What happens during heart screening

By Dr Peter Ting

Heart disease is one of the top killers in Singapore and the world.

Quite often, it presents suddenly and catastrophically with a heart attack or sudden death. Earlier detection of underlying heart disorders helps us reverse its progression and prevent serious complications. Heart screening refers to a medical evaluation which may include one or more specialised tests to detect underlying heart disorders in people who are otherwise well an have no symptoms.

So what happens during heart screening? It begins first with a thorough consultation and physical examination by a general physician or cardiologist to assess for the presence of risk factors that predispose to the narrowing of blood vessels, also known as atherosclerosis. These include diabetes, hypertension, high cholesterol, obesity, smoking, sedentary lifestyle, poor nutrition, excess alcohol and an existing family history of heart disease, stroke or sudden death.

A resting electrocardiogram (ECG) is performed, and blood test are carried out, which include but not limited to the fasting cholesterol and blood sugar. After this initial assessment, the physician would then determine based on the age and background of the patient, as well as the presence and severity of risk factors on what would be the most appropriate tests to conduct subsequently.

There are several tests available to assess the heart, each looking at different aspects of the function and structure of the heart to determine the overall health, and subsequent risk of developing heart disease and its complications. Some common tests include an echocardiogram or ultrasound of the heart which allows us to look into the heart and observe the internal structure of valves and chambers, and the ability to pump.

Another important aspect to investigate is the health of the coronary arteries, which are crucial in supplying the heart muscles with blood oxygen. Unhealthy narrowed vessels may be detected by stressing the heart either with exercise or with drugs, to look for any evidence of inadequate blood supply. This is done through treadmill ECG testing which may additionally involve cardiac imaging with echocardiography or nuclear perfusion for greater accuracy.

The anatomy of the coronary artery may also be directly assessed with a Computed Tomography (CT) scan either in the form of a calcium scoring study or coronary angiogram, which requires a slightly higher dose of radiation as well as injection of intravenous contrasts agents.

After completing the tests, the doctor will review all the findings with you, establish your individual risk, and make further recommendations in terms of preventive interventions. This may range from just simple healthy lifestyle modifications or even surgeries in more serious cases. Depending on the findings, the patient may also require future monitoring, in order to see if the interventions have stopped or even reversed the progression of any existing disease.

Do ask your doctor whether heart screening might be suitable for you, even if you feel well, especially if you fulfil the following criteria :

Male >45 yrs or female >50 yrs
Planning to start vigorous exercise
A pre-existing family history of heart disease, stroke or sudden death

Or if you already have 2 or more of the above-mentioned risk factors for heart disease.

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