Question: I am a woman in my 40s and I feel like no matter how much I exercise, I don’t have great cardio fitness. My father has had a triple bypass and my mother has atypical hyperplasia. I went for a general health check and everything came back fine but I was wondering if there were more extensive heart tests I could ask for? I know of someone who had a general check-up recently and was clear but had a heart attack subsequently due to blocked arteries even though they felt very fit and healthy.
Dr Grant replies: I bet if you trained correctly you could improve your overall cardiovascular fitness. Often short bursts of high intensity exercise (e.g 6 x 400m runs) are better at improving cardiovascular fitness than running at a varied pace for 10km on your own. The same applies to building muscle mass. Unless you are eating the appropriate high protein diet and performing reps correctly in a supervised fashion, it is difficult to see results. Persistence pays off and you won’t regret spending money getting professional help.
There are several free online cardiovascular tools to estimate a person’s risk for potential coronary heart disease (CHD). While these tools can be reassuring to see a low-risk profile, they are obviously not definitive and questions still linger such as, is there any current evidence of CHD or the likelihood of future events related to CHD? No test is 100pc definitive and there will always be an element of doubt.
It’s good that your recent health check went well and you were not advised to attend a cardiologist for further assessment. This means your lifestyle factors, such as current level of physical activity, overall fitness, dietary choices, cigarette/alcohol intake, use of illicit drugs, stress levels, and overall quality of sleep were all deemed appropriate.
Your body mass index (BMI), body fat, muscle mass, blood pressure and cholesterol profile (breakdown in good and bad cholesterol) also contribute to your cardiovascular risk assessment. Having a positive family history of heart disease (a first degree relative under 55 years old suffering heart attack) and early menopause before 40 years old may also impact your risk of CHD.
Patients with multiple risk factors for CHD such as strong family history, current heavy smoker, morbid obesity, familial high cholesterol or poorly controlled hypertension, should consider CHD screening. Just to mention, patients with diabetes, metabolic or kidney disease, are at increased risk of CHD and should discuss their need for CHD screening with their doctors at a routine review.
An exercise stress test is generally the first preferred screening tool in patients who are without symptoms (e.g chest pain or tightness or difficulty breathing when exercising) that are deemed to be at intermediate or high risk of CHD and who are able to exercise.
For patients who develop a positive stress test at a low workload or have more than 20pc of the heart muscle showing evidence of inducible ischaemia, an invasive formal coronary angiogram is indicated. A positive test at higher workloads may warrant treatment with additional imaging modalities, and a CT coronary angiogram would be favoured given the advantage of anatomic coronary assessment.
However, in patients with a higher baseline risk, proceeding directly to CT coronary angiogram would provide the advantage of an anatomic assessment to help assess the extent of underlying disease.
There are other specialised tests like cardiac perfusion MRI scans that are sometimes indicated for further reassurance.
Dr Jennifer Grant is a GP with Beacon HealthCheck
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