What is Cardiovascular Assessment?

A cardiovascular assessment is to estimate you risk of progressing to cardiovascular disease in the future.  Your PCP conducts routine assessment with goal of identifying risks factors, initiate treatment, lifestyle and behavioral modification to lower your chance of having fatal or non-fatal heart/vascular outcomes.  These include heart attack, strokes, ulcers in legs, bowel health, kidney diseases, and vision.  Through history and physical examination and in office simple tests and studies your doctor can determine your cardiac risk.

We incorporate the following to our practice:

  • CVD risk discussions for all patients between 20 and 79 years of age without known CVD.
  • Periodic risk assessment offers the opportunity to identify CVD risk factors and offer guidance on the appropriate management of specific risk factors (eg, dietary modifications for hypertension or dyslipidemia, etc.) and overall CVD risk (eg, maintaining a healthy diet, regular exercise, etc.).
  • For patients older than 79 years of age without known CVD, for whom there are no data on risk assessment, we engage the patient in a discussion of the risks and benefits of primary preventive therapies and pursue shared decision-making.

Cardiovascular History & Physical

Your doctor will identify risk factors for heart disease including presence of high blood pressure, diabetes, cigarette smoking, family history of CVD, family history of high cholesterol, chronic kidney disease, and obesity.

Your doctor will check your lipid profile.   Your doctor may order familial hypercholesterolemia if your lipid profile is abnormal.

For patients 20-39 years of age an informal CVD risk assessment, access for risk-enhancing factors, emphasize assessment of lifetime risk, in particular for patients with diabetes.  Your doctor may reassess risk in 4-6 years or at age 40 years.

If you are Age 40-79 years of age a formal estimation of 10 year CVD Risk.  Cardiovascular risk assessment in adults (10-year, ACC/AHA 2013).

Electrocardiogram/ECG

According to the Centers for Disease Control and Prevention, more than 600,000 people in the United States die from heart disease each year, making it the leading cause of death for both men and women. Noting this, medical professionals often suggest that their aging patients or at-risk patients take an electrocardiogram, or ECG, test to check for signs of heart disease.

ECG tests are non-invasive, painless, safe and fast, and they help our doctors check things like heart rhythm and blood flow as well as diagnose previous heart attacks or anything else that seems abnormal. In the best case scenario, the ECG test confirms good heart health. However, if we see something abnormal, we will likely send you for further testing to get an idea of how to best treat or manage the issue.

The standard ECG test consists of a doctor attaching 10 or more electrodes in the areas of your chest, arms, and legs – the key places where major arteries exist. You’ll then likely start by lying flat while a computer records your heart rhythm. Aside from this “resting” ECG, your doctor may also have you exercise to get an idea of how your heart works under activity. This typically consists of a doctor monitoring your heart as you jog on a treadmill. In most cases, the ECG test lasts less than 20 minutes and quickly helps give the doctor a better understanding of your heart health.

Eating right and getting plenty of exercises is crucial to maintaining good heart health, but ECG tests are an ideal way to either verify heart health or address small issues before they become big ones. It’s why they’re often a part of a physical exam for aging men and women.

Echocardiography/ECHO

An echocardiogram uses sound waves to produce images of your heart. This common test allows your doctor to see your heart beating and pumping blood. Your doctor can use the images from an echocardiogram to identify heart disease.

Your doctor may suggest an echocardiogram to:

  • Check for problems with the valves or chambers of your heart
  • Check if heart problems are the cause of symptoms such as shortness of breath or chest pain
  • Detect congenital heart defects before birth (fetal echocardiogram)

The type of echocardiogram you have depends on the information your doctor needs.

Information from the echocardiogram may show:

  • Changes in your heart size. Weakened or damaged heart valves, high blood pressure or other diseases can cause the chambers of your heart to enlarge or the walls of your heart to be abnormally thickened.
  • Pumping strength. The measurements obtained from an echocardiogram include the percentage of blood that’s pumped out of a filled ventricle with each heartbeat (ejection fraction) and the volume of blood pumped by the heart in one minute (cardiac output). A heart that isn’t pumping enough blood to meet your body’s needs can lead to symptoms of heart failure.
  • Damage to the heart muscle. An echocardiogram helps your doctor determine whether all parts of the heart wall are contributing normally to your heart’s pumping activity. Areas of heart wall that move weakly may have been damaged during a heart attack, or be receiving too little oxygen.
  • Valve problems. An echocardiogram can help your doctor determine if your heart valves open wide enough for adequate blood flow or close fully to prevent blood leakage.
  • Heart defects. An echocardiogram can show problems with the heart chambers, abnormal connections between the heart and major blood vessels, and complex heart defects that are present at birth.

Cardiac Imaging

A heart scan, also known as a coronary calcium scan, is a specialized X-ray test that provides pictures of your heart that can help your doctor detect and measure calcium-containing plaque in the arteries.

Plaque inside the arteries of your heart can grow and restrict blood flow to the muscles of the heart. Measuring calcified plaque with a heart scan may allow your doctor to identify possible coronary artery disease before you have signs and symptoms.

Your doctor will use your test results to determine if you may need medication or lifestyle changes to reduce the risk of heart attack or other heart problems.

Your doctor may order a heart scan to get a better understanding of your risk of heart disease or if your treatment plan is uncertain.

A heart scan uses a specialized X-ray technology called multidetector row or multi-slice computerized tomography (CT), which creates multiple images of plaque deposits in the blood vessels. The imaging test provides an early look at levels of plaque.

Plaque is made up of fats, cholesterol, calcium and other substances in the blood. It develops gradually over time, long before there are any signs or symptoms of disease. These deposits can restrict the flow of oxygen-rich blood to the muscles of the heart. Plaque also may burst, triggering a blood clot that can cause a heart attack.

Stress Testing

A stress test, also called an exercise stress test, shows how your heart works during physical activity. Because exercise makes your heart pump harder and faster, an exercise stress test can reveal problems with blood flow within your heart.

A stress test usually involves walking on a treadmill or riding a stationary bike while your heart rhythm, blood pressure and breathing are monitored. Or you’ll receive a drug that mimics the effects of exercise.

Your doctor may recommend a stress test if you have signs or symptoms of coronary artery disease or an abnormal heart rhythm (arrhythmia).

A stress test can help:

  • Guide treatment decisions
  • Determine how well heart treatment is working
  • Diagnose the severity of an existing heart condition

Your doctor may recommend a stress test to:

  • Diagnose coronary artery disease. Your coronary arteries are the major blood vessels that supply your heart with blood, oxygen and nutrients. Coronary artery disease develops when these arteries become damaged or diseased — usually due to a buildup of deposits containing cholesterol and other substances (plaques).
  • Diagnose heart rhythm problems (arrhythmias). Heart arrhythmias occur when the electrical signals that coordinate your heartbeat don’t work properly. An arrhythmia can cause your heart to beat too fast, too slowly or irregularly.
  • Guide treatment of heart disorders. If you’ve already been diagnosed with a heart condition, an exercise stress test can help your doctor determine if your current treatment is working. The test results also help your doctor decide on the best treatment for you.
  • Check your heart before surgery. Your doctor may use a stress test to determine when you can safely have surgery, such as valve replacement or a heart transplant.

If an exercise stress test doesn’t pinpoint the cause of your signs and symptoms, your doctor may recommend a stress test with imaging, such as a nuclear stress test or stress test with an echocardiogram.

Specialist Referral

Your doctor may chose to work with a Cardiologist (a specialist who focus on heart and cardiovascular system) to help optimize your heart health and reduce your risk of having a fatal or non-fatal heart event (heart attack, stroke, peripheral vascular disease, arrhythmia, etc).  Sometime a interventional cardiologist may be required if you have high risk cardiovascular disease for invasive testing.