Institute leads in autonomic disorder care

Disturbances in the autonomic system can lead to a wide variety of issues, including irregular heartbeat, and an inability to maintain proper blood flow and pressure. Autonomic conditions can be devastating to quality of life, with symptoms that could include light-headedness, sudden loss of consciousness (syncope), fainting upon standing, debilitating brain fog and nausea, among others.

Early on, Dr. Robert Sheldon, MD, placed the Libin Cardiovascular Institute on the map when it comes to treatment and research of vasovagal syncope, an autonomic condition commonly known as fainting. His expertise in this area, as well as in other autonomic conditions laid the groundwork for what is now a world-class team that is tackling debilitating autonomic conditions. This work is providing hope to thousands of Canadians suffering from these conditions. 

Dr. Robert Sheldon: Pioneering research into common condition

Fainting (vasovagal syncope) affects a wide variety of people and can impact quality of life. Syncope is often associated with low blood pressure, but because fainting can have many possible causes it’s difficult to treat. 

Very little was known about syncope 30 years ago when electrophysiologist and researcher Dr. Robert Sheldon began his investigations into the condition. His findings in this area earned him global renown. He was selected as vice-chair of the writing committee that penned the first North American syncope guidelines—developed by the American College of Cardiology, American Heart Association, and the Heart Rhythm Society—and published in March 2017 in Circulation. 

Sheldon’s outstanding work on arrhythmias and syncope also earned him an Annual Achievement Award at the Canadian Cardiovascular Congress (CCC) in October 2016. In 2018, he received the prestigious Lifetime Achievement Award of the Arrhythmia Alliance.

Growing Team

The Libin Institute’s expertise in this area increased with the arrival of clinician-scientists Dr. Satish Raj, MD, in 2014 and Dr. Carlos Morillo, MD in 2016. Both have gained national and international attention and have helped firmly establish the Libin Institute as a world-class centre of excellence in autonomic research – literally. 

The Libin Cardiovascular Institute was recognized in 2022 as a Centre of Excellence by STARS (Syncope Trust And Reflex anoxic Seizures), a United Kingdom-based patient advocacy organization. 

Morillo’s work has been recognized internationally throughout his career. He was awarded a Golden Caliper Award from the Latin American Pacing/EP Society & Brazilian Society of Cardiac Arrhythmias, but he has earned other prestigious awards, such as the Charles Pfizer Research Award, the National Academy of Medicine – Aventis Clinical Research Award and the Award for Best Researcher from the Sociedad Colombiana de Cardiologia. 

Raj is the president of the American Autonomic Society and heads Calgary’s Autonomic Investigation and Management Clinic, which treats several hundred patients from across Western Canada with autonomic conditions. The clinic is one of the largest in Canada, conducting more than 100 comprehensive autonomic tests annually, as the main referral clinic in Western Canada. 

“There are relatively few clinics in Canada to treat a growing number of patients with POTS and orthostatic hypotension,” says Raj. “The clinic integrates research and clinical care with the goal of improving patient care.” 

Shedding light on a mysterious condition

Sheldon, Raj and Morillo not only see POTS patients from all over Western Canada, but they are well known experts on the subject. They give talks around the globe, sit on committees, and contribute to position statements and national and international guidelines to help improve awareness of POTS and enhance the quality of life for people who live with this condition. 

Dr. Satish Raj is a global leader in POTS research and patient advocacy. His research program focuses on finding practical approaches to treating the common complaints of individuals with POTS. His research team has proven the efficacy of using compression garments to help decrease the spike in heart rate that often occurs when POTS patients stand. His team has also shown that increasing dietary salt intake can be used to help manage symptoms. 

Libin the “place to be in Canada” for studying POTS

Kate Bourne is a PhD candidate in the lab of Drs. Satish Raj and Robert Sheldon who is passionate about finding real-world solutions for POTS patients. An example of her work is a study, published in the Journal Of The American College of Cardiology (JACC), that found that compressing either the abdominal or entire lower body kept the heart rates of POTS patients from surging as much.

Bourne received a prestigious Vanier Scholarship in 2020, placing her amongst Canada’s elite graduate scholars for her research into POTS.

She attributes her success, in part, to her learning environment. 

It’s been a phenomenal experience to study in Calgary with Dr. Raj and Dr. Sheldon,” says Bourne. “Being exposed to their expertise and having access to the facilities at the Libin Institute, including the tilt table, and the local patient base is great. The Libin is really the place to be in Canada to study POTS.” 

The future of autonomic care and research 

Given the growing number of patients with autonomic conditions, Libin’s autonomic team is more critical than ever before. According to Raj, the plan is to continue treating patients, conducting meaningful research and educating the next generation of autonomic researchers and care providers with the ultimate goal of helping patients.  

Numerous studies are underway in his lab, including one looking at a comparison of two heartrate lowering drugs in the treatment of POTS, one investigating the cause of chest pain, and another looking at brain fog in patients with POTS. 

“Our real focus is bridging the gaps in the understanding and treatment of POTS,” says Raj. “We have been working for years with local patient partners and Dysautonomia International (a patient advocacy group), to try to understand what’s important to patients.” 

The group also hopes to set up a national network to raise the bar in patient outcomes. 

Read more about the Libin Cardiovascular Institute's Top 20 Achievements of the last 20 years here.