Pictured, Dr. Tom Haffner gives a tour of Stratford General Hospital’s stress testing lab where medical professionals can examine a patient as they exercise to detect signs of blockages in the heart or chest pains. “We can often make a diagnosis on the spot from that,” he said.
By Dan Rankin
There is no cure for heart disease, an illness that affects roughly 1.4 million Canadians in a variety of ways, but, thanks to local infrastructure and advancements made in the field in the past 20-30 years, “it can be very well-managed,” said internist Dr. Tom Haffner, who has practised at Stratford General Hospital since 2012.
Apart from a small variety of cases that may call for testing to be done in London – and an even smaller minority that may require intervention there – “most people can be managed locally,” either in Stratford or at satellite clinics they run in St. Marys, Clinton and Seaforth, he said.
“Every once in a while we need more sub-specialized tests, things like coronary angiograms, for example,” said Dr. Haffner, who studied medicine at Western in London before doing a four-year residency in internal medicine in Hamilton. “Those tests are done in London, but then a patient’s followup can often be done locally, either with their family doctor or with some of our local specialists in internal medicine. I think we are quite capable of managing most cardiac issues, with occasionally needing to branch out for support.”
As an internal medicine specialist, Dr. Haffner said roughly half of the patients he treats are dealing with some form of heart disease, such as coronary artery disease (blockages in the vessels), congestive heart failure (a backup of fluid from the heart into the lungs), or atrial fibrillation (abnormal heart rhythm). He called it “by far the most common” type of illness seen by Stratford’s internal medicine group.
While the young doctor hasn’t seen many radical changes or improvements to how heart disease is treated since he began practising, he said that outcomes for patients with heart disease have “improved significantly” compared to the 1980s and 1990s. Reasons for that include better treatments, particularly medications, he said, “but also some specialized treatments like angiograms or cardiac catheterization.”
“Part of it is due to earlier detection and recognition of disease,” he added. “We’re able to treat and prevent things before they can cause a lot of the troubles we used to see in the past.”
These advancements have introduced doctors and others in the medical field to some new issues that require a delicate balancing act, he said.
“Because we’re getting better at treating heart disease and other medical issues, people end up living longer,” he said. “The longer you live, the more likely you are to develop diseases. So, one of the struggles that we have to work with is balancing people’s heart disease with their other diseases as well. A patient with heart disease may also have lung disease and kidney disease. So, it’s important for us to consider how each of these diseases affects each other, and how each of these medications may affect one of the other diseases.”
That requires good communication between medical specialists and family physicians, he said. “It’s a good way general internists, which is what I am, and all other internists in Stratford, can provide a bridge role, because we don’t just look at their heart disease, but we look at all of their other medical issues and how they might play out as well.”
After people’s longer life spans, he said other factors that contribute to someone’s risk of developing heart disease include smoking, diabetes, a lack of physical activity, and being overweight.
Looking into the future of heart medicine, Dr. Haffner said he expects doctors in Stratford and area will have new tools at their disposal to diagnose maladies such as coronary artery disease.
“Right now, the gold standard is what’s called an angiogram, that’s where they take a picture of the heart, and that has to be done in London,” said Dr. Haffner, who is originally from Waterloo. “But there are many other ways in which we can also diagnose heart disease. We find out about a patient’s history and do a physical first, but then we’ll do something called a stress test, which can be done here locally. In the future, there may be other options to diagnose coronary artery disease – with CT Scans, for example.”
Another change he sees coming, as technology and miniaturization develop further, will be the different procedures that can take place in “minimally invasive ways,” without the need for open heart surgery, such as the small mesh stents currently used to treat heart valves.
For a patient who has come to their family doctor or gone to the emergency room due to chest pains, Dr. Haffner described the steps many would go through in receiving treatment. “Chest pain can represent a number of things,” he said. “It can be heart issues, like angina, but it can also be due to a strained muscle, or lung problems.”
So, the next step would often be seeing a doctor of internal medicine, such as himself. “There are a number of us here in Stratford who function in that capacity,” he said. “We would then decide what the likely cause is and put them through different tests to help diagnose that. In many cases we can diagnose them with heart disease specifically with a ‘history and physical,’ and then through some simple tests like a stress test or an echocardiogram,” which is a type of ultrasound test that uses high-pitched sound waves that echo and bounce off different parts of the heart.
“In the majority of those cases, they can then be managed medically without needing to do anything else – such as having to go to London to have extra tests done,” he said, adding that the majority of the time they are able to diagnose and begin treating a patient’s heart disease without them ever having to spend a night in hospital. “A small minority of those patients will then need further testing, like an angiogram, in London. A small minority of them will then need an intervention that can be done in London.”
However, some people arrive at the hospital after having experienced a heart attack. “Those people are then admitted to hospital either to our ICU or to our telemetry unit, which is where we can keep them in a more monitored setting and watch every heartbeat on a screen and make sure that there is no trouble,” Dr. Haffner said. “Those people we treat a little bit differently. We give them similar medications, but we tend to be a bit more aggressive in looking for other underlying problems and often we’ll send them for other testing such as an angiogram.”
However, overall, this is becoming a less frequent occurrence. The reasons outcomes have improved over the years include early detection and compliance with medication, he said. “We know that there are a number of medications that decrease the risk of your heart disease getting worse, or, if you’ve had a heart attack, the risk of you having another heart attack,” he said, adding that continuing with physical activity, not smoking, controlling other medical issues such as diabetes and making sure cholesterol is well-treated, also play a role in managing heart disease.