Cardio-Rheumatology Clinic

The Cardio-Rheumatology Clinic Team (from left to right): Shani Nagler (Clinic Assistant), Dr. Dana Jerome (Rheumatologist), Dr. Lihi Eder (Rheumatologist & Co-Director), Dr. Paula Harvey (Cardiologist & Co-Director), Saima Bhatti (Clinic Assistant), Dr. Shadi Akhtari (Cardiologist), Keith Colaco (PhD Student)

The Cardio-Rheumatology Clinic at Women’s College Hospital is Canada’s first Clinic specializing in the early screening and treatment of heart disease in individuals with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis.

  • The Cardio-Rheumatology Clinic was established to help those with inflammatory rheumatic conditions manage their heart disease risk.
  • Patients undergo a thorough assessment by a cardiologist and are evaluated for abnormal heart function using a variety of advanced imaging and laboratory tests. 
  • For these reasons, the clinic’s staff are searching for better ways to assess heart risk through its research program.

Our Team

Dr. Shadi Akhtari headshot

Dr. Akhtari is a staff cardiologist at Women’s College Hospital, Assistant Professor in the Department of Medicine, and a Clinician in Quality and Innovation, University of Toronto.  She specializes in advanced cardiac imaging.  Apart from clinical practice of general cardiology and multi-modality cardiac imaging, her other areas of interest are prevention, diagnosis, and management of coronary artery disease, particularly in those with underlying inflammatory disease.  She runs the cardio-rheumatology clinic at WCH, directed at improving quality of cardiac care offered to patients with rheumatic disease. She has an interest in development and evaluation of innovative models of care and healthcare delivery, particularly through virtual care.

Dr. Akhtari graduated from Queen’s University School of Medicine and has completed further specialty and subspecialty training in Internal Medicine, Cardiology, and Adult Echocardiography (Level 3 training) at McGill University.  She worked as a staff cardiologist at McGill University Health Centre prior to leaving to pursue additional training in Cardiovascular Magnetic Resonance Imaging (Level 3 training) at Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, as well as certification in Cardiac Computed Tomography (Level 2 training) from Johns Hopkins Bayview Medical Center, Baltimore, Maryland.  Most recently, she has completed a Master’s degree in Quality Improvement and Patient Safety at the University of Toronto Institute for Health Policy, Management and Evaluation.  She is a fellow of the Royal College of Physicians and Surgeons of Canada, fellow of the American College of Cardiology and a diplomate of the National Board of Echocardiography.

Dr. Lihi Eder headshotDr. Lihi Eder is a Rheumatologist and Clinician Scientist at Women’s College Research Institute and Assistant Professor of Medicine in the Department of Medicine, University of Toronto. Dr. Eder is the Director of the Psoriatic Arthritis Research Program and Co-Director of the Cardio-Rheumatology Ambulatory Program at Women’s College Hospital. Dr. Eder’s research interests are in the area of clinical epidemiology of psoriatic disease and cardiovascular co-morbidities in patients with rheumatic diseases. Dr. Eder is also an expert in musculoskeletal ultrasound and performs research in this field. She serves as the Research Director of the Canadian Rheumatology Ultrasound Society.

Dr. Paula Harvey headshot Dr. Paula Harvey is Physician-in-Chief at Women’s College Hospital, a scientist at Women’s College Research Institute, and Co-Director of the Cardio-Rheumatology Program at Women’s College Hospital. Dr. Harvey’s research focus is on cardiovascular disease in women, with a special interest in hypertension, lifestyle interventions including cardiac rehabilitation and cardiovascular disease in patients with autoimmune and rheumatologic diseases. Dr. Harvey’s research explores how blood pressure and the health of blood vessels are regulated by the body – and how this system of regulation may differ between women and men. She is also interested in the role of inflammation in autoimmune diseases in the development of cardiovascular disease.

Dr. Elsie Nguyen headshotDr. Elsie Nguyen completed her medical school training at the University of Toronto, Radiology Residency at the University of Ottawa, Thoracic Imaging Fellowship at the University of British Columbia in Vancouver followed by a Cardiovascular Imaging Fellowship at Stanford University. She is an Associate Professor at the University of Toronto within the Cardiothoracic Division of Medical Imaging at Toronto General Hospital, Peter Munk Cardiac Centre. She is passionate about education and has been honoured with several teaching awards. She is the Director for Undergraduate Medical Education for Medical Imaging at the University of Toronto. She is also the Director of the Cardiac MRI and CT imaging program at Women’s College Hospital. Her research interests include optimization of cardiac CT techniques and calcium score risk prognostication in under-recognized high risk groups, microcoil pre-operative localization of lung nodules, and MR imaging of myocardial iron overload.

Cardio-Rheumatology Clinic

Women’s College Hospital
76 Grenville Street
Floor 4
Toronto, ON M5S 1B2

Phone: 416-323-6400 x5109
Fax: 416-323-6115

The clinic operates on Thursdays from 8:30 am to 4 pm.

Please note that we currently only accept referrals for individuals with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis.

Fax completed form to 416-323-6115.

What can I expect at my first visit?

When you arrive on the 4th floor, please proceed to check in at the registration desk. Please arrive 30 minutes before your scheduled appointment.

What should I bring with me?

  • Completed questionnaire (which will be mailed to you prior to your appointment)
  • A list of medications you are currently taking
  • A list of doctors and hospitals
  • Questions to ask

What will happen during my appointment?

  • Your first appointment will take approximately 2 hours and will involve:
  • A comprehensive assessment by a cardiologist (45mins)
  • Electrocardiogram (ECG) (30 minutes)
  • After your visit, you will go to the Lobby Lab for a non-fasting blood test
  • No preparations are required for your visit, and you do not need to fast for your blood test

After your first appointment, you will need to return to the hospital on another day to complete other imaging tests of your heart. Once we receive the results of these tests, a third visit (20 minutes) will be required to discuss the results of these tests with your cardiologist.

What does heart disease have to do with my arthritis?

  • People with inflammatory arthritis, such as rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis, have up to a 50% higher risk of developing heart disease compared to people without inflammatory arthritis.
  • Inflammatory arthritis is associated with known risk factors for heart disease, including high blood pressure, diabetes and abnormal cholesterol levels.
  • The increased risk of developing heart disease is related in part to these known risk factors, but the severity of inflammation in the joints is also important.

Why do people with inflammatory arthritis develop heart disease?

  • Atherosclerosis, the buildup of cholesterol within blood vessel walls (also known as plaques), is the process that leads to the majority of heart diseases.
  • Atherosclerosis leads to the narrowing of blood vessels, increased blood pressure and decreased blood flow to the heart and other organs. Some unstable plaques can rupture, triggering a clot that may cause a heart attack or stroke.
  • Uncontrolled inflammation, such as in active rheumatoid or psoriatic arthritis, leads to rapid progression of atherosclerosis and increases the risk of plaque rupture.

How to know if you’re at Risk

  • Your age and sex as well as information about your blood pressure, blood sugar, cholesterol levels, and lifestyle habits help the physician to estimate your future risk of developing heart disease.
  • More advanced tests, like CT and ultrasound of the heart, can improve the accuracy of identifying people who are at high risk of developing heart disease.
  • The risk also depends on the severity of inflammation in the skin (for psoriatic arthritis) and joints.

There are many resources available for both patients and health care professionals. The following are websites that will provide the answers to many questions you may have about the association between inflammation and arthritis:

Arthritis Foundation: Why People With Arthritis Are at Greater Risk for Heart Disease