Proactive Heart Checks Offer Peace of Mind for HSA Patient

According to the Cayman Islands’ Compendium of Statistics, cardiovascular diseases are the leading cause of death, accounting for 35.8% of all fatalities in 2024. This is an increase of 8.8% from 2022; therefore, Ms. Gardiner’s concerns were not too trivial to be ignored.

Following her consultation with Health Services Authority’s (HSA) Consultant Cardiologist Dr. Brian Noronha, he recommended Computerised Tomography (CT) Coronary Angiography and Calcium Scoring tests to assess for blockages and calcium buildup. These tests showed an incidental finding of an aortic aneurysm.

An aortic aneurysm is a bulge or ballooning in the wall of the aorta, the largest artery in the body. The aorta carries blood from the heart to the rest of your body. If ruptured, an aortic aneurysm can lead to life-threatening complications.

Following this result, Ms. Gardiner continues to maintain scheduled cardiology assessments with Dr. Noronha, including undergoing an echocardiogram (heart ultrasound) to monitor the size of her heart. These assessments, she admits, have given her “peace of mind”.

Ms. Gardiner’s proactive approach is exactly what Dr. Noronha hopes to see more of among Cayman Islands residents. “Early diagnosis and treatment are often a result of the patient taking on a strict healthcare regimen, following up with their general practitioner, eating healthily and being active,” he explains.

At the HSA, non-invasive CT Coronary Angiography and Calcium Scoring are key tools for early cardiovascular screening. Performed using a CT scanner, these tests are recommended for men over 40, women over 45, smokers or ex-smokers, persons with a family history of heart disease, diabetes, high cholesterol, high blood pressure and those with a sedentary lifestyle.

“Outside of prevention, early detection of cardiovascular diseases provides opportunities for early specialist intervention, offsetting various related diseases that may prove debilitating and costly,” Dr. Noronha highlights. “The availability of advanced imaging equipment at the HSA provides an opportunity to be proactive in patients’ risk assessment. With CT Calcium Scoring, we can stratify patients’ risk before symptoms even appear, and CT coronary angiography allows us to non-invasively pinpoint blockages when further investigation is needed.”

CT Calcium Scoring uses a non-contrast CT scan to measure the buildup of calcium, an early sign of atherosclerosis, in the coronary arteries. The widely used procedure to assess a patient’s cardiovascular risk takes five to 10 minutes to complete.

“The scan was easy; I just lay there,” indicated Ms. Gardiner of her experience of undergoing the test. “They put an IV in my arm to give me contrast. The scan itself was painless and fast. Quick, easy and peace of mind. It’s all about prevention. That is the key!”

Data from the Ministry of Health’s STEPS 2023 National Health Survey indicate that 3.7% of the population reported having a heart attack or chest pain from heart disease (angina). The survey further highlights the increased risk of experiencing cardiovascular diseases for persons aged 45-69, almost three times more likely compared to those aged 18-44.

“In patients with elevated scores, vigorous management of blood pressure, cholesterol, diabetes, and smoking cessation can significantly reduce the likelihood of a heart attack. Patients with no calcium detection should repeat the test after five years, but we still advise them to maintain a healthy diet and exercise. Where patients have risk factors, we may follow up with a CT Coronary Angiography,” Dr. Noronha stated.

Unlike CT Calcium Scoring, the CT Coronary Angiography test utilises an intravenous injection of contrast dye to highlight the coronary arteries, enabling radiologists to identify narrowing or blockages. The test is usually performed after an overnight fast and does not require the insertion of tubes or catheters into the heart arteries.

If significant narrowing is detected, patients are referred for an invasive coronary angiogram using coronary catheters, where blockages can be treated with stents or, in some cases, bypass surgery.

Dr Noronha is a member of the Royal College of Physicians, London and the Royal College of Physicians, Ireland. He completed his doctorate in medicine at King’s College London and his specialist training in Internal Medicine and Cardiology in Liverpool and London.

His clinical interests include transthoracic echocardiography, exercise and dobutamine stress echocardiography, transesophageal echocardiography, cardiac computed tomography, knowledge of nuclear stress tests, implantable loop recorders, radial and femoral angiography, single- and dual-chamber pacemakers, and ICD and pacemaker battery replacements.

For more information on the Cardiology team and services, visit https://www.hsa.ky/medical-services/cardiology