Monday, February 13, 2006

Heart Check 1: See your doctor

This is part 15 of the series heart of the matter. Part 14 can be found here and the disclaimer can be found here.

The most important part of a heart check is the interview with the doctor. This must form the basis of all checkups. The present day factory style "go through a barrage of test" and then have someone interpret the results and prescribe health is medically incorrect. There is much that can be gained from having a doctor see you first and take a careful history and do a thorough physical examination, even if you feel well.

This simple clinic check will allow the doctor to make an assessment and arrive at a provisional diagnosis, know what aspect of the heart check is important, what to look for, prescribe test that are relevant and not do test that are irrelevant (be cost effective). For example, we often see 30-something females without significant CAD risk factors going for a stress ECG. This subject has such a low possibility of CAD that the stress ECG cannot be interpreted. We see respiratory function tests being done for subjects who cannot blow, stress ECG being done for hemiplegic who can hardly stand.

Moreover, some "screening test" carries risk which are not well highlighted to the subject. Radiation risk for example. Deaths has been known to occur with some "routine screening test". If you are a healthy adult without disease, going for a health check, any risk, no matter how small, from any test, be it radiation risk, medication risk from tablets taken before tests, physical injuries sustained while performing test that you cannot perform, etc. is unacceptable. Even one is too many.

After a clinic interview, as part of the checkup, the resting ECG and CXR usually give us invaluable clues about the heart. It helps the doctor to know what other test may be pertinent. These test (ECG and CXR) are simple and cheap, and gives good information. The CXR does have a small risk of radiation,(relevant to the pregnant female subject) but is virtually harmless otherwise. As you can see, some test do carry risks although small.

Blood tests too are important as they allow us to form a risk profile for the individual. Just as in insurance where we risk profile clients, so also in heart check-ups. The higher the risk profile, the more likely the presence of disease, and vice versa. Blood tests eg the lipid profile and the exclusion of diabetes and renal disease helps us to risk profile the subject. We can also mark out a person's risk for a heart attack by checking for certain high risk markers in the blood like hs-CRP. These blood tests are cost effective.

In the next part we discuss echocardiograms.

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