Heart Health Screening

my name is sanup I'm a cardiologist in New York now before we get started I just wanted to some of you will be wondering where I am I'm actually in Kenya which is where I grew up which is um you know where I did a lot of my education and which is where my mom is still uh living uh and the place the actual room I'm in is uh has a has an interesting story you know my father unfortunately left us three years ago prior to this he had this dream that he was going to build a little guest house uh on the coast on the on the diani south coast which is right next to the beach really uh so he constructed a building but um he unfortunately never got around to realizing his dream and after he passed away we had this derelict building um you know that was of no use really because uh the workmanship was very poor and my mom who uh is 80 uh single-handedly you know cuz I live in the UK so she's sing single-handedly got it up and running and now it's a flourishing guest house so if you ever get a chance and you're on the south coast please do come and pay her a visitor would make her day U it's called Arman guest house I will show you a little bit of the guest house after the video but let's get down to the reason why we're here um today's um video is on heart health screening uh and um I suppose perhaps the single most important way to tackle a problem is to to detect it in its infancy or as early as possible as heart diseas is common and heart attacks in particular can manifest with little or no initial warning to the patient the idea of undergoing a battery of screening tests when we are healthy to understand what is happening in our bodies to understand the underlying state of the heart is obviously very attractive to the general public who want to actively invest in their medium and long-term health now very clever people with a background in medicine and marketing have realized this and they've decided to capitalize on this and they've started offering heart health screening packages at fairly Hefty prices to the general public um such a screening package will often consist of the following uh you will be seen by a nurse or a doctor they will assess your family history and your risk factors they will measure your body mass index they will measure your blood pressure they will measure your fasting cholesterol values they'll measure your hba1c to look for diabetes they will do an ECG they will do some blood tests to measure your kidney function and then after a screen like this is done the patient is informed which of their numbers is within range as per recommended guidelines and which are out of range and then the patient is advis on Lifestyle Changes plus minus medications to make the numbers look better the obvious assumption is that a bad number implies a bad process and therefore making the number look better implies a reversal of that bad process but it's very important for us to realize that this is an assumption and may not always be true and therefore some people end up being made more anxious being labeled with additional and unnecessary unnecessary medical diagnosis and may even be subjected to the indignity of a lifetime of potentially harmful medications now the problem for me as a cons as a cardiologist who deals with cardiac disease on a daily basis is that I believe these tests that we rely on in these screening packages are very unsophisticated and the numbers that are measured definitely do not particularly correlate well with the presence or absence of underlying harmful processes they may be helpful as a means of cheaply screening a huge population but they're fairly unhelpful for the individual and I would therefore much rather look for the presence or absence of the harmful process rather than just relying on a number in an Ideal World we should not just study the heart because the but but instead we should study the whole of the vascular system because the heart is just a part of this network of arteries and capillaries and veins and it is is vascular disease that is the biggest killer rather than purely heart disease in isolation and therefore any screaming package for heart health should actually study vascular Health now let me give you some examples of why the current measurements that are done in screening packages aren't very helpful let's look at blood pressure so all screening packages will say look you know we need to measure your blood pressure but those of you who have had their blood pressure measured will appreciate that you rarely ever get the same value twice if you measure your blood pressure four times in a row you will get four different blood pressure readings how then is it possible to compare something which is so labile by Nature with a single value which is produced by a bunch of experts sitting in some conference room uh in Europe or America and how then is it possible to make a diagnosis on the basis of this number which is constantly fluctu now when a bodybuilder is lifting say 200 kg above his head in the Olympics we see him on TV and you see the eyes and they look like they're going to pop out of his head and you look at all these veins bulging to the point that they look like they're going to burst his blood pressure that weightlifter's blood pressure could easily be over 200 over 100 at the time this does not mean he has hypertension we do not see weightlifters suddenly drop down dead on TV due to massive Strokes because of this high blood pressure in fact we admire them for their strength and good health so when you go and get your blood pressure measured during a health screen how do we know whether that elevated reading is simply due to the situation we're in or whether it is truly high for us the number does not tell us because the number is fickle and will change the next time of asking imagine if you were a weight loss regime and your weighing machine spouted out a different number every time you weighed yourself surely you would throw the weing machine in the dust bin because it is useless for its purpose and this is why I don't believe that hypertension should be defined by a set of numbers because your numbers will change all the time depending on so many different confounders the only good true definition of high blood pressure is that pressure that is going to do that person or is doing that person whose pressure it is some form of harm if and I would always Advocate looking for evidence of harm if you have no evidence of harm then on what evidence does one say they have high blood pressure we surely can't rely on the experts the experts change their mind every year moreover the experts in Europe disagree with the experts in America and yet we do not see everyone in America living till 100 and everyone in Europe dying of a heart ATT or a stroke in their 50s you know the the what is called hypertension for example in America is different to what is called hypertension in Europe so measuring blood pressure in this manner does not really tell us anything measuring blood pressure in this manner will only do one thing and that one thing is that it will raise your blood pressure forever so a better way would be to say what kind of harm does high blood pressure cause and then look for that and the answer is that whenever pressure in any container is excessive then there is risk to the Integrity of the container if you have too much pressure in a balloon then the balloon will burst it is therefore far better to look at the most fragile compartments of the vascular system such as the tiny blood vessels in the eyes to see if there's any evidence of damage such as micro beds and if there is then you know that whatever your blood pressure is it's perhaps too high for you another way to study tiny blood vessels is the blood vessels of the kidneys and you can look for something called microalbumin in the urine these are this is a microscopic amount of protein that is released in the urine uh and is a sign that the kidney vessels are becoming damaged and therefore the kidneys are starting to leak out protein but it is such a small number that it has to be specifically measured it's so small that you can't even detect protein when you dipstick the urine so you actually to actually have to measure it uh but when it is present and if it is elevated then it's a good sign that something is going on with the kidneys at that point all other tests may look normal but this is giving you clue that something is going on at a microscopic level another test that gives us Insight is an echocardiogram which actually allows us to visualize the heart and a heart that has had to work against a higher pressure high blood pressure becomes more muscular and so again if the heart does not look more muscular then it is less likely to be working against a higher pressure now the really helpful thing about looking at processes is that you can monitor the effect of interventions on these processes so if you carry extra weight and decide to lose 10 kg it would be far more instructive to see what effect this has on the progression of eye disease or kidney disease or or the muscularity of the heart rather than just relying on a number okay a lot of uh screening packages which will look for hba1c they're basically looking for type 2 diabetes you know let's talk about type 2 diabetes currently the diagnosis of type 2 diabetes is measured on uh is measured uh by uh measuring a blood test called hba1c and if the hba1c is elevated then the pressure then the patient is deemed Di diabetic and all efforts are made to lower the hba1c as it is believed that if we don't do so bad things such as eye disease kidney disease heart attacks and strokes may happen in the future and if we do lower the hb1c aggressively then those bad things are less likely to happen it is worth noting however that bad things such as diabetic retinopathy kidney disease can take 5 10 years to develop and so this is the current way diabetes is managed you find the hba1c to be elevated you make the diagnosis of diabetes then you do everything to lower the hb1c the problem I have with this is that there are studies which have shown that at the time at the time of first diagnosis of type 2 diabetes up to 10 to 15% of patients already have diabetic eye disease which suggests that they've had the harmful process going on for several years before the hba1c went up to the level that the diabetes was diagnosed this therefore tells us two things hba1c elevation is a late sign two how can we feel comfortable that we have controlled the harmful process by lowering the hb1c when the process had already been happening before the hba1c was found to be very high so you know why does the retinopathy happened retinopathy which is taking 10 years to develop why does it happen in PTI patients who are diagnosed with their diabetes today surely it means that this process had been going on all this time without their hb1c being high You could argue that maybe no one measured their hb1c in 10 years but it is also very possible that the hba1c wasn't at the cut off where we've diagnosed diabetes but the diabetic process had been going on all along and very interestingly there are no convincing data at this point in time to suggest that controlling the hba1c in the manner it is being done is uh it reduces the risk of heart attacks and strokes anyway and therefore I really feel we shouldn't rely on hba1c when we're doing screening we should be looking for the marker that precedes the hb1c remember the aim is to detect Things Early not late you know it's a little bit like saying okay we know that the snake in your garden is poisonous because 10 to 15 out of 100 people die as a result you know you want to know before the snake bites you bites anyone that it's poisonous so so we should be looking for the marker that precedes the hb1c and that is the presence or absence of diabetic retinopathy or perhaps even diabetic nephropathy which can again be measured by measuring urine microalbumin another thing that is measured is cholesterol everyone gets really hung up about cholesterol oh my God your cholesterol is a bit High high cholesterol is cholesterol that is harming you high cholesterol is not a number high cholesterol is cholesterol that is harming you cholesterol gets stuck in blood vessels which are inflamed and have gone through lots of wear and tear much like fat sticks on a non-stick frying pan in the areas where the non-stick layer has been eroded if there is no fat seen to be stuck in your arteries then I don't see why people need to be take have to be medicated to lower cholesterol there is a group of patients who have something called familial hyper cholesterolemia where they actually lack a gene to break down the cholesterol and I'm not referring to those people because those people probably do need medications to lower their cholesterol uh but if your cholesterol is perhaps only mildly elevated you don't have any evidence of familiar hypog gleria and you can visualize the heart arteries and the cored arteries the arteries of the neck and these do not show any evidence of coronary disease or pla then there is no good reason in my mind for these patients to be subjected to the indignity of taking medications long term well the good news is that we can visualize the CDs using ultrasound and we can visualize the heart arteries using cardiac CT angiography so to my mind rather than subjecting a patient to a lifetime of anxiety and medications it is far better to visualize the arteries look for the presence or absence of the disease that you are trying to work work out from a number which isn't very good and then at least you know what you are treating so in my opinion a far more sophisticated heart health screening packet should look like this you would want number one a retinal screen to look at the tiny vessels in the eyes a kidney micro alamin assessment so urinary microalbumin to assess the microvasculature of the kidneys an echocardio to assess the heart structure and function a Doppler ultrasound of the neck to assess the blood vessels going to the brain so cored ultrasound and a cardiac CT scan to assess the coronary arteries if all these are normal then to my mind you can be very reassured that your cardiovascular system is healthy if these are abnormal then you can work with lifestyle and maybe perhaps medications and repeat the same test to understand the effect of those interventions on the process I really don't think it's a good idea to spend your hard-earned money having things like oh we'll do a blood pressure and we'll do a cholesterol we'll do an hba1c far better to do something like this which may be a little bit more expensive but at least it gives you some insight into what's going on in the body so um I hope you found this useful I was desperate to try and do a video in Kenya whilst I was in you know uh in in a you know my father's dream and and the place my mother built uh so I'll show you around if you like um just to see whether you like it uh you know please feel free to critique uh but uh once again thank you so much so I'm going to just take you around very quickly uh and then we can show you what this place looks like oops so this is the room and then there's a little TV and there's a little fridge and I know it's not much but you know it's it's ours it's it's ours so it's a particularly um you know it means something so I hope you like it and we have a little toilets and um there we go and then outside if you go outside there are all these rooms you see so this was all built by my father but really resurrected by my mother so all of those are rooms so I just thought you know because everyone's on the Channel's a little bit like my family now so I thought I'd tell you where I came from excellent take care bye

Channel: York Cardiology

Views: 18,997

Keywords: Heart palpitations anxiety, Heart palpitations after eating, Heart palpitations causes, Heart palpitations symptoms, Heart palpitations treatment, Heart palpitations cure, Ventricular ectopics, Heart disease symptoms, Heart racing, Heart flutter causes, Heart palpitations at night, heart screening

Id: jmZW_nar-6c

Length: 18min 2sec (1082 seconds)

Published: Thu Mar 21 2024