Nuclear stress testing can reveal a heart in trouble
February is the month when we turn our attention to matters of the heart, but it’s not confined to feelings of love and romance, it’s also about the health of the physical organ.
In Bermuda heart disease is the number one killer. Every week we send at least two people abroad to have their heart diseases tended to.
Maintaining a healthy heart one that is not diseased should be the goal of each of us. It would be easy if we could see our hearts. When you get a disease on your skin or gums, because it’s visible, you tend to address it straight away. In the case of our hearts, it’s not so obvious.
But cardiologists at King Edward VII Memorial Hospital have the ability to actually look at the heart and according to chief of the department, Dr Carl Levick, it’s being done regularly now.
Dr Levick started at KEMH in 2010 and at the time told Body & Soul he wanted to introduce nuclear stress testing, to get a better picture of what was happening with people’s hearts.
He got his wish and nuclear stress testing has been available for over a year at KEMH.
“We are currently doing several hundred of these a year,” he said. “It allows us to use radioactive material to show which portions of the heart are suffering from impaired coronary blood flow (blood flow to and from the heart).”
Having this information enables more accurate diagnosis to take place in Bermuda. Before this type of test was available on Island, patients were sent overseas to determine exactly where coronary blockages might be.
“We are more effectively able to diagnose the severity of coronary disease here on the Island,” said Dr Levick. “We send about two people a week for cardiac procedures overseas,” he added. “It’s about 150 people a year.”
While he had no figures for the numbers sent overseas before he implemented the nuclear testing, they were definitely higher. In fact it’s likely that the several hundred tests done locally every year, would have been done overseas.
Nuclear stress testing is more specific than regular stress testing where just the readings of the electrocardiogram are used.
According to Dr Levick most people in Bermuda only require the regular stress test for diagnosis. Nuclear stress testing is used in severe cases of heart disease.
According to Dr Levick about 75 percent of those sent overseas have major cardiac surgery.
This includes placement of defibrillators, open heart surgery, angioplasty where a balloon is placed in the blood vessel to widen it and stenting, where a wire ring is placed in the vessel after ballooning, to keep it in place.
The high percentage pleases him as it’s an indication that sending the patient overseas was necessary.
“About 20 percent have testing overseas and a decision is made to use only medicine in treatment,” said Dr Levick. This does not mean sending them abroad was unnecessary.
“I think we are doing a good job of sorting out who needs to go for further treatment,” he said and he explained that intricate cardiac work and testing will always have to be done overseas because equipment costs make offering such services here prohibitive.
The most expensive element in providing nuclear stress testing is the cost of the camera equipment involved more than $250,000.
But at King Edward VII Memorial Hospital implementing the new testing only required an outlay of about $15,000. Why? According to KEMH Chief Cardiologist, Dr Carl Levick, the hospital already had the $300,000 camera needed for other procedures.
“We are using the same camera that is used in the hospital to study other parts of the body,” he said. “What we had to get was computer software for the camera built into a cardiology analysis package. This was about $15,000,” he added.
And the cost of the test to patients? According to the hospital’s billing department $1,274 before insurance deductions.