's true some minimum hand shovelling is also required.

The research team looked at days with no snowfall to the opposite; those with 20-centimetre snowfalls, during the winter months of November through April, from 1981 to 2014, in Quebec. They identified a firm link between the amount of snow fallen and resulting hospitalizations and deaths related to heart attacks. Almost 200,000 people were included in the study; 128,073 individuals admitted to hospital with an MI, and 68,155 deaths from MI, with the acknowledgement that some of those affected died before making it to a hospital.

Some experts theorize that combining a snowstorm with cold weather and hard work resulting in great physical strain to shovel wet, heavy snow, conceivably causes a sudden surge in blood pressure and heart rate. The study conclusion suggested that a snowfall of 20 cm increases the chance of being hospitalized by 16 per cent — dying from a heart attack by 34 per cent. One third of heart attacks occurred a day after a storm, while  10 per cent took place after snowfalls of five cm or more.

The association was even stronger after snowfalls lasting two to three days. 

In Ottawa last week a 49-year-old interventional neuroradiology expert who was a fitness buff was taking part in a ski marathon. This was a talented expert who performed skilled medical interventions, removing deadly blood clots and saving peoples' lives, a man whose professional talents were peerless and whose healthy lifestyle marked him as a model doctor who was intimate with the major problems that arise in cardiac arrest. His colleagues trusted and admired his professionalism and expertise, committed to his patients.

A nurse and a doctor on the scene directly followed by paramedics were unable to revive this athletic health professional at the ski event when he suddenly suffered cardiac arrest. He was dead at the scene. "I have seen patients with no family history [of heart disease], with a pristine lifestyle, who are endurance athletes at a very high level and all of a sudden they have a sudden, dramatic cardiac arrest", noted Ottawa cardiologist, Andrew Pipe, chief of rehabilitation and prevention at the University of Ottawa Heart Institute.