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Speaker 1: Our guest right now is, oh, we can have a

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Speaker 1: really really great conversation. Conversation around prevention is better than cure,

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Speaker 1: and it's also around hearthouse. So stress is something that

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Speaker 1: most of us think of as a mental or an

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Speaker 1: emotional issue, the pressures of work, family responsibilities, deadlines, the

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Speaker 1: constant pace of this modern convenient life that we're living,

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Speaker 1: where our to do list actually just seems to get longer.

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Speaker 1: What many people don't realize is that chronic stress can

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Speaker 1: have a very very real, measurable effect on your heart

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Speaker 1: long before any symptoms appear. And in fact, many people

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Speaker 1: are considered themselves really healthy, especially busy professionals, could actually

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Speaker 1: be living with hidden cardiovascular risk without even knowing about it.

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Speaker 2: Now.

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Speaker 1: The good news is that advances in cardiac imaging are

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Speaker 1: helping doctors to detect potential problems much earlier, shifting the

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Speaker 1: focus from reacting from reacting to heart attacks to preventing

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Speaker 1: them in the first place, and to help us understand

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Speaker 1: our stress affects the heart and how modern imaging can

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Speaker 1: pick up on warning signs early. We are joined by

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Speaker 1: doctor Tyrone Annaw. He's a radiologist as well as a

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Speaker 1: cardiac imaging specialist and that's at Morton and Partners radiologists

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Speaker 1: could afternoon.

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Speaker 3: Hi, Saskia, thank you very much for having me.

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Speaker 1: And I want to just encourage anyone if they've got

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Speaker 1: any questions, to give us a call oh to one

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Speaker 1: four four six of five sixty seven or seven two

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Speaker 1: five six seven one five six seven. We often hear

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Speaker 1: about stress affecting our mental wellbeing, but I don't think

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Speaker 1: many of us realize that that chronic stress actually impacts

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Speaker 1: the body quite physically, and it's actually the heart and

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Speaker 1: the cardiovascular system that comes under the most attack, and

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Speaker 1: that's where it starts early early on. Tell us a

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Speaker 1: little bit about just how stress affects that system.

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Speaker 4: Okay, so yeah, you have it right, stress, and we

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Speaker 4: can define it a little bit more because you get

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Speaker 4: different types of stress. You get physiological and you get

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Speaker 4: psychological stresses. We talk about psychological we're thinking about work

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Speaker 4: stress and emotional stress from a relationship or a deadline

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Speaker 4: or anxieties. And then physiological stresses are things more like

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Speaker 4: chronic pain, chronic illness, and sometimes with athletes as well,

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Speaker 4: and putting your body under a lot of stress. These

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Speaker 4: two things can contribute to our actual heart health, even

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Speaker 4: though they are predominantly emotional and we feel it in

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Speaker 4: the moment, but they can have a long lasting effect

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Speaker 4: on the heart. And how this works is I'm just

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Speaker 4: going to paint a picture for you. So the heart is,

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Speaker 4: as we all know, the muscle that provides blood to

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Speaker 4: all of the organs in our body. So the heart

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Speaker 4: takes care of the rest of our body. But what

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Speaker 4: takes care of the heart, and that is the coronary arteries.

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Speaker 4: There these vessels that sit on the surface of the heart,

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Speaker 4: providing nutrients to the heart so that the heart can

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Speaker 4: provide nutrients to the rest of the body. And these

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Speaker 4: vessels thus become the most important vessels in our bodies.

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Speaker 4: And it turns out that stress is as we just mentioned,

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Speaker 4: they have an effect on these vessels.

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Speaker 3: We've moved away from. Well, we do know that.

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Speaker 4: Patients that experience heart attacks, which is the end stage

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Speaker 4: of all of this, we have seen them as patients

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Speaker 4: that have high cholesterol, have bad eating habits, smoking, etc.

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Speaker 4: And we almost have an image of what somebody would

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Speaker 4: look like who would experience a heart attack, But we

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Speaker 4: don't often take into account that somebody who's just experiencing

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Speaker 4: a lot of stress can also put themselves at a

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Speaker 4: great danger of this. The stresses raise your adrenaline levels

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Speaker 4: and other hormones that raise the rate of damage that

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Speaker 4: cholesterol can do to your heart, and smoking and etc.

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Speaker 4: The damage that all of that is doing to our heart,

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Speaker 4: it is accelerated by these stresses. So what ends up

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Speaker 4: happening is that these vessels that are sitting on the

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Speaker 4: heart at providing nutrients to the heart, those get attacked

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Speaker 4: further and faster when we're under stress.

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Speaker 1: I've just struck that a lot of people, like when

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Speaker 1: we're stressed, you know, we're always thinking, ah, just like

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Speaker 1: get over it or get on top of it. Like

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Speaker 1: we're always looking at ourselves as it's almost being self

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Speaker 1: inflicted or manageable or But what you're saying is physiologically,

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Speaker 1: there are.

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Speaker 2: Things that's happening.

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Speaker 1: So even if you think, oh, I can just cope

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Speaker 1: with it, I'll just you know, go sleep early tonight,

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Speaker 1: or I don't know, meditate or something, you know that

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Speaker 1: it's not always that simple. That actually you need to

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Speaker 1: be checking both. So one is because we're always anxious nowadays,

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Speaker 1: so we're like then for the anxiety, but that we

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Speaker 1: also need to be checking then what's happening actually physically

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Speaker 1: to your body, what physiological stress is happening.

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Speaker 3: Yes, no, definitely.

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Speaker 4: We can see things like being sick, having the flu,

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Speaker 4: or having a bug, needing an operation. Those kinds of

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Speaker 4: illnesses are very well understood as somebody being sick. But

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Speaker 4: we don't see somebody who's under a lot of stress

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Speaker 4: as somebody being sick. You know, you can't call into

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Speaker 4: work six saying oh I'm sure.

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Speaker 2: In fact, we see them as weak.

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Speaker 1: Yeah, we'll like deal with it, man, bigle panties on exactly.

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Speaker 4: Meanwhile, the person who has the flu is most more

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Speaker 4: likely to get over that bart of the flu. The

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Speaker 4: person with the chronic stress is building up something that

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Speaker 4: is like a ticking time bomb, right.

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Speaker 3: Yeah.

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Speaker 4: So that's why as a radiologists and radiology images we

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Speaker 4: want to try and get ahead of that. We need

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Speaker 4: try to identify people that are under stressed and that

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Speaker 4: are at further risk of getting heart attacks later, trying

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Speaker 4: to identify them and scan them before it ends up

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Speaker 4: happening too late.

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Speaker 1: Because go ahead, Was this always in your field of specialty?

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Speaker 1: Was this always something that we could have done? Is

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Speaker 1: this relatively new?

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Speaker 4: Relatively new as of maybe twenty years, but it's coming

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Speaker 4: to the fore and the strengths of doing this testing,

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Speaker 4: which is crimary artery calcium scoring, which I'll go into

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Speaker 4: just later, but the strengths of that are really coming

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Speaker 4: to the fore and we're realizing that the more patients

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Speaker 4: that we can scan, the earlier doctors can put them

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Speaker 4: on changes in their lifestyle, changes in their habits, and

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Speaker 4: really make patients wake up and say, Okay, the stress

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Speaker 4: that I'm going through, I really need to manage it

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Speaker 4: or else is going to be the end of me.

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Speaker 4: So over the last twenty years, it's really been coming

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Speaker 4: to the fore.

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Speaker 2: Doctor.

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Speaker 1: Now, how would I know that I'm a candidate for this,

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Speaker 1: because I just think I need to put my big

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Speaker 1: old panties on and just like get on with it,

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Speaker 1: do you know what I mean? And so like, especially

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Speaker 1: South Africans, like we've got a deep well for resilience here.

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Speaker 1: I'm sure there's a lot of walking ticking time bombs

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Speaker 1: walking around. How do I know that this is something

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Speaker 1: that I need to be taken taking more seriously?

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Speaker 4: Okay, So yeah, there are a few patients that know

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Speaker 4: already that they are risk at risk because of their

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Speaker 4: family history. If you have a parent, a father, or

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Speaker 4: a mother who had heart disease, and especially young heart disease.

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Speaker 4: Thanks Dad, then you already know that you are at

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Speaker 4: risk and you should seek just to check up in

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Speaker 4: if but those of us who are also under chronic stress,

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Speaker 4: and you know that you have a highly stressful job,

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Speaker 4: or you know that you've been going through a relationship turmoil,

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Speaker 4: you know that you've been going through physical turmoil for

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Speaker 4: a long time. We usually advise patients from the age

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Speaker 4: of forty to see your GP and mention these symptoms.

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Speaker 4: Say that, Okay, my parents had heart disease, or I'm

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Speaker 4: concerned that I have really high stress levels, and we

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Speaker 4: can send you for a CT scan to check the

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Speaker 4: amount of calcium in your cornery arteries. The calcium in

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Speaker 4: your carny arteries that the CT scan would be measuring

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Speaker 4: is a sign of stresses, but almost at a later stage. Yes,

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Speaker 4: so it's able to pick up fine amounts of thickening

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Speaker 4: inside the vessels that has happened maybe over a year

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Speaker 4: or a few years, and it can indicate to us

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Speaker 4: what is going to happen to the future. It's a

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Speaker 4: look into the future and it's a little look at

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Speaker 4: the past. So these scans are very easy to do,

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Speaker 4: doesn't require any preparation, doesn't require any any drips or

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Speaker 4: needles or anything. It takes about ten minutes coming into

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Speaker 4: your local hospital that can do these CURRENTARYCD scans, and

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Speaker 4: then within the ten minutes, we will have a measurable

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Speaker 4: score where you sit on a chart and that scores

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Speaker 4: from zero to the thousands, and depending on where you

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Speaker 4: fit on that scale, we will know how severe your

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Speaker 4: chrinary arteries and your risk for future heart attacks.

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Speaker 1: So that's your coronary artery calcium SCORECT.

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Speaker 2: And it's done with a CT scan.

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Speaker 3: Yes, that's correct.

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Speaker 2: Do I need to are like, that's it? I just

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Speaker 2: lay there, you scan me.

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Speaker 3: Yep.

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Speaker 4: So you go into a big old doughnut. Yeah, and

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Speaker 4: it's basically a bunch of that are spinning around you. So, yes,

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Speaker 4: there is some risk because it is you were using radiation,

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Speaker 4: and radiation does have the ability to change a little

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Speaker 4: bit of your genetics of the long term, but the

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Speaker 4: benefits way outlast the risks. So you would just slide

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Speaker 4: down on the table, you'd pass through the little donut

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Speaker 4: in and out and it would do a cycle around

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Speaker 4: your heart and scan to find out where is all

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Speaker 4: of the plaque sitting in your vessels.

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Speaker 2: I've got to get that done.

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Speaker 1: Lizca says, very interesting topic today, and in fact, she

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Speaker 1: was wanting me to ask you about something called coronary

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Speaker 1: artery calcium score. What exactly is it and how do

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Speaker 1: I know if I should have one? I think just

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Speaker 1: to answer her question because you've kind of answered it,

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Speaker 1: but just to wrap it up so we are very clear.

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Speaker 2: We are fascinated now.

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Speaker 3: Yeah, so let's go. Thank you for your question.

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Speaker 4: As I said, if you have any history in your

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Speaker 4: family of heart is ease, if you have a very

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Speaker 4: highly stressful job, or you've undergone some acute stress or

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Speaker 4: long term stress, either physiological or psychological, or you're over

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Speaker 4: the age of forty and you're just trying to look

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Speaker 4: out for your health. We do advise that patients would

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Speaker 4: come in for their first one after the age of

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Speaker 4: forty and thereafter, depending on your score, you can come

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Speaker 4: in every five to seven years. If your score is

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Speaker 4: a lot higher, then we know we can refer you

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Speaker 4: on to a cardiologist that's going to do a full

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Speaker 4: work up and see what else is going on. Obviously,

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Speaker 4: if you have chest pain, or if you are symptomatic.

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Speaker 4: We're talking about the asymptomatics, the ones who are the

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Speaker 4: silent ticking time bops, the ones that have chest pain.

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Speaker 4: They come to the hospitals. And the reason why this

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Speaker 4: is a silent killer. The thing that brings people.

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Speaker 3: To the hospital.

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Speaker 4: And I don't know about you, Saskia, but I am

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Speaker 4: a doctor. I don't even like going to hospitals. But

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Speaker 4: the thing that usually brings patients to hospitals is pain

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Speaker 4: and something really daunted, but something that is like, oh no,

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Speaker 4: it's a little bit of a niggle, you stay away.

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Speaker 2: That's actually not right, is what you're saying.

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Speaker 4: Exactly exactly, So I don't want people to shy away

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Speaker 4: from this. It's better to have the preventative scan done,

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Speaker 4: which is a quick scan, than coming back in ten

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Speaker 4: years and you have a heart attack, which if you survive,

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Speaker 4: might mean multiple operations and a pacemaker and a stroke

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Speaker 4: or multiple interventions, multiple interventions and a way more expensive

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Speaker 4: way to adopt with it than coming in earlier, which

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Speaker 4: is quick, cheap, and you get out of the hospital

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Speaker 4: very quickly.

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Speaker 1: We are talking to doctor Tyrone and now he's a

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Speaker 1: radiologist and cardiac imaging specialist at Morton and Partners. We're

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Speaker 1: talking about stress, We're talking about coronary artry calcium score

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Speaker 1: and scans that you can do to test your heart health.

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Speaker 1: We've got quite a few questions here. Janet wants to

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Speaker 1: know what is the cost of a scan?

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Speaker 3: Would okay? Yes?

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Speaker 4: So if you are on medical aid. There are multiple

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Speaker 4: medical aids that have programmed specifically. Discovery has a heart

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Speaker 4: program that encourages patients to get to get their hearts

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Speaker 4: checked and they should cover at least one scan in

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Speaker 4: a year as a private patient who's paying up front.

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Speaker 4: The scan varies from about three eight hundred to four

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Speaker 4: two hundred grand, right, And.

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Speaker 1: I think because Gail is saying, your medical aid won't

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Speaker 1: cover a CT scan of this nature. But that depends

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Speaker 1: you just said depends on it.

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Speaker 3: It depends on your package. Correct.

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Speaker 2: Yeah.

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Speaker 1: Let's see, I had a CAC scan. It caused a

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Speaker 1: huge amount of anxiety. Statins are prescribed. They cause severe

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Speaker 1: muscle pain. That's from BEV or.

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Speaker 4: Yeah, so this this can be a side effect of

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Speaker 4: the following treatment or I will tell you BEV. The

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Speaker 4: statins are doing something really important, which is limiting the

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Speaker 4: rate of the cholesterol being depositive in ther crimary arteries.

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Speaker 2: So don't take don't get off the status fare.

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Speaker 3: Please don't get off the statins.

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Speaker 2: Don't be like me vev.

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Speaker 1: I went off the statins for a year and I

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Speaker 1: just came back from my doctor today and she was like, girl,

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Speaker 1: are you going back on them?

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Speaker 2: Status? Okay, so I'm back there. Let's see.

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Speaker 1: Please ask the doctor how often I should get my

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Speaker 1: mitral valve pro lapse checked and if it's dangerous, thank

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Speaker 1: you or sure that.

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Speaker 2: I don't even know what all those words.

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Speaker 4: So we've moved to a completely different section, but still

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Speaker 4: in the heart. The microvolve is one of the volves

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Speaker 4: in the heart. The heart is actually a big pump

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Speaker 4: and there are basically two parts of the of the heart,

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Speaker 4: the part that fills and the part that pushes everything out.

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Speaker 4: And the microvolve is a that opens and closes and

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Speaker 4: allows blood to move through the heart. Very very important volve. Now,

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Speaker 4: I cannot be the one to recommend exactly how long

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Speaker 4: you should wait between your microvolve prolef checks. It highly

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Speaker 4: depends on how your heart is functioning, your last cardiologist

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Speaker 4: to visit, and whether they've replaced your microvolve or they're

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Speaker 4: thinking about replacing it. I would say you should check

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Speaker 4: with your cardiologist and he will give you a really

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Speaker 4: good indication as to how often you should come back

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Speaker 4: based on how you're doing right now.

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Speaker 1: And then one more question from Valerie is a can

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Speaker 1: a snologist do these scans?

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Speaker 4: So this scan is exclusively a CT scan, which is

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Speaker 4: a rotating X ray. A sonologist uses ultrasound to determine

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Speaker 4: what is going on with your heart, and a sonologists

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Speaker 4: can determine quite a lot. They can take a look

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Speaker 4: at the heart and see how the heart is functioning,

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Speaker 4: if it's beating and pumping enough blood out in every

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Speaker 4: single every single heartbeat. But a sonar or an ultrasound

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Speaker 4: can't really see the coronary artery. So even if you've

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Speaker 4: had a sonar of your heart, I would recommend still

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Speaker 4: considering getting your coronary artery calcium score done.

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Speaker 2: We've run out of time.

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Speaker 3: Oh no, just when I was getting into.

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Speaker 2: It, doctor, I know, thank you so much for coming

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Speaker 2: to tell us.

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Speaker 3: About absolutely pleasures.

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Speaker 1: Really, what seems like a very effective tool in early

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Speaker 1: risk assessment. It's the coronary artery calcium score. A quick

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Speaker 1: non invasive CT scan that can detect caulcified plaque in

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Speaker 1: the coronary arteries. And after my visit to the doctor today,

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Speaker 1: I shall be booking one. Does my doctor need to

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Speaker 1: recommend it or can I just kind of go?

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Speaker 4: I think, get your doctor to recommend one. But if

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Speaker 4: he doesn't, you can come and talk to me.

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Speaker 2: Perfect. Thank you so much.

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Speaker 1: That is doctor Tyrone anaw of course, a radiologist as

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Speaker 1: well as cardiac imaging specialist at Morton and Partner's radiologists