biggest killer.

But the use of echo cardiograms in addition to traditional stress tests has not helped to halt the high rate of deaths from heart attacks and strokes.

Heart disease, including heart attacks and strokes beat out cancer and infectious diseases as the main cause of death in Bermuda.

Now Government is making use of the machines in an initiative to educate people to live healthier lives.

February was recently declared heart and Education month by Minister of Health the Hon. Quinton Edness and Minister of Education the Hon. Clarence Terceira.

Mr. Edness reported said that 195 people -- 109 men and 86 women died from heart disease in 1992 and there did not appear to be any marked reduction in those figures this year.

It follows trends throughout the 1990s so far with 205 deaths in 1990 and 193 in 1991, both around 40 percent of total deaths.

Thanks to organisations like the Heart Foundation and generous private donations, the King Edward VII Memorial Hospital has obtained some of the latest technology available as it aims to keep pace with developments in the treatment of heart problems.

The healthy human heart is an amazing muscle capable of pumping five litres of blood around the body while it is resting and double that amount when the body is under heavy stress.

Smoking, lack of exercise, and a family history of heart disease or diabetes are some of the many factors that lead to heart problems.

The echo cardiogram, and stress testing are two pieces of technology used at the hospital to diagnose heart ailments.

Before the echo cardiogram was purchased three years ago, stress testing was used extensively to pinpoint problem areas.

First, the patient is connected to the testing machine's computer by means of several wires attached at various points around the chest and their resting heart rate is measured.

Next they get onto a treadmill which is set at a leisurely pace, this is slowly increased along with the gradient until the patient has reached their maximum stress level for their age and ability.

This whole process is carefully monitored and recorded on an electrical graph printout from the computer. Any irregularities are noted and checked out.

However, there are limits to this equipment as Dr. Marshall explains: "I can only make indirect inferences about the blood supply to the heart,'' he says, "this is done by looking at how the electrical patterns change as the patient is subjected to increased stress.'' Dr. Marshall says the echo cardiogram, which the hospital purchased for $175,000 three years ago thanks to generous public donations, allows him to make more accurate assessments.

The echo cardiogram which has a monitor and VCR, uses sound waves to look at the heart from various angles. It also measures the various parts to ensure they are within acceptable ranges.

Three wires are attached to the patients chest and a device called a transducer is rubbed over the chest area with a little gel. The transducer converts electrical energy from the machine into sound waves which are pointed at the heart. When they reach, the rebounding sound waves are then changed back into electrical signals which creates a picture of the heart on the screen.

"One of the good features of this machine, is that it has a cursor which can be placed on any vessel anywhere on the heart. It can tell how fast the blood is flowing and its direction.

"This machine is better than a static X-ray, because it shows how the heart is actually functioning. We use the VCR to record all of the images so they can be played back and kept for future reference.

"We will often use this machine with the stress test. I can use the echo cardiogram to look at the patient's heart while it is at rest, and then put the patient on the treadmill. After their heart rate has been worked up on the treadmill, they can be put under the echo cardiogram without cooling off so we can look at their heart under the stress of exercise.'' IN SHAPE -- Dr. Shane Marshall takes a moment to explain the results of the echo cardiogram to Royal Gazette reporter Mr. John Burchall who took an echo cardiogram and stress test recently at the King Edward VII Memorial Hospital.

Behind Dr. Marshall is the $175,000 echo cardiogram which converts sound waves into two dimensional images on the screen. For the stress test Mr. Burchall's heart rate was increased to 167 beats per minute using a treadmill of steadily increasing gradient.

PRESSURE TEST -- Mr. Cal Ming took the opportunity to check on his progress since his heart transplant last year. Mr. Ming was in the Phoenix Centre where free blood tests were being carried out by nurse Ms Marilyn Sannenalm.