Heart Checks

What is the best way to have a heart check?
At the Executive Medicine Centre, we calculate your 5 or 10 year risk of heart attack and/or stroke. We don't rely on stress tests alone but start with assessing how your heart is functioning now and ask you whether you have current symptoms of heart disease:

• Chest tightness or pain with exertion
• Undue shortness of breath
• Feeling faint especially with exertion etc

A word of warning
It is important to keep in mind that the first warning of heart disease in 68% of men and 48% of women is sudden death or a heart attack. In other words, you can't rely on symptoms as an early warning because most of us don't get that early warning!

Next, we check the heart’s current state with simple, non-invasive testing including a resting ECG to look for:

• Evidence of prior heart damage - so called 'silent heart attacks' are not uncommon
• Other clues such as rhythm disturbances or aberrant electrical ECG changes. Note: Severe heart disease is possible with a normal ECG.

An exercise ECG or stress test is often used. If normal, these results can be reassuring - particularly if you are in a low risk group. However, it is important to realise that for a stress test to be abnormal you would need to have severe advanced coronary artery disease - at least one artery already blocked more than 80%.

Note of caution
We know from experience that 3 in 10 people with significant arterial blockages will not show problems on a stress test.

How do we deal with the inaccuracies of these stress tests?
If your risk is at an intermediate level (not low), we will often encourage you to have additional testing which involves looking at an artery directly for evidence of plaque, assuming the exercise test is normal.

If we can identify signifant plaque, and if the stress test is normal, we then arrange for further testing and look harder to ensure you do not have a ‘false negative’ stress test result.

The imaging is critical because, in our practice, if plaque is present over and above the normal amount for your age, we would offer you “long term management” with intensive measures. Sometimes this involves lifestyle and medication to slow down the progression of plaque. We also recheck your plaque load over time to make sure you are on track.

A critical part of the executive health check program is the long-term management of your arteries by the same practise/provider. A normal stress test simply tells you that there is a 70% chance or so you do not have a critical arterial narrowing on the day. It cannot tell you what your arteries will be like in 6 month's time.

For example ...
Recently a 64 year old business man came in for this first executive health check. By our calculations his 5-year risk of heart attack and/or stroke was intermediate, not low, even though his exercise stress test was normal.

At our suggestion, he agreed to have his artery looked at directly and discovered that he had a surprisingly high amount of plaque present. Further testing revealed a significant partial obstruction of an artery in his heart. We arranged to have this obstruction corrected with a coronary stent, avoiding heart attack and heart muscle damage.

Fortunately this businessman is currently well, exercising and having his long-term health monitored and managed by us in conjunction with our cardiologist colleagues. He is also checked regularly for cancer and other signifant medical illnesses such as kidney and liver disease as part of our annual health check program.

What are the key messages for a healthy heart check?
1. Have your 5 or 10-year health risk profile calculated. This indicates the extent of testing required, the level of concern and the follow up necessary.

2. Have a thorough heart check. Remember a stress test is a good start but sometimes these tests can be misleading because they just tell you what your heart is like on the day - not how healthy your arteries are likely to be over the next few years.

3. Often, but not always, it is useful to look at arteries directly or employ other medical testing - for example nuclear scans or angiograms may be useful. This is why it is critical to see an expert who knows how to tailor this information and knowledge for your particular situation.

4. See an expert who is interested in you and can work with you to get you health risks down as low as possible. Discover the benefits of an in depth annual health check to help prevent illness and maintain optimal health.

Measure Up
Even the Federal Government is aware of the benefits of simple preventative measures that can be taken. In October 2008 television commercials went to air and the Health Department is distributing 700,000 tape measures to highlight the dangers of  an expanding waist line in both women and men. This result allows you to measure your risk, not just your waist. A great simplification of a strong message and important now as Australians are now ahead of the USA with adult obesity statistics.

The tape measures are colour-coded - green for lean and red for spread. For most Australians a waist measure of more than 94 centimetres for men and 80 for women means a risk of developing a lifestyle-related chronic disease such as diabetes or cardiovascular problems. The tape moves into the red if it goes over 102cm for men or 88cm for women, indicating a greatly increased risk of deadly and disabling diseases.

Go to www.australia.gov.au/measureup  for your free tape measure and information.

Book yourself in for an in-depth health check , heart check and health risk assessment today. Phone 02 9290 3259.