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Heart and Stroke prevention

Heart and Stroke Preventative Screening

Modern medical treatment is so effective in this field that screening is really worthwhile.

Coronary disease and stroke account for nearly 35% of all deaths. Therefore we are seriously proactive about vascular and coronary screening. While considering the risk factors of diabetes, smoking, family history, cholesterol and high blood pressure, unfortunately a third of first heart attacks occur in people with no risk factors. Consequentially we advise the importance of screening, even in the absence of risk factors.

We do not advise routine exercise-testing, as it is a remarkably poor screening test. In essence you may have to have a 95% coronary narrowing before a stress test is positive. Unfortunately it also gives false positives, particularly in women .
We recommend considering Coronary Calcium Score screening. This is a simple test, with minimal radiation being equivalent to about 14 chest xrays. It gives a total score for the amount of fatty plaque which is calcified. The scan also picks up early disease which would be too mild to be found at a routine treadmill test, allowing early preventative treatment where necessary.
Limitations: It does not detect soft uncalcified plaque, and does not say where exactly the plaque is in the vessel and if it is causing a significant narrowing to the vessel.

In patients with a high level of risk factors, depending on individual assessment, we may suggest a CT coronary angiogram. This entails an injection in the arm of a contrast agent followed by a non-invasive scan which gives a detailed picture of all the coronary arteries. We have a close association with European Scanning at 68 Harley Street which gives our patients priority with appointments. These scans are a significant step forward against coronary disease.
Limitations: the radiation involved is about 60 chest x-ray equivalents and does involve an injection of contrast which can very rarely, in 1 in 30,000 people, cause a serious allergic reaction, as with any contrast agent. The radiation dose is very reasonable considering a standard invasive coronary angiogram, (involving the passing of a catheter to the heart via the arm or leg), involves about 600 chest x-ray equivalents of radiation and has a mortality rate of about 1 in 2,000.

A myocardial perfusion scan is another very useful test used for assessing coronary arteries, anddelivers about 400- 600 chest x-ray equivalents.

Stress echo is a cardiac test we particularly recommend in appropriate patients. This involves no radiation, and will detect coronary narrowings of more than 50 %. An ultrasound of the heart is performed while the heart-rate is increased by either exercise on a bicycle, or by an infusion of dobutamine. The risks of this test are negligible.