Brain fluid leaks, heart troubles, environmental health in the Kimberley and defining health poverty

episode

Health Report 29 min 2 speakers 8 chapters transcribed 3 days ago

▲ 0

Transcript

jump: chapters · speakers · find in transcript

Transcript

Transcript generated automatically by AI and may contain errors.

Could a severe headache be a sign of a hidden brain‑fluid leak?

Unknown 0:02

This is an ABC podcast.

Dr. Norman Swan 0:06

Hello and welcome to this week's health report with me, Norman Swann. Today could that headache be something your doctor hasn't thought about?

Sophie Michael 0:13

I was at work.

Dr. Norman Swan 0:14

Sophie Michael 0:14

just started to feel really off. And then all of a sudden I had the headache from hell. It's the only way I can describe it. It's like someone had taken a piece of elastic, wrapped it round my head, and then pulled it really tight.

Dr. Norman Swan 0:27

That's headaches later. Politicians and bureaucrats tear their hair out about why the gap in illness and life expectancy between the non-Indigenous and Aboriginal Storestry Islander communities in Australia isn't budging. But if you actually listen to Aboriginal communities, the mystery disappears, and it could save a fortune in hospital costs along the way. Could a new concept called health poverty shift thinking for all disadvantaged communities? and a shocking finding of extraordinarily high death rates from a common heart valve problem. The aortic valve controls the exit to the heart as it pumps blood around the body, including to the heart muscle itself. When the aortic valve narrows, it's called stenosis, and aortic stenosis has several causes, including defects from birth, damage from rheumatic fever, and calcium buildup as we age.

Dr. Norman Swan 1:18

Aortic stenosis may have no symptoms, but as it becomes severe, there's breathlessness, feeling faint, fatigue, and chest pain on exertion. And it's well known to increase the risk of premature death from stroke and abnormal heart rhythm, amongst other causes. The question though is what is the risk of death relative to the degree of narrowing? That's been answered by the world's largest follow-up study of people who've had a heart ultrasound. It's called echocardiography. The technique is used to diagnose aortic stenosis, and in this study, there were 530,000 echoes and 340,000 people detecting aortic stenosis in 25,000 of them who are followed for over a million person years. So it's not small. David Playford is Professor of Cardiology at North.

Dr. Norman Swan 2:03

Notre Dame University in Western Australia and one of the founders of this huge registry of data.

David Playford 2:08

As the aortic valve starts to narrow down, the person with that problem doesn't know they've got a problem. They they don't have any symptoms, they don't have any knowledge that the issue is there. And over time the valve as it progressively narrows, puts a strain on the heart, and then eventually, as it's severely narrowed, it does then produce symptoms. And and at that point with it was discovered a very long time ago that when the symptoms occurred, the risk of death was very high. And so that was the point where the decision had to be made on whether or not to intervene. So the challenge over the years has been to work out when should we fix this valve. The actual surgery of the valve has some risks associated with it, so we don't want to subject somebody to surgery unless the timing is right.

David Playford 2:53

But at the same time, we don't want people to be left too long. So our question here was not related to the presence or absence of symptoms, was just can we work out purely based on the data we can pick up from a echocardiogram? Whether or not there is a risk associated with leaving the aortic valve as it is without fixing it.

Dr. Norman Swan 3:11

And what did you find?

David Playford 3:12

We found that aortic stenosis itself is associated with risk at any level, and that severe aortic stenosis, as previously known and as expected, was associated with a very high risk of mortality if nothing is done about it.

Dr. Norman Swan 3:26

And quantified?

David Playford 3:27

Over five years there was a sixty eight percent mortality risk.

Dr. Norman Swan 3:31

That's extraordinary. So nearly seven out of ten people, when you've diagnosed spheriotic stenosis, which is simply how narrow the valve has got, how dysfunctional the valve has got, seven out of ten will be dead in five years of a stroke or a heart attack or something like that.

David Playford 3:45

We don't know exactly but it's most likely going to be a sudden cardiac death. So that is consistent with what we already know though.