Heart Checkup
In order to make a correct diagnosis of ischaemic heart disease, the general practitioner or cardiologist worlds go through the:
1. History
2. Physical examination
3. Baseline investigations
4. Special investigation
History
The patient’s presenting complaint is
recorded in detail; “chest pain” for example, would have to be analyzed in
terms of position, severity, subjective description and it’s relation to
exertion and stress. From a careful history, the origin of the pain may be
elicited. A detailed evaluation of the family history and history regarding
coronary risk factors particularly smoking (current smoker and past smoker),
diabetes and hypertension are also noted. The patient is also asked about the
level of physical activity he is capable of.
Physical examination
The height, weight, blood pressure
and pulse rare are routinely taken at the first visit, so as to provide a
baseline for future comparison. The next step is to record blood pressure and
pulse rate at least twice. The next step is to listen to the heart with
stethoscope. In this way, the doctor can assess several problems; these include
evidence of heart failure, valvular dysfunction or any suggestion of hole in
the heart.
Basic investigations
1. The 12-lead
electrocardiogram (ECG) is very important in assessing heart rate, heart
enlargement and the presence of coronary heart disease. Doctors can confidently
diagnose the presence of coronary heart disease and indirectly the extent and
severity of ischaemia. But many patients may have significant block in coronary
arteries though their ECG appears normal at rest. One third of patient with
angina (coronary heart disease) may have apparently normal looking ECG at rest.
It indicates that blood flow in the heart is normal at rest but coronary arteries
are not capable enough to supply sufficient blood to heart during exercise.
These patients complain of chest pain only during exercise or physical exertion
and pain is relieved by rest. So if you have symptoms of chest pain and your
ECG done at relaxed state which apparently looks normal does not completely
exclude the possibility of having block in your coronary arteries. So history
taking is of paramount importance in the diagnosis of ischaemic heart disease.
If your symptoms are suggestive of angina (heart pain) and but your ECG is
normal even then you should undergo thorough heart checkup to exclude or
establish the diagnosis of angina.
2. A urine examination is
done to exclude the presence of diabetes and also to look for protein or casts
in urine which may suggest kidney involvement.
3. A chest X-ray is also
done to look at heart size and see any evidences of heart failure.
4. Blood tests for sugar,
cholesterol, urea and creatinine (to test kidney functions) and electrolytes
for example potassium, sodium levels are all important when evaluating patients
for/with hypertension and prior to drug therapy.
Special Investigations:
1. Stress test
2. Echocardiography
3. Thallium scan/MIBI scan
4. Coronary angiogram
5. Multidetector CT
