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  1. 1

    Janet hunter

    The calcium score is the big news. See the Ivor Cummins. Glad he made it through

    1. 1.1

      Jan Sheringham

      Hi Janet,
      I too am very glad Bruce made it through all this, BUT I disagree about the calcium score. There is a reason it is not funded – it is only an INDICATOR of POSSIBLE risk, and in Bruce’s case, as in many others, there were other indicators present. The classic reduction in exercise tolerance, while apparently small, is MUCH more relevant, and is indeed THE take-home message from this story. While a raised calcium score suggests stiff vessels, it is by no means always associated with SIGNIFICANT arterial flow reduction – it is entirely possible, and not infrequent, to have a high calcium score BUT normal or minimally restricted arterial flow! Medicare would certainly be funding these tests if it was actually a GOOD INDICATOR of arterial flow reduction – unfortunately it is not, it us just another relatively expensive test which only confirms what you should already know in a currently treated vasculopath – the need to be vigilant about changing symptoms and signs! Now, whether there is a cheaper way to use calcium scores as a SCREENING tool, that is an entirely separate can of worms! After all, how hard is it to take a good family history, check the BP, and, if sufficiently concerned, do both resting and exercise ECGs! Even adding in your fasting glucose and lipid levels, you are STILL way ahead both with sound risk stratification AND costs!
      No, from my experience over the last 45+ years as a GP, the telling elements in Bruce’s story were his known aortic valve issue AND his reduced exercise tolerance, only recognised in hindsight. NEVER ignore changing symptoms, and ALWAYS advise patients AND their immediate carer/partner about what to look for, especially in the presence of known aortic valve changes.

      1. 1.1.1

        Lesley Russell

        Dear Dr Jan

        Thanks for your comments here – totally agree, as do various doctors we have talked to. The way Bruce’s increasing exercise intolerance played out – including the fact that it varied across the day – was as indicative of cardiac problems as chest pain. But we didn’t know (and it was insidious and not sufficiently severe to have B wondering what was going on). If it had not been for the sepsis, Bruce would have been another older male unexpectedly dropping dead while running, skiing, hiking etc.

        But this sort of discussion – and increased awareness- is exactly what Bruce and I want to generate with this article. Has also garnered lots of comments from our anti-statin friends!



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