What does preventive examination for heart disease include?

For routine preventive examinations for heart disease, for ordinary asymptomatic people, it is enough to first perform blood pressure, blood lipid, and fasting blood glucose tests plus routine electrocardiogram and cardiac ultrasound. For those with high-risk factors, dynamic electrocardiogram, coronary CTA and other items can be added in a targeted manner. There is no need to pursue expensive and comprehensive examinations right from the start.

I met a 38-year-old Internet operator at a community free clinic last week. After staying up all night for a week, he occasionally felt pain in his chest. When he came, he asked if he wanted to have a coronary angiogram. I stopped him at that time and ordered several basic tests. Finally, it was found that the blood lipids were high, and the electrocardiogram showed nothing. I adjusted my work schedule and took lipid-lowering drugs for half a month, and the symptoms disappeared.

In fact, many people are either too negligent or too anxious about heart screening. If you think about it, basic blood pressure, blood lipids, and blood sugar are used to score the "living environment" of the heart. After all, the three high blood pressures are the number one culprit of damaging blood vessels. If there are any abnormalities in these items, even if the heart has no symptoms for the time being, intervention must be made in advance, just like if a water pipe flows with dirty water every day, it will definitely be easier to block than clean water. A conventional electrocardiogram captures instantaneous heart rhythm abnormalities and checks whether the heart's "circuit" is beating randomly. A cardiac ultrasound is more direct and can reveal the structure, size, and pumping function of the heart. It is equivalent to taking a dynamic "structural color ultrasound" of the heart. Congenital heart disease and valve problems can be screened out.

If you have high-risk factors, such as an immediate family member who suffered from myocardial infarction or sudden death before the age of 50, or you have had three highs for many years, smoked for more than ten years, often socialized and drank, and you always have chest tightness and pain after exercise, or inexplicable palpitations that last for a few seconds, then you need to add targeted items. For example, if you can't catch a panic attack, you can memorize a 24-hour dynamic electrocardiogram. The small machine is fastened to your waist. You can go to work and sleep normally without delaying it. As long as you don't touch the water, you can record any "random beating" of your heart in 24 hours, which is much more effective than a single electrocardiogram. If there is suspicion of coronary artery stenosis, coronary CTA can be done. It can be done in an outpatient clinic. After the contrast agent is created, the CT scan can be used to see whether the blood vessel is blocked and how much it is blocked. There is no need to be hospitalized for invasive procedures like coronary angiography.

Here is another point that is not yet completely unified in the industry, which is whether high-sensitivity troponin should be included in routine screening. One school of thought believes that ordinary people without symptoms do not need to check. After all, staying up late the night before or running a half-marathon may cause a transient increase, which can easily cause unnecessary anxiety.； The other group believes that people with multiple high-risk factors can undergo additional procedures to detect hidden myocardial damage earlier. This can be done based on their own situation and communicated with the treating doctor, so there is no need to worry.

In the past two years, there was a 47-year-old business executive who only had a regular electrocardiogram during his annual physical examination, which was normal every time. However, his triglycerides had been high for 6 years and had never been checked. Later, he had chest pain and sweating after eating with a client. When he went to the emergency department for examination, he found that 80% of the anterior descending artery was blocked. After a stent was inserted, it was fine. If he had done a coronary CTA in addition to the routine screening a year or two earlier, it would not have developed to such a critical point.

Don’t believe in the promotion of a “full set of cardiac examinations”. For example, it is completely unnecessary for ordinary young people to undergo coronary angiography and heart disease genetic testing when they have no symptoms. The former is an invasive diagnosis and treatment method and is not used for screening at all. The latter, unless there is a family history of familial cardiomyopathy or hereditary arrhythmia, is found to be “high risk” and has no practical significance except to cause trouble for oneself. It is better to take some time to exercise every week and stay up less late at night.