What does preventive examination for heart disease include?

Routine basic screening, advanced screening for medium-risk groups, and special examinations for high-risk groups can basically cover the early screening needs of most heart diseases. Ordinary people do not have to rush to order the most expensive examinations. It is enough to adapt to their own risk profile.

The four items of blood pressure, fasting blood sugar, blood lipids, resting electrocardiogram and cardiopulmonary auscultation in our annual routine physical examination are actually the most basic preventive examinations for heart disease. Don’t underestimate these items. 80% of the risks of early myocardial ischemia and arrhythmia can be detected through these preliminary screenings. Last week, I met a 35-year-old Internet product manager in the clinic. He had skipped three consecutive physical examinations because he thought the blood lipid test was useless. Recently, after staying up late to catch up on projects, he always felt his chest was tight and stuffy. When he came for the test, his blood lipids were already twice the normal value, and his coronary arteries had been mildly narrowed. If he had checked his blood lipids two years earlier, he would not have been able to adjust his diet and rest to this point.

If you smoke, drink alcohol for a long time, have a BMI over 28, or have an immediate family member who was diagnosed with heart disease before the age of 50, just doing the basics may not be enough. Many people have a misunderstanding. They think that a normal resting ECG means that there is no problem with the heart. In fact, many hidden myocardial ischemia will only show up when the heart load increases. At this time, it is generally recommended to do an exercise treadmill test. To put it bluntly, it means that you run uphill on a treadmill at a rhythm while monitoring ECG changes in real time. It is equivalent to a "stress test" for the heart. Ischemia problems hidden in the resting state can basically be revealed. Speaking of this, there is another controversial point that has not yet been unanimously agreed upon in the academic community: whether coronary CTA should be used as a routine screening item for medium-risk groups. Those who support it believe that people over 40 years old and with more than two high-risk factors at the same time can do it once a year to detect early coronary stenosis and nip the problem in the bud. ； The opposing side believes that coronary CTA has a certain radiation dose. If there are no clear symptoms of chest tightness or chest pain, there is no need to do it routinely. On the contrary, it will only increase the risk. Currently, clinical practice generally recommends that mid-risk people with suspected symptoms do it. Those who are asymptomatic can first do an exercise treadmill test for preliminary investigation.

If you have a history of high blood pressure or diabetes for many years, or if you have previously been diagnosed with arrhythmia or myocardial ischemia, you are a high-risk group and require more targeted special examinations. For example, the 24-hour dynamic electrocardiogram can be carried on the body to monitor the changes in the electrocardiogram for 24 hours. Whether you feel flustered when climbing stairs during the day, or have chest tightness when sleeping in the middle of the night, any abnormal electrocardiogram during an attack can be recorded. It will not only capture information for a few dozen seconds like ordinary electrocardiograms. There is also cardiac ultrasound, which is equivalent to taking a dynamic "stereoscopic radiograph" of the heart. The size of the heart, whether the valves are tightly closed, the strength of the myocardial contraction, and whether there are congenital structural abnormalities can be clearly seen. Early heart failure and valvular disease are basically diagnosed by this.

In fact, you don’t need to worry about incomplete examinations. It’s enough to find a specialist to evaluate your risk level and choose the corresponding examination. For young people in their 20s with no underlying diseases and no family history, basic screening every year is enough. There is no need to blindly pursue expensive examinations and waste money.