Every Hospital and Clinic is offering screening examinations and encouraging you to undergo examinations and testing. It is difficult for you to judge whether this is an appropriate for you, which tests should be performed and whether the benefits justify the expense. The Bangkok Heart Hospital, in the Bangkok Hospital Medical Center offers excellent Cardiac Screening programs. Here is some information to help you to understand them.

Screening Examinations
The ideal medical screening tests are ones that can be done easily, with minimal risk, are reliable in detecting existing disease and can also detect the presence of conditions which may not be causing any problems at the present time, but will, if left untreated, give problems in the future. A test is said to have a ‘predictive value" if it can forecast the future by identifying situations which will lead, if untreated, to problems occurring in the future. The purpose of screening examinations is to detect ‘hidden' problems and to treat them before they become life-threatening.

The tests that are available for assessing cardiac status fulfill all these criteria. We can test your heart, assess both its present status and also predict whether there are hidden problems that may lead to problems in the future. Like all things in medicine these forecasts are not a hundred percent accurate but they do have a high ‘predictive value.

It is a strange irony that the heart, the organ that pumps blood to every other part of the body, can be damaged by not being able to pump enough blood to itself. The principle function of blood is to carry oxygen as every cell in the body needs oxygen to survive. As arteries age they can be damaged by a sediment that builds up in their walls. The coronary arteries that supply blood to the muscular wall of the heart are the arteries most likely to be blocked by this plaque that builds up in the wall of arteries. The development of the cholesterol plaque is influenced by life style risk factors such as: diet, smoking, high cholesterol level, diabetes, high blood pressure and the lack of exercise. These atheromatous plaques narrow the arteries but as long as the heart muscles are getting a reasonable amount of oxygen from the blood supply, there will be no symptoms. If, however, the arteries narrow to a critical level then the blood flow will be insufficient to support the heart muscles cells and a group of them, lacking oxygen, may die. The patient may have a heart attack; some may not survive.

The Bangkok Heart Hospital offers Cardiac screening programs which provide a thorough assessment of your cardiac status and can identify treatment or life-style changes that will lower you chances of you developing serious heart problems in the future.

Traditionally it has been thought that cardiac disease was one that principally attacked males; more recent work has shown that in older age groups the risks to women are equally worrying. Female patients should also undergo cardiac testing, especially if there is a family history of heart disease.

The tests will examine the rate, rhythm and efficiency of your heart, will evaluate the blood supply of the heart muscles and asses whether the heart is getting sufficient oxygenation. The really good news is that if we can identify factors that are putting you at risk of having a heart attack, we can recommend treatments to eliminate these factors and prevent a catastrophe from occurring.

Although the medical technology is helpful it is important that you first be seen by a physician. You will have the opportunity to discuss any symptoms or concerns that you might have. A family history and details of previous illnesses and Hospitalizations will be taken. A physical examination including taking your blood pressure and listening to your heart through a stethoscope will be performed.

An important part of the testing is the examination of our blood. A measurement of the Hemoglobin will indicate the oxygen carrying capability of the blood. A measure of the Blood Sugar will indicate the presence of Diabetes, a measure of the Thyroid Stimulating Hormone (TSH) will indicate thyroid disease and a measure of the Creatinine and the Blood Urea Nitrogen (BUN) will indicate kidney problems. All of these conditions can affect Cardiac function.

A measure of the level of Cholesterol and tri-glycerides in your blood is essential. Having the wrong levels of these important factors can lead to heart problems. The level of the Low Density Cholesterol (LDL or bad Cholesterol) and Tri-glycerides should ideally be low and the High Density Cholesterol (HDL, the good Cholesterol) should be high.

 If the tests show abnormal results you can be counseled on the dietary and life-style changes that you should make in order to lower your risk. If these simple changes are not successful there are medications which are effective in improving the levels. It has been shown that improving your lipid profile lowers the risk of you having a heart attack or stroke.

An X-ray of the chest is performed. This old-established test is helpful in showing the size of the heart. It also gives useful information about the lungs the organ that is responsible for oxygenating the blood.

The work of the heart is controlled by a self-generated electrical system which causes the heart muscle to contact. These signals can be studied by performing an Electro-cardiogram or ECG. (EKG in the USA) Leads are placed on your chest, arms and legs and the machine documents this activity. By studying the graphs produced we can check that this system is working well. It can also give a clue that areas of the heart muscle have been damaged possible due to lack of oxygen to these areas.

If the ECG is showing some changes then an exercise ECG can be performed. The regular ECG shows how the heart is behaving when no stress is being placed on it. In the exercise or Stress ECG we connect all the leads to your body and then have you run on a treadmill while we observe the ECG. This will show whether the heart is obtaining the appropriate blood supply that it needs when it is working hard.

Ankle-Brachial Index. Blood pressure (BP) studies are performed; cuffs are placed on your arms and legs and a pulse graph is obtained of both. The BP in the arms and legs should be almost the same and any difference can indicate problems in the arterial supply of the legs.

Echocardiography is a technique to study the anatomy and physiology of the heart. Ultrasonic sounds waves are bounced off the structures of the heart and a picture made of the returning signals; by studying them we can gain information about congenital anomalies of the heart, the size of the chambers, the structure of the walls and the working of the valves. We can also calculate the ability of the heart to pump blood; this is expressed as an "Ejection fraction". Just as the ECG can be performed with the heart under stress exercise (stress test); the same can be done with an echo study, so called "Stress Echo".

Bangkok Heart Hospital has a package, the Basic Heart package that includes the Doctors visit, the Blood tests, Chest X-ray, ECG and Exercise stress test for 7,100 baht. Other packages that include Echo testing, stress Echo testing, CT 64 slice CT scan for Calcium score and anatomy of the coronary artery, MRI studies are also available.

These are the most commonly performed tests but others are available to provide more information when it is needed. CT scanning can identify the amount of calcium that has been deposited in arteries; the dangerous atheromatous plaques contain calcium and can be seen and evaluated on CT scanning. The CT scan has become the most useful tool to evaluate the coronary artery disease. This latest technology provides the information almost as good as coronary angiogram.  Magnetic resonance imaging (MRI) can also be useful as it can give more information about the heart at the cellular level. 

Alan Goddard is a semi-retired man living in Thailand. He held a pilots license and although he is not using it, he would hate to loose it. In order to re-license he had to have a physical examination. He was in good health, played golf several times a week and apart from occasional breathlessness on exertion had no symptoms. He came to Bangkok Medical Center for a routine heath examination and a minor change was noted on his ECG. He was referred to the heart Hospital and a stress ECG was performed which showed a more worrying tracing. After consultation with a Cardiologist he returned the following day and an Echo study and Coronary angiography were performed. In this latter test dye is injected into the coronary arteries and the vessels studied. It was found that he had severe blockage of three major coronary arteries. After more consultations he decided to accept the Doctor's advice and two days later underwent Coronary Artery By-pass surgery in order to restore blood supply to his heart. The operation and rehabilitation went well, he has been counseled about his diet and life-style and hopefully will live to enjoy his retirement in Thailand; he has a Health screening examination to thank for this. 

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