15 April, 2024

General check up for heart

Introduction:
Everyone should get a routine medical check-up for heart health, not just because of some sensational news of some celebrity dying due to a heart attack. Unfortunately, heart disease is prevalent, and is often unpredictable. Heart disease is responsible for the majority of the deaths and disability worldwide. Keeping our hearts healthy and happy is an essential component of general well-being.

Essential components of a routine check-up for heart health include:
1. An in-person meeting with a cardiologist
Ideally, the check-up should start here. Unfortunately, it usually ends here. A cardiologist can assess an individual’s baseline risk of heart disease and recommend investigations or medications tailored to the individual’s needs. Various aspects of risk assessment can be ascertained simply by taking a history and performing a physical examination.

2. Blood investigations
Blood investigations can test many of the risk parameters for heart disease. The common ones include blood glucose and cholesterol levels. Other special tests can be done as indicated.

3. Risk assessment scans
Certain scans are available which can be done to assess the baseline risk of an individual. The CT-coronary calcium score (CAC) is one such. CAC is a simple CT scan which does not require any preparation. It gives the extent of calcium deposition inside the heart arteries, indicative of future risk for heart attack. Many other scans are also available, and they are done as needed.

4. Evaluate the current state of heart function
Various components of the heart and tests to evaluate it are listed below:

Components of the heart:
4.1. Muscle power
The heart is a muscle whose main job is to pump the blood out. In purely physical terms, the human heart acts as a double positive displacement pump. The power with which the heart muscle pumps the blood out is measured as ‘Ejection Fraction (EF)’. The overall health of the heart muscle can be checked with Echocardiogram (echo). Echo is a simple ultrasound-based test for which no preparation is required. Cardiac MRI provides higher-resolution images of the heart muscle and provides highly precise EF assessment, and is ordered in specific clinical situations.

4.2. Valve function
The human heart has four valves which open and contract with each heart beat. Echo is an excellent test to evaluate the valve function. A modified echo, called Trans-Esophageal Echo (TEE), is sometimes ordered as it provides a more precise assessment of the heart valves. TEE test is done like an endoscopy and requires patients to be in a fasting state.

4.3. Current
Current flows through the heart muscle, in a fashion similar to that of concealed wiring of our houses. The current flow is responsible for a regulated rhythmic heartbeat. The current is checked with an Electrocardiogram (ECG). ECG is the most basic investigation of the heart. Other than looking at the current, ECG can also provide early signals of other abnormalities of the heart. ECG is the key investigation in diagnosing a heart attack.

4.4. Heart arteries
Blood vessels that supply blood to the heart are called coronary arteries. Blockages of the coronary arteries are responsible for angina (heart-related chest pain) and heart attacks. The best tool to check for the presence of blockages is coronary angiography (CAG). Since CAG is an invasive procedure, indirect tests are available, which can act as a gatekeeper to decide whether a person should be subjected to CAG or not. These indirect tests are: Treadmill test (TMT), Dobutamine stress echo (DSE), SPECT scan (also known as thallium scan), or a CT-coronary angiography.
*If the clinical suspicion for the presence of blockages is very high, a cardiologist may suggest skipping the indirect tests and directly going for coronary angiography. Otherwise, an indirect test is often performed first.

Salient points of heart check-up:
*One test or one health package does not fit all. That is why it is always better to get a customized recommendation from a cardiologist rather than visit a cardiologist to review the reports of a generic set of package investigations.
*It does not make sense to repeat the same tests frequently without a proper indication. For example, in an otherwise healthy individual, annual echo is a waste of time and resources.
*Understand the purpose of the test before going for it. An echo will never provide information regarding blockages, no matter how many times you repeat it. The presence of blockages can only be assessed by coronary angiography or the indirect tests mentioned above. Similarly, an abnormal indirect test should always be followed up with a coronary angiogram (barring a few exceptions). It does not make sense to do an indirect test for blockages, and not go for an angiography in case the test comes positive.

I am sure I didn’t answer all your questions on this topic. Feel free to message me with your queries; I will happily answer them.

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