Cardiac Check Up

A cardiac checkup is an important part of health maintenance. The checkup aims to assess cardiovascular health and identify any risk factors or early signs of heart conditions. The specific components of a cardiac checkup may vary based on individual risk factors, age, family history, and existing health conditions, but generally, it includes the following:

Medical History Assessment

  • Personal Medical History:
    • Includes past heart problems, hypertension, CKD, diabetes, and hospitalizations.
  • Family History:
    • Checking for a history of heart disease, hypertension, CKD, diabetes, or stroke in close family members.
  • Lifestyle Factors:
    • Discussion about diet, physical activity, smoking, alcohol use, and stress levels.
  • Medication Review:
    • Review any current medications, including over-the-counter drugs and supplements.

Physical Examination

  • Blood Pressure Measurement:
    • High blood pressure is a significant risk factor for heart disease.
  • Heart Rate and Rhythm:
    • Checking for irregular heartbeats or palpitations.
  • Heart and Lung Auscultation:
    • Listening to the heart and lungs for any abnormal sounds.
  • Weight and Body Mass Index (BMI):
    • Obesity is a risk factor for heart disease.
  • Peripheral Arterial Examination:
    • Checking pulses in the arms and legs for any signs of poor circulation.

Diagnostic Tests

  • Blood Tests:
    • Including lipid profile to check cholesterol levels, blood glucose to screen for diabetes, and other markers that may indicate heart risk.
  • Electrocardiogram (ECG):
    • Records the electrical activity of the heart to identify irregular rhythms or heart damage.
  • Chest X-Ray:
    • To check the size of the heart and the state of the lungs.
  • Treadmill Stress Test: Assesses the heart’s response to physical stress.
    • Only useful for flow limiting disease
  • Echocardiogram:
    • An ultrasound of the heart to visualize heart structure and function.
  • Stress Echo:
    • Combines traditional transthoracic echocardiography (TTE) with a stress test, which can be performed using either exercise (usually on a treadmill or bicycle) or pharmacological agents that mimic the effects of exercise (such as dobutamine).
  • CT Coronary Calcium: 
    • Detects and measures the amount of calcium in the walls of the coronary arteries.
    • Calcium deposits are an indicator of atherosclerosis.
  • CT Coronary Angiogram: 
    • Visualizes the lumen (inside) of the coronary arteries to detect narrowing or blockages.
    • Can assess plaque characteristics and the severity of coronary artery disease withour resorting to an angiogram.

Risk Assessment

  • Cardiovascular Risk Calculators:
    • The Australian CVD risk calculator https://www.cvdcheck.org.au/calculator can help stratify patients into 5 year low (<5%), intermediate (5-10%) and high (>10%) categories and suggest the possible benefit of blood pressure and cholesterol treatment.
  • Note that eGFR < 45 or Familial hypercholesterolaemia are automatically high risk.

Lifestyle Counseling

  • SNAP – Smoking, Nutrition, Alcohol, Physical Exercise
    • Dietary Advice: Recommendations for a heart-healthy diet, typically low in saturated fats, cholesterol, and sodium.
      • The Mediterranean diet is a good exam option.
      • The DASH (Dietary Approaches to Stop Hypertension) diet is also a good option
    • Exercise Guidance: Tips on physical activity to maintain a healthy heart.
      • 5 x 30 minutes of moderate exercise a week or
      • 5 x 15 minutes of vigorous exercise a week
      • 2 days of muscle strengthening
    • Smoking Cessation and Alcohol Consumption: Advice on quitting smoking and limiting alcohol intake.

Follow-Up and Management

  • Regular Monitoring:
    • Based on findings, regular follow-ups may be scheduled.
  • Management Plan:
    • For identified risks, a management plan including lifestyle changes and possibly medications will be developed.
  • Referral to Specialists:
    • If necessary, referrals to cardiologists or other specialists for further evaluation or treatment.

MBS Item 699 – Heart Health Assessment

  • MBS item 699 is specifically for a comprehensive cardiovascular risk assessment for patients aged 45 years and older (or 30 years and older for Aboriginal and Torres Strait Islander patients) who do not already have known cardiovascular disease.

Conclusion

The scope of a cardiac checkup can be broad and should be tailored to the individual. It’s not just about the tests and physical examination; it also involves understanding the whole person, including lifestyle, family history, and other health issues. Regular cardiac checkups help in early detection and management of heart disease risk factors, leading to better long-term health outcomes.