What does preventive examination for heart disease include?

First of all, it must be made clear that there is no unified list of preventive examinations for heart disease that applies to everyone. Risk stratification is first done based on age, basic medical history, family genetic history, and daily routine, and then the corresponding items are matched. The more expensive the better, nor does the more complete the examination, the more reliable.

Last week, a 32-year-old young man who works in Internet products came to my outpatient clinic. After working on a major project for half a month, he occasionally felt tightness in his chest. After watching too many cases of sudden death while watching short videos, he was so frightened that he had to undergo a full set of cardiac examinations, including coronary angiography. I assessed the risk for him: apart from staying up late and being slightly overweight, he had no family history or high blood pressure or diabetes. He would not experience chest pain even if he climbed the fifth floor. He was a low-risk group. He did not need to undergo invasive or radiation examinations at all. He only prescribed an ordinary electrocardiogram, a blood lipid and blood sugar test, and a heart ultrasound. The final results came out okay, but the low-density lipoprotein was slightly higher. He just had to drink less iced milk tea and have a regular schedule when he went back. I was worried for several days in vain.

In fact, for the vast majority of ordinary healthy people who have no underlying diseases and no obvious discomforts, annual routine physical examinations of blood pressure, blood lipids, fasting blood glucose and an ordinary 12-lead electrocardiogram are enough. These items are equivalent to an "entry security check" for the heart. It is cheap, zero-invasive and can be done in ten minutes. Most abnormal heart rhythms and potential signs of myocardial ischemia can be screened out at this step. If you always feel flustered and have a pounding heartbeat from time to time, but you just don’t have an attack during the normal electrocardiogram, you can also add a 24-hour dynamic electrocardiogram, which is often called a Holter. A small box the size of a soybean hangs on your body 24 hours a day. You can go to work, work overtime, or sleep. , every beat of the heart can be recorded during exercise. I used to have an aunt who always woke up with panic at two or three o'clock in the middle of the night. Three ordinary electrocardiograms were performed and all were normal. After wearing the Holter for two days, paroxysmal atrial fibrillation in the early morning was detected. Timely intervention prevented it from developing into a more serious problem.

If you have basic diseases such as high blood pressure, diabetes, or hyperlipidemia, or have a family history of myocardial infarction before the age of 55 in your immediate family, or if you smoke, drink alcohol, or are overweight all year round, and you are a medium-to-high risk group for heart disease, then you need to add a heart ultrasound to the basic examination. This examination is equivalent to taking a dynamic high-definition image of the heart. The size of the heart's chambers, whether the myocardium is thick, whether the valves are tightly closed, and whether the blood pumping function is sufficient, can all be seen clearly, without fasting and without radiation, which is very convenient. If you always have chest tightness and pain after exercising or climbing stairs, and it will be relieved after a few minutes of rest, you can also do an exercise treadmill test, which is to walk uphill on a treadmill under the supervision of a doctor, slowly increase the amount of exercise, and monitor the changes in the electrocardiogram to see if there will be signs of ischemia when the heart load increases. The sensitivity is much higher than ordinary electrocardiograms.

As for the coronary CT and coronary angiography that many people have heard of, these are targeted examinations that are invasive or involve radiation, and are really not recommended for ordinary people for routine screening. There is actually a bit of controversy in the academic community. Some studies believe that early coronary CT screening for medium-risk groups can detect hidden coronary artery stenosis and avoid sudden myocardial infarction events. However, more clinical guidelines still believe that the false positive rate of this test for low-risk groups is too high. It is nothing, but a mild plaque is detected, but it brings unnecessary anxiety, and even more excessive examinations are required in the future, which is not worth the loss. Generally, this type of examination is only recommended if there are abnormalities in the previous basic screening, or if you already have typical symptoms of angina and belong to a very high-risk group. It is equivalent to taking a high-definition fluoroscopy directly on the coronary arteries that supply blood to the heart. Whether there is stenosis and how much stenosis is is clear at a glance. As the gold standard for diagnosing coronary heart disease, coronary angiography is usually chosen directly when serious stenosis is suspected and stent placement is planned at the same time.

There are also many people who want to check for cardiac enzymes and troponin when they feel chest pain. In fact, these two tests are for acute myocardial injury. If there are no suspected symptoms of acute myocardial infarction such as persistent severe chest pain and squeezing sensation, these two tests are not necessary for routine preventive examinations. It is a waste of money.