Bermuda's new Cardiac Diagnostic Unit at King Edward VII Memorial Hospital officially opens this month, making available invaluable cardiac care to residents through its state-of-the-art technology, knowledgeable staff and extensive resource centre.

Established with the assistance of the Bermuda Heart Foundation, the Unit is testament to all that cardiac caregivers and patients on the island have long hoped for.

This week, the Mid-Ocean News takes a look at heart disease and how staff at the new Unit are helping to educate patients and residents at risk.

BERMUDIANS have a new ally in the war against heart disease, one of the leading causes of death on the island.

The Cardiac Diagnostic Unit at King Edward VII Memorial Hospital is to officially open this month, offering diagnostic care and valuable resources to those at risk.

While factors such as one's family history and age remain beyond our control, with careful monitoring there is no reason why anyone need suffer a heart attack, stroke or angina, according to Myrian Balitian-Dill, a nurse involved in providing post-cardiac care to patients who have been abroad for treatment.

With monitoring, she says, it becomes easy to detect atherosclerosis - a condition caused by cholesterol build-up and inflammation - and prevent the onset of a heart attack or a stroke.

"Atherosclerosis leads to lesions in your arteries called plaques," she explained. "These plaques are made up of excess cholesterol, other fats and inflammatory cells in the artery wall.

"(They) can lead to narrowing of your arteries and cause symptoms from decreased blood flow such as (angina) or pain in your legs. In addition, these plaques can sometimes suddenly become unstable and rupture, leading to heart attacks and strokes.

"Individuals that have developed atherosclerosis are five to seven times more likely than the general population to have a cardiac or vascular event. Having atherosclerosis means you are at higher risk for developing a heart attack or stroke (and), once you have developed atherosclerosis you remain at increased risk for the rest of your life."

Atherosclerosis may be diagnosed in a number of ways, she says. A doctor will reach his diagnosis by looking at a patient's "clinical history, such as a prior angioplasty, cardiac bypass surgery or carotid surgery; clinical presentation, such as a heart attack angina or stroke; through a physical examination which then determines noise heard over an artery or absent pulses; through non-invasive testing such as an ECG, stress test or ultrasound study or through invasive testing such as an angiogram which reveals narrowing or obstructions".

Even those at increased risk have hope, Mrs. Balitian-Dill says. Medication and lifestyle changes can greatly improve one's health - facts that members of staff at the Diagnostic Unit are hoping to share with patients.

Four types of medication have been shown to dramatically reduce the risk - by 70 to 80 per cent - of a heart attack, stroke or heart failure or the need for angioplasty, bypass surgery or repeated hospital visits. They are:

Aspirin works by inhibiting platelets in the blood and preventing blood clots from forming in the arteries.

Beta blockers protect the heart and blood vessels from damage. Although they lower heart rate and blood pressure, they have proved to be of benefit to individuals starting out with a normal blood pressure level. These include Metoprolol, Atenolol, Propranolol and Carvedilol.

Ace inhibitors also protect the heart and blood vessels from damage. Again, they lower blood pressure but are of benefit to those whose pressure was originally at a normal level. These include Captopril, Benazepril and Moexipril, among others.

Statins reduce bad cholesterol and inflammation in the arteries, preventing the build-up of plaques and keeping those which already exist from rupturing. These lower cholesterol levels but have proved to be of benefit to people starting out with normal or low cholesterol levels. Examples of these include Simvastatin, Pravastatin and Cerivastatin.

Although other medications are available, the nurse says, the four listed above are the only ones which have proved effective at saving lives. If in doubt, you should always check with your doctor as other medications may be used to control symptoms or for other purposes.

For those at risk, Mrs. Balitien-Dill says, it is important changes are made to their lifestyle. And it was in this area as well, that the cardiac unit would offer help.

"Once approved by your doctor, you should begin a regular exercise programme. In general, you should aim for exercising for a minimum of 30 to 60 minutes, three to four times weekly, supplemented by an increase in daily activities.

"After a heart attack or bypass surgery, you may benefit from a supervised exercise in a cardiac rehabilitation programme. Talk to your doctor about what would be best for you to do."

A proper diet, the nurse adds - one that is low in fat, saturated fat and cholesterol and that helps maintain a normal weight - is just as important. A good guide, she says, is the American Heart Association diet which contains 30 per cent of calories from fat and seven per cent saturated fat and 200 milligrams a day of cholesterol.

Smoking, she stresses, is a no-no.

"If you smoke, you must stop. Continued smoking once you have atherosclerosis makes you five times more likely to have a heart attack, stroke and die. If you quit, however, your risk goes down dramatically, even in a few days."

It is planned that the Unit, which became fully functioning in July, will be a great asset as Bermuda works to fight against heart disease through treatment, education and prevention. It was through the efforts of the Bermuda Heart Foundation that millions of dollars of lifesaving equipment - including a Digital Image Analysis Machine and Telemetry, which allows the constant monitoring of up to eight patients' vital signs at once - were donated to the facility.

SAID the Unit's programme manager Norma Smith: "We can provide echo-cardiogram tests, stress tests. If, for example, someone is experiencing chest pains, we put them under a stress test with the doctor present - we have them run on a treadmill for a while, say - to determine any problems that might require intervention.

"We've renovated the wing and built a resource room with videos and other material donated by the Bermuda Heart Foundation and plan to have an opening on September 17 to acknowledge Mr. Barber, who was our major benefactor, and who allowed us to do the expansion and development of the Cardiac Care Unit.

"Heart attacks and strokes are (two) of the leading causes of death in Bermuda. Prevention is a big thing. If we can pick (the problems) up early it's the best way."

When the planned renovation of the existing operation and the new resource centre was announced last year, KEMH cardiologist and the long-time chairman of the Bermuda Heart Foundation (BHF), Shane Marshall, said the idea was to create a facility "that combines a stress-free environment, advanced technology and the ability to serve more cardiac patients".

A registered charity, the Heart Foundation was created by Dr. Marshall and Ramona Anderson nearly ten years ago after her experiences with her father at Johns Hopkins University Hospital in Baltimore, Maryland. Ms Anderson's father underwent a triple by-pass and an operation to correct an over-sized valve.

She was so impressed by the state of the art technology available to the doctors there that she worked with Dr. Marshall to raise funds for new cardiac technology on the island.

It was only recently that scientists discovered a gene variant, said to be exclusive to people of African descent, which raised their risk of abnormal heart rhythms. A study, funded partially by the American Heart, Lung and Blood Institute, revealed that people with structural heart disease, known as cardiomyopathy, or with low blood potassium, can also develop arrhythmias if they have the variant.

Heart attacks are a leading cause of arrhythmia, as is heart disease. Such arrhythmias kill 450,000 Americans a year.

The Institute estimates that 4.6 million US blacks carry the gene variant with 13.2 per cent of 205 African-Americans examined found to have at least one copy of the variant gene while it was discovered in 19.2 per cent of the 468 West Africans and Caribbean residents researchers looked at.

With a similar lifestyle and heritage, Bermuda's largely black population could also be at risk, placing even greater importance on the new unit and its functions.

Most important, for those who are unsure whether or not they are at risk for heart disease, is not to ignore warning signs.

"Don't ignore the warning signs of a heart attack or stroke. Symptoms of chest pain, shortness of breath, dizziness, weakness, trouble speaking, numbness lasting more than one to two minutes should prompt you to stop your activities and sit down," she warned.

"Don't delay seeking medical attention if you cannot get through to your doctor right away. If your symptoms are severe, call 911 first. Prompt medical attention can make the difference between life and death."

q For more information on heart disease, diagnostic care or preventative measures, contact the Cardiac Care Unit at KEMH.