Heart service manual being drawn up

Technology is making giant steps forward in the field of cardiac imaging and heart surgeons are eagerly awaiting the day when it will become so sophisticated that patients could undergo less invasive surgery for heart disease.

Maltese patients can already benefit from a sophisticated computer programme that can sort out the data to generate detailed, three-dimensional images of the heart.

At present, Saint James Hospital is the only hospital on the island that has this specific CT scan that can take detailed images of the heart to reveal calcium and fat-filled plaques lodged in the arteries.

"This calcium scoring scan can be used to determine the patient's risk. It is a recent addition that has given doctors an extra tool to detect any problems in those who are at an intermediate risk," Kevin Schembri, a heart surgeon and head of the Saint James Hospital's cardiac services department, said.

Mr Schembri, who also operates at St Luke's Hospital's cardiac unit, said that for now the gold standard remains an angiogram to see the heart's exact anatomy.

"However, the technology of CT scans will eventually supersede an angiogram and it will be so sophisticated we will be able to do away with the angiogram," he said in an interview.

Mr Schembri explained that heart disease was extremely complex and doctors still did not fully understand what was happening.

"The hypotheses is that disease can result from injury. If we fully understand the pathology in the future we will be able to address heart disease with just one tablet. If so all surgery will stop and we'll be unemployed," he said with a smile. With World Heart Day being celebrated on Sunday, Mr Schembri stressed the importance of educating young people aged between 10 and 16 years to take care of their heart.

"This is a time when children are still easy influenced, so it's crucial that we instil in them lifelong habits to eat healthily and exercise regularly," he said.

If these messages are not stressed at an early age, bad habits will easily be picked up from spending too much time in front of the television, eating junk food and smoking.

People in their 20s and 30s should not be under the illusion that heart disease is an illness reserved solely for older people and they should ensure they check their cholesterol and blood pressure levels and steer clear from piling on the pounds.

People with a family history of heart disease should be doubly careful of the life they lead, he said.

Mr Schembri takes these issues to heart and he is presently in the process of putting together a heart and service manual, which has been interestingly laid out along the same design of a car manual.

"Everybody makes sure they regularly service their car to avoid serious problems, so we should do the same with our heart. The manual even has a service programme on caring for your heart," he said.

Once completed, the idea is to distribute the manual to car dealers to hand out to those who purchase a car. There are also plans to hand out copies to those who attend the heart fitness programme being organised at Saint James Hospital.

This six-week programme, which will be launched shortly, is geared at both primary and secondary prevention.

It is intended for men over 45 and women over 50, who have never had any heart problems but have one or several risks from high cholesterol, hypertension, smoke, diabetes, obesity, lead a stressful life or have a family history of heart disease.

The programme will also tackle secondary prevention and address the needs of those who have either had an angina, a heart attack or a bypass as well as instil the need to change their lifestyle.

Lectures will be held twice a week by professionals, including doctors, nurses, personal trainers, a psychologist and nutritionist. A session of exercises will also be carried out to learn to keep fit from a heart point of view.

"If we reduce the risk factors we can reduce the chance of dying," Mr Schembri said.

Dietary guidelines for a healthy heart

Healthy food habits can help you reduce three of the major risk factors for heart attack - high blood cholesterol, high blood pressure and excess body weight. They'll also help reduce your risk of stroke because heart disease and high blood pressure are major risk factors for stroke. The American Heart Association Eating Plan is based on these new dietary guidelines:

¤ Eat a variety of fruits and vegetables. Choose five or more servings per day.

¤ Eat a variety of grain products, including whole grains. Choose six or more servings per day.

¤ Include fat-free and low-fat milk products, fish, legumes (beans), skinless poultry and lean meats.

¤ Choose fats and oils with two grams or less saturated fat per tablespoon, such as liquid and tub margarines, canola oil and olive oil.

¤ Balance the number of calories you eat with the number you use each day. (To find that number, multiply the number of pounds you weigh now by 15 calories. This represents the average number of calories used in one day if you're moderately active. If you get very little exercise, multiply your weight by 13 instead of 15. Less active people burn fewer calories.)

¤ Maintain a level of physical activity that keeps you fit and matches the number of calories you eat. Walk or do other activities for at least 30 minutes on most days. To lose weight, do enough activity to use up more calories than you eat every day.

¤ Limit your intake of foods high in calories or low in nutrition, including foods like soft drinks and candy that have a lot of sugars.

¤ Limit foods high in saturated fat, trans fat and/or cholesterol, such as full-fat milk products, fatty meats, tropical oils, partially hydrogenated vegetable oils and egg yolks. Instead choose foods low in saturated fat, trans fat and cholesterol from the first four points above.

¤ Eat less than six grams of salt (sodium chloride) per day (2,400 milligrams of sodium).

¤ Have no more than one alcoholic drink per day if you're a woman and no more than two if you're a man. "One drink" means it has no more than 1/2 ounce of pure alcohol. Examples of one drink are 12 oz. of beer, 4 oz. of wine, 11/2 oz. of 80-proof spirits or 1 oz. of 100-proof spirits.

Source: www.americanheart.org

Facts and figures

¤ Extensive studies have shown that 50 per cent of deaths due to heart disease occur in people with no symptoms.

¤ A third of people with heart disease don't have any of the traditional risk factors - diabetes, high blood pressure, high cholesterol, family history or peripheral vascular disease.

¤ In Malta, 46 per cent of deaths are due to circulatory problems, including heart disease and stroke.

¤ In the past 10 years a total of 4,134 open heart operations - including 3,390 bypass operations - and 10 heart transplants, were performed at St Luke's Hospital's cardiac unit.

¤ The unit also performed 4,233 angioplasties - the opening of a narrowed artery without the need for open heart surgery - and 18,140 angiograms, apart from installing 1,738 pacemakers.

¤ An average of 520 open-heart operations, 550 angioplasties, 200 pacemakers and 2,100 angiograms are conducted at the unit every year.