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A different way of looking at the heart

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Jennifer Day and Dr. Horlick
As part of a multi-disciplinary team approach, Jennifer Day (L), cardiac sonographer, Peter Munk Cardiac Centre, and Dr. Eric Horlick, interventional cardiologist, review a patient’s echocardiography imaging test in the operating room, prior to a transcatheter aortic valve implantation (TAVI) procedure. (Photo: UHN/PMCC)

An ultrasound image of a heart flickers with each beat, emitting a glow from the monitor in the dimmed clinic room.

Jennifer Day sits in front of the screen, periodically adjusting the various knobs and buttons with one hand, and moving an ultrasound camera slowly across the patient's chest with the other, concentrating on fine-tuning details like the brightness and depth for the best image possible.

As a cardiac sonographer at the Peter Munk Cardiac Centre, her job is to see what others can't.

"We're the eyes for a procedure," says Jennifer, whose role is to create images of the heart to help guide a patient's treatment.

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A different perspective of the heart

Echocardiography, or echo, is a test that uses ultrasound (sound waves) to record moving images of the heart. It can also assess different aspects of the heart such as chamber size and function as well as valve function, to look for the presence of blood clots or masses, holes or defects, fluid, and abnormalities of blood flow.

In the echo department, Jennifer works regularly with physicians and researchers. She splits her time performing routine echocardiograms, supporting interventional procedures, and research studies, often working overtime to accommodate all the requests for her expertise of the heart's anatomy.

Her technical skills, close attention to detail, and patience, have made Jennifer an indispensable member of these various teams but it's her passion for helping patients that keeps her motivated.

"It's rewarding," says Jennifer. "I enjoy what I do very much.

"Every day is different and I have the opportunity to interact with various teams within PMCC on a continual basis. I am always learning from the best people."

The eyes of the physicians

Dr. Eric Horlick, an interventional cardiologist at PMCC has been working alongside Jennifer for the past five years and is thrilled to have her support his cases.

She assists him in the cardiac catheterization lab and the operating room with procedures such as transcatheter aortic valve implantation (TAVI), a non-surgical procedure performed on patients with aortic stenosis in which the aortic valve cannot open and close properly.

"Jennifer is the best example of someone with superior skill, knowledge, and an eye for quality that can positively impact the functioning of the whole team," says Dr. Horlick.

Jennifer Day
Jennifer Day, cardiac sonographer at the Peter Munk Cardiac Centre, plays an integral role in ensuring patients are cared for safely, through her expertise analyzing moving images of the heart. (Photo: UHN/PMCC)​

She uses her screening expertise to make sure there are no complications before, during, and after the procedure. The team relies on Jennifer to provide the images which help them navigate equipment to and around the heart – an intricate team effort of communication and coordination.

"The images don't talk to you, they don't tell you what's going on," says Dr. Horlick. "Reacting to trouble starts with being able to quickly assess a situation with imaging. Echo is a key element in our armamentarium.

"Jen is a great communicator, she's confident and speaks up when she feels she needs to. We can then assess together as a team and plan our next moves."

The environment is stressful and the work can be draining. Some cases can be particularly tricky, such as abnormal holes between two heart chambers beside a prosthetic valve, which is often a challenge to close. Procedures can last anywhere from one to four hours. The cardiac sonographer must be focused the entire time.

"She lifts everybody up around her," says Dr. Horlick. "She's the type of person who has an eye for quality, an eye to improve processes, and she asks the right questions."

Looking out for patient safety 

Katherine Tsang is a clinical research manager PMCC and works with Jennifer on various studies. One of these looked at the potential of stem cells to repair the heart muscle in patients with mechanical assist devices like VADs (ventricular assist devices).  In this study, the battery power of the patient's device is lowered and they complete a six-minute walk test to assess heart function before and afterwards.

Throughout this process, the patients undergo three sets of echoes to monitor and look for safety issues like blood clots. Katherine emphasizes that this potentially life-saving research wouldn't be possible without the dedication of cardiac sonographers like Jennifer, and the care she provides to patients. 

"These research echoes are very detailed; there are so many steps involved and this patient population is complex," says Katherine. "Jennifer is excellent with them.

"She consistently obtains quality images while working with patients to ensure that they are as relaxed and comfortable as possible."

Jennifer says her approach to interacting with patients is simple:  just be kind and make them feel at ease. Between appointments and procedures, she makes the time to train others on what she's learned, passing on her knowledge and enthusiasm.

"It's my niche and I absolutely love what I do," says Jennifer. ​

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