Ask the Doctor: My family has a history of heart problems and I’m concerned about my cardio fitness. Can I get more tests?

Question: I’m a woman in my 40’s and I feel like no matter how much I exercise, I don’t have great cardio fitness. My father had a triple bypass and my mother has atypical hyperplasia. I went for a general health check and everything was fine again, but was wondering if there are more extensive heart tests I could ask for? I know someone who recently went for a physical and was clear but later had a heart attack due to clogged arteries despite feeling very fit and healthy.

dr Grant replies: I bet if you train right, you can improve your overall cardiovascular fitness. Often, short, high-intensity workouts (e.g., 6 x 400m runs) are better for improving cardiovascular fitness than running 10km alone at a varied pace. The same applies to building muscle mass. It’s difficult to see results unless you eat an appropriately high protein diet and do the reps correctly under supervision. Persistence pays off and you won’t regret spending money and getting professional help.

There are several free online cardiovascular tools to assess a person’s risk for potential coronary artery disease (CAD). While these tools can be reassuring to see a low-risk profile, they are obviously not definitive and questions still remain, such as: B: Is there any current evidence of CHD or the likelihood of future CHD-related events? No test is 100% definitive and there will always be an element of doubt.

It is good that your recent health check went well and you were not recommended to see a cardiologist for further examination. This means that your lifestyle factors, such as B. current level of physical activity, general fitness, dietary habits, cigarette/alcohol consumption, use of illicit drugs, stress level and general quality of sleep were all considered appropriate.

Your body mass index (BMI), body fat, muscle mass, blood pressure and cholesterol profile (breakdown into good and bad cholesterol) also contribute to your cardiovascular risk assessment. A positive family history of heart disease (a first-degree relative under age 55 having a heart attack) and early menopause before age 40 may also affect your risk of CHD.

Patients with multiple risk factors for CHD, such as For example, anyone with a strong family history, current heavy smoker, morbid obesity, family history of high cholesterol, or poorly controlled hypertension should consider CHD screening. Just to mention that patients with diabetes, metabolic or kidney disease are at increased risk of CHD and should discuss their need for CHD screening with their doctor at a routine check-up.

A stress test is generally the first screening tool of choice in patients without symptoms (eg, chest pain or tightness or difficulty breathing with exercise), who are at moderate or high risk of CAD and who are able to to move.

Invasive formal coronary angiography is indicated in patients who develop a positive exercise test at light workloads or in whom more than 20% of the myocardium shows signs of inducible ischemia. A positive test at higher workloads may justify treatment with additional imaging modalities, and a CT coronary angiogram would be preferable given the benefit of coronary anatomical assessment.

However, in patients with a higher baseline risk, direct CT coronary angiography would offer the benefit of an anatomical assessment to assess the extent of underlying disease.

There are other specialized tests such as cardiac perfusion MRI scans that are sometimes indicated for further reassurance.

dr Jennifer Grant is a GP at Beacon HealthCheck