Heart screening: what tests will I need?

To check your heart thoroughly, your doctor will conduct several tests

Some can be done in a day clinic, while others might require you to stay in the hospital. Dr Francois Erasmus, a physician at Mediclinic Kloof, explains more.

Stress electrocardiogram

A stress electrocardiogram (ECG) is performed while you exercise on a treadmill or stationary bicycle in your doctor’s office. As your body works harder during exercise, it requires more oxygen, so your heart must pump more blood. If any blockage exists in the arteries supplying blood to your heart muscle, it will reduce oxygen supply and the ECG will change. This test will also unmask an arrhythmia (Abnormal heart rhythm) brought on by exercise. If you experience any chest pain or other symptoms, your doctor will stop the test.

Ambulatory ECG monitoring

If you have heart palpitations that can’t be recorded during a stress test, you might need an ambulatory electrocardiogram (ECG). Electrodes attached to wires that lead to a small recorder worn on a belt can record your heart over a period of 48 hours. Your doctor might ask you to keep a diary of any symptoms you experience during this time, so they can correlate them with any changes that occur on the monitor.

“If you’re at low risk for heart disease, you should visit your doctor for a heart assessment at least every five years,” says Dr Erasmus. If you’re at intermediate or high risk, you should have a heart screening at least every two years. Some high-risk patients might need an annual screening.”

Echocardiogram

An echocardiogram, commonly referred to as an echo, is essentially an ultrasound of the heart. It is performed in a similar manner to that of a scan of an unborn baby during pregnancy. It gives your doctor a picture of the shape and size of your heart, plus a close look at the functioning of the chambers and valves. The ultrasound image may indicate previous damage caused by coronary artery disease or other diseases of the heart muscle. It also provides information about leaking or narrowed valves.

For a standard non-invasive transthoracic echocardiogram, (TTE) your doctor will place a transducer (an electronic device that converts energy from one form to another) on your chest. Having a TTE is slightly more complicated as the transducer is attached to a flexible tube and guided down your throat to get a closer look at your heart. This test will only be performed when your doctor has a more serious concern that requires further investigation.

Carotid ultrasound

Carotid ultrasound can be used to determine whether there is any narrowing in the carotid arteries that supply blood to your brain. While you lie on your back, your doctor places

an ultrasound probe on the arteries in your neck. Changes in the thickness of the artery can predict similar changes that may occur in the heart. The presence of plaque in the carotid arteries may help decide whether a patient should be on statin therapy (tablets) to reduce cholesterol levels in the blood.

Coronary angiogram

If your stress test is positive, or you’re experiencing angina (chest) pains, your doctor might suggest a coronary angiography. This is a detailed way of examining the coronary arteries and is performed under local anaesthetic in hospital. It can be performed from your groin or arm.

The catheter is passed from your groin or arm up the aorta and to the coronary arteries. A contrast (iodine) is injected into the arteries and pictures are taken to provide a very accurate assessment of the state of your arteries. If your doctor sees narrowing of your arteries, they can insert a stent to open them at the time of the procedure. While any procedure that involves invasion of the heart can be risky, the advantages certainly outweigh the disadvantages.

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