Inside your Heart Health Check - Part 1
Have you had your heart health check?
Not had a heart attack yet? Then you might want to find out more about the healthy heart check.
Heart attacks were once, and still can be, a sudden occurrence. But in reality there are warning signs that you, and your doctors can identify well before you have a heart attack.
By finding early, less serious problems, and taking action either through your lifestyle or through medical interventions can help you avoid the severe consequences of a heart attack.
The ‘heart health check’ isn’t marketed as a fancy longevity check.
But that’s what we’re doing. And it’s funded by the government.
Statistically, your heart and the cardiovascular system is going to get you. If your parents are still alive they’re doing their best to avoid an earlier ending by taking medications for blood pressure and cholesterol.
I know, how morbid. How frank.
But how relevant for today. A heart health check, before you get sick.
We often talk about what’s most likely to kill you based on population data. but this can feel very abstract and removed from the realities of our own personal health, our parents and even siblings.
But the data tells me these conditions have affected your family.
And cardiovascular-related illnesses are what you are most likely to die from. That includes heart conditions, strokes and dementia.
It matters whether you die from one of these conditions in your sixties or in your nineties. Those years of older age also need to be healthy years rather than unhealthy years.
In Australia, GPs are able to offer heart health checks to anyone over 30 with at least one risk factor for heart disease.
UK patients and doctors. this article is still for you.
While this is framed through the Australian heart health check, I walk you through what’s important for your doctor to know about health health.
This has relevance globally, and more than just heart health.
A heart health check is similar to an NHS health check.
While the heart health check in Australia is clearly focused on cardiovascular health, the NHS health check considers largely heart health and metabolic health (including diabetes).
Metabolic health conditions contribute to the development of heart disease.
While a heart attack is not the only issue related to heart disease, it is the one that is most memorable to patients and loved ones. These sudden events leave a lasting memory even if the person affected survives.
Other heart conditions include atrial fibrillation other electrical problems, valve disorders and even heart failure.
By focusing on cardiovascular and heart health, this enables far reaching unintended positive consequences.
As this focus simultaneously helps to reduce risks of metabolic health including diabetes, dementia, cancers and even fracture risk. All conditions that affect us in older age.
What a heart health check looks like in my clinic.
I do these structured heart health checks typically over two appointments.
The first appointment is a detailed medical, family and lifestyle history. We identify risk factors that put you are higher risk, do necessary basic examinations and decide what, if any, tests to do next.
This post (part 1) details out the important information you need to know about your own health and more about that first consultation.
In part 2, I cover the actions that you can discuss with health professionals based on the information we have gained and tests that we have done.
Information that’s important for your doctor to know.
1. Symptoms
Do you experience any symptoms of heart conditions including: palpitations, chest pain, shortness of breath or leg swelling.
2. Your previous medical history
Any history of:
heart related problems
high cholesterol
raised blood pressure
What allergies or reactions you have had in the past, and knowing vitamins, supplements and of course medications you’re taking.
3. What medical conditions have affected your family?
I want to know about health conditions that affect your siblings, parents and grandparents. I also want to know if there are frequent health conditions that affect the family.
I typically think about your family history with the following conditions:
Cardiovascular
Heart attacks, strokes, high blood pressure and high cholesterol
Metabolic
Including diabetes and thyroid conditions
Cancers
Each cancer is considered separate to other cancers, although some are related to each other. So knowing not just that they had cancer, but where the cancer originated from is important.
Dementia
Memory related conditions are increasingly understood to have a strong cardiovascular component to them. In Australia more patients now die from dementia and related consequences of dementia, rather than heart attacks and strokes.
This is, in one part a success, but also a failure to prevent another horrendous, progressive condition from taking it’s hot spot.
Why these conditions are important
Cardiovascular related conditions that kill us include dementia and stroke, as well as heart attacks.
Diabetes, high cholesterol and high blood pressure contribute to this risk. Untreated, they significantly increase the risk of the conditions that kill us.
4. Your lifestyle and social context
This contributes to the higher risks of high blood pressure, raised cholesterol, diabetes and increasing weight.
Weight matters at very high levels, nearly always.
It can put increasing strain on the heart, increase the risk of conditions such as obstructive sleep apnoea, high blood pressure, diabetes and inflammation within the body.
For men, this is one of the biggest reasons I see falling testosterone levels (fat leads to increased estrogen conversion in the body) especially when combined with reduced activity levels.
Yes, it is true that being very active and overweight is far better than being overweight on its own, but it doesn’t fully negate some of the risks.
Discussing weight can be emotive, but important to talk about. This this is a common subject in my consulting room with patients, brought up by my patients as well as myself.
Do you smoke?
Do you drink higher amounts of alcohol?
How are your eating habits?
Usually at this stage it’s a quick check into how patients feel they eat, healthy or unhealthy as we don’t have time to go deeper.
Knowing if patients are active, and if there’s time, doing a brief check on sleep, stress and any other health issues.
Your work contributes to your risk.
Whether you work in a mine (very common in Australia), are active with your work and whether you’re sat at a desk all day.
How do you get to and from work?
Are you human-powered or do you need a vehicle?
5. Examination
Listening to your heart to check for murmurs, get your height weight, BMI, waist circumference and check your blood pressure.
Yes there are problems with BMI but it still remains a valid tool when it is used in context - there’s certainly an article due on this.
This is a relatively straightforward examination. The power is in the information you provide, combined with this examination that will then help us to determine the next actions.
6. Arranging further tests.
For most people they will get the following tests:
A full cholesterol profile which includes your total cholesterol, triglycerides, HDL (‘good’ cholesterol), LDL and non-HDL (‘bad’ cholesterol).
There are other blood tests that a relevant to your heart health including:
a full blood count, checking your kidney function, liver function, thyroid function and a check for diabetes with a fasting blood glucose, and an average blood glucose over 3 months (Hba1c).
Occasionally I’ll arrange further tests on top of this, but this depends on the risk profile of patients, their financial means and whether they are appropriate for patients and it requires a further discussion.
Sometimes the decision on this will depend on the results and ongoing discussion.
We might consider doing an ECG (12-lead heart tracing) to get a better understanding of how your heart is functioning.
Reviewing your results and taking further steps in teh next consultation.
So that’s part 1 of your healthy heart check.
The next article will discuss what we do with your results, and we’ll discuss the blueprint I give my patients to help reduce their long term risk.