Thursday, February 09, 2006

Heart Checks

This is the fourteenth part of the heart of the matter. Part 13 is here and our disclaimer is here.

The saying is true, "prevention is better than cure ". Medicine has entered the era of preventive medicine, where we hope to create greater awareness among people of their health and teach them to know and appreciate good normal health, as opposed to sickness. In a way, we are trying to work ourselves out of a job. Incidentally. it is to this end that this column is initiated.

If all illnesses can be prevented and the population at large can follow all the preventive steps, then the need for doctors will be less. But alas, that will never be, although it remains our dream. Preventive medicine is also much more cost effective, and has lesser morbidity and mortality. It is our hope that this message gets through.

As a result of this paradigm shift, we see the setting up of many wellness centers whose aim is to check normal people and give them a clean bill of health. This is now a flourishing industry, spreading on to health tourism and mega-dollars.

Myths to correct

What are we looking for when we go for a heart check? Well, we are obviously trying to see if our heart is in good condition and if we are at risk from heart disease in the near future. Whenever I get a request for a heart check, I sense that the client (we can't call them patients as they have no illness), expects that after the heart check, he will be guaranteed that he is not going to suffer any cardiac events. This is the first myth that we must correct.

There is no one cardiac test (or even a series of test) that can completely exclude a cardiac event. Heart checks merely establish the state of your heart at that point in time with the current available tests, none of which have a 100% predictive accuracy.

The second myth to correct is that one test can tell all. That is simply not true. There are so many aspects of heart disease and so many kinds of heart disease, that it is not possible for one test to tell all. There is heart disease present from birth which we call congenital (eg hole-in-the-heart), heart disease from valve defects (valvular heart disease), heart muscle disease (cardiomyopathy), cholesterol heart artery disease (coronary artery disease), disease of the heart from hypertension and other related body maladies, and many others. Besides these, there are tests for the functional aspects of the heart, test for the structural defects of the heart, and test for the electrical aspects of the heart. No one test can tell all. How can they?

The third myth is that all tests are free of risk. Generally, the more sophisticated the test, the more likely the side-effects.

Most often, we are trying to establish three things.
1. Is the heart structurally normal
2. Is the heart functionally normal
3. In those at the CAD risk group, is there any evidence of heart artery blockage causing lack of blood supply?

In the next part we describe the first step in a heart check.

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