HOW I SCORED IN MY HEART SCAN

By Kee Thuan Chye,   New Straits Times

SOMETIMES that pain in your chest can be more than just muscle protest. I thought as much when I felt it recently. But the stress tests I had undergone over the years had shown that my ticker was tip-top, so I was not about to subject myself to another punishing drill on the treadmill. I decided to check out HeartScan. I had driven past this place along Jalan Maarof, Kuala Lumpur, countless times and heard and read about what it does. Its promise of being able to detect coronary disease through a quick and painless procedure appealed to me greatly. I hate having to work for anything. You might think that at the young and tender age of 46, I might not warrant such a scan, but I believe
that its always better to be safe than stroke-struck. Besides, there were the symptoms. And the risk factors. Not only because, like that line goes in that song by The Animals, "I smoked my first cigarette at 10"; but also because I'm male, overweight, hypertensive, blah blah blah. Electron Beam Computed Tomography (EBCT) seemed the best bet for me, short of an angiogram. The atmosphere in HeartScan was reassuring. Very informal and pleasant. That there were other patients? clients? scanees? in long-sleeved shirts and ties waiting to be scanned made it seem like we were going in for a business meeting than a medical procedure. Even when I was taken into the scanning room and instructed by the radiologist on what would be done, the informality prevailed. I was put at ease by the simplicity of it all. I didn't even have to remove any item of my clothing. That's a blessing for anyone whose experience of midlife crisis is breaking out in bulge.

 I lay on the cot, the radiologist made final checks, popped into the adjacent control room where she could see me through the glass partition, and at some point told me to hold my breath for 30 seconds to enable her to take pictures of my heart. That was all. It was over so fast you might think it wasn't value for money! Shortly after, I met with the HeartScan's consultant to go through the findings on the computer. He showed me cross-sections of my heart captured by the Ultrafast Scanner and explained that I had registered a calcium score of 2.1, which was "average" for someone my age. He pointed out that my arteries were clear except for some calcification in my right coronary artery, but it was nothing significant to worry about. He said studies had shown that if one's cholesterol level could be brought down to 4.0 and below, the process of atherosclerosis (build-up of plaque in arteries) could be reversed. He advised that I try to reduce my total cholesterol and increase my HDL (high-density lipoproteins), the good cholesterol that  transports bad cholesterol away from arteries. At this point, I was quite reassured that all was well, and the doctor reiterated that I was an unlikely candidate for a heart attack in the near future. Of course, if I did nothing to lower my cholesterol level, the plaque build up  would double  very two-and-a-half years and the story would be different perhaps a decade down the road.

 "The important thing is that you know what your condition is now and you can start doing something to prevent further plaque build-up that could precipitate a heart attack," said the doctor.  Then he asked me about my symptoms and I told him about the chest discomfort I felt under conditions of physical and emotional stress. I must have looked really worried because it led him to suggest that if I wanted a more comprehensive investigation, I could opt for an electron beam angiogram (EBA). This would undertake a 3-D imaging of my heart and look directly into my arteries. The cardiologist revealed that the calcium detection scan was only "95 per cent accurate", and that even a zero calcium score did not necessarily rule out the presence of coronary artery disease.  He recounted the case of a patient who came for a scan and, like me, registered a low incidence of calcification. But he complained that he experienced chest discomfort just pulling his golf cart, so the doctor put him through the EBA. More detailed in its analysis, the EBA revealed that one of his arteries was actually 100 per cent blocked. Fortunately for him, his heart muscle was well preserved and the  blockage was successfully treated with angioplasty. Fearful that my situation might be the same, I decided to go for the EBA as well, to clear any doubt inherent in that errant 5 per cent. This time, I had to take off my shirt and put on a gown. The radiologist had to be sure I wasn't allergic to iodine because an iodine-based dye would be injected into my body to illuminate my arteries for the benefit of the  scanner. I disclosed that the only effect seafood had on me was that it made me feel randy. Nonetheless, as a precaution, an anti-histamine was injected into me as well, just in case I did get an allergic reaction. For all I know, it might have been an anti-randymine. What happened next was -- and I had been forewarned about it -- my bottom started to itch like a flea-infested dog, and it desperately needed scratching. I looked in vain for a nurse to do it. One of the attendants asked if I needed a male or a female. I suppose nowadays you really have to ask. But seriously, the support from the laboratory and nursing staff was really excellent. At intervals during the 25-minute procedure, they came in to make sure I was fine and in good spirits.  The entire experience was painless except for the needle-pricks to inject the dye (if you could call that pain) and some tiredness in the arms from holding on to a pole above the head, with the left arm kept straight at all times so as not to disrupt the flow of the dye. Even having to hold my breath for 60 seconds for the crucial picture-taking was as easy as, well, breathing.  After that came the moment of facing the results. There on the computer screen. The heart in 3-D. Even in full colour if you want it, although its easier to spot aberrations in black-and-white. I saw the insides of my arteries with the blood coursing through them. It reminded me of the sci-fi movie Fantastic Journey, except that there was no Raquel Welch busting her way through my arteries. Perhaps it was just as well; she would have really melted them. 

My cardiologist’s  interpretation was positively encouraging. No significant plaque build-up was detected, and my heart functions were normal. He said my arteries were big and therefore blood-flow-friendly. And even if I didnt take precautionary measures, it would be quite a while before I got into trouble -- maybe 15 to 20 years' time. You can't imagine how I felt hearing that, although it still means I should be careful from now on -- watch my diet, exercise, stave off stress. But then that's the point about doing the scan. I wanted to know and now I knew, and from here on I can hopefully better handle my heart. That night, I went for dinner with a friend and drank a whole bottle of wine. To celebrate. Why not? It was red wine, anyway. Supposedly good for  preventing plaque build up. Or so they say. In any case, it was also a good relief for pain. Hang on, you might say. What about that pain in my chest? That discomfort that led me to HeartScan?  Who knows? In this cold and wet season, might it not be just rheumatism?