23 OCTOBER 2021 • HEALTHCARE INNOVATIONS DISTRIBUTED WITH THE SATURDAY DAILY MAIL A divine image: the human heart


Recent medical experience during Covid-19 has reinforced what we knew already: that keeping fit and healthy can help to reduce the risk of serious consequences following a challenge to our health, either physically or psychologically. Further, that we should seek help as soon as we notice symptoms


Ample data exists that shows reducing risks following primary prevention advice will, by and large, achieve better patient outcomes. Medicine must be both proactive and reactive against disease. Te ‘art of medicine’ is still


important, and a focused history and clinical exami- nation by an expert is funda- mental in reaching a diagnosis and treatment. Past medical and family history play an impor- tant role, along with previous blood tests such as blood sugar and cholesterol levels. Medicine has witnessed Covid-19 infec- tion provoking, accelerating and unmasking heart disease. Radiological cardiac imaging, during these past 18 months, has remained the keystone to diagnosis and management of cardiac disease, and continues to exclude heart disease or help to reduce the risk of future harm. No one cardiac investigation


can answer all medical ques- tions, and no one test is without its pros and cons, both in terms of patient


experience terms of the relevant


and in informa-


tion gathered. Different tests can answer different medical ques- tions posed. In the diagnosis of coronary


vessel disease, CT coronary angiogram (CTCA) is an imaging modality often preferred because of its non-invasive nature. Radi- ation exposure during a CTCA raised concern in the past, but patients may be reassured that its roughly equivalent to around four years of background radia- tion experienced by a person. Modern CT scanners now use


much lower doses of radiation than when this technique was first invented, and year on year, scientific advances reduce radi- ation exposure further utilising improved technology and better understanding of cardiac disease. Pathways are adhered


CT SCANNERS TODAY USE MUCH LOWER DOSES OF RADIATION THAN WHEN THIS TECHNIQUE WAS FIRST INVENTED


to that ensure a person will only be investigated if indicated, and internationally recognised and agreed protocols are adhered to so ensure best practice and outcome for every person. As well as looking at the coronary arteries in detail, a CTCA can also utilise ‘the calcium score’: an algorithm that gives a risk of future heart attacks and guides treatment stratification for heart attack risk reduction. Another technique used is


stress echocardiography; this is real-time ultrasound (US) imaging looking at


the heart’s


performance when challenged by exercise. Te person either exer- cises on a treadmill or their heart is stimulated with an injection of dobutamine, simulating exer- cise conditions. Tis technique is non-invasive, straightforward to perform for an experienced operator, holds limited risk to the patient and provides data that is more accurate than that gathered with a conventional treadmill. Stress MRI scans provide


excellent imaging and can answer clinical questions or note subtle changes in heart function that other techniques can’t, such as the degree of cardiac damage resulting from a previous heart attack. Some patients are concerned that they may experience claustro- phobia. MRI teams are adept at assuaging such worries and use techniques to aid patient relaxa- tion and give reassurance during this investigation.


SEVERE NARROWING OF A CORONARY ARTERY SEEN ON CT SCAN


5


An invasive coronary


CLOT INSIDE A HEART AS SEEN ON ECHOCARDIOGRAM


angiogram is now reserved for cases when there’s signifi- cant evidence that this inves- tigation is necessary. Because it involves the injection of a dye, called ‘contrast medium’, and because it’s an invasive procedure, this investigation is explained in detail to the patient, and all patients receive coun- selling before signing a consent to proceed. Cardiologists


have many


imaging techniques at their disposal to help diagnosis heart disease and to provide a bespoke management plan for everyone. If you’re experiencing any worrying symptoms, such as chest pain, chest tightness, increasing short- ness of breath during exercise or numbness radiating to your left arm or jaw cramp, don’t hesi- tate to seek immediate expert medical advice.


MEET THE EXPERT


Dr Nick Pantazopoulos is a consultant cardiologist at Chelsea & Westminster NHS Foundation Trust. He qualified in 1994 from Queensland University, Australia. He gained experience in general medicine as a hospital intern in Brisbane, as a doctor in the Greek Armed Forces and as part of an air retrieval service in the Greek islands. He specialised in cardiology at Athens University and


pursued subspecialist training in echocardiography and cardiac catheterisation at St George Hospital, Sydney, Australia. He trained in Cardiac CT at Johns Hopkins University, Baltimore, USA.


Laura Stacey (PA) T: 07415510585 E: laurastacey.cardio@gmail.com Twitter: @PantazopoulosDr


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