Cardiovascular disease covers disorders of the heart and blood vessels. It is the number 1 cause of death globally, including amongst developed countries, and growing in prevalence amongst young people.
Poor dietary habits, sedentary lifestyles and the consumption of toxic substances such as alcohol and tobacco, are the main causes of cardiovascular disease.
It is vitally important that even seemingly healthy people be screened, as these pathologies can manifest themselves in a wide variety of ways: at the cardiological level in the form of an angina or infarction, at the vascular level in the form of a peripheral arterial disease (PAD) or claudication, and at the cerebrovascular level in the form of a stroke.
The aim of cardiology is to carry out early detection of these health issues via the patient’s clinical history and different diagnostic tests.
Prevention of cardiovascular health issues is important for everybody, including for those who start a strenuous sporting hobby later in life. Taking up physical activity is almost always a great idea, but it is recommended that such people undergo a preliminary screening in order to rule out or help prevent potential cardiological issues.
Ideally, men should undergo their first cardiological check-up around 45-50 years of age, provided they do not have any prior risk factors or an unfavourable family history. In the case of women, it is recommended that they see a specialist during the perimenopausal stage, as it is then that tachycardias typically start.
As for children, pediatrician’s check-ups are essential because they may detect heart murmurs which, although the vast majority are harmless in children, may sometimes lead to other health issues.
In general, the most frequent symptoms that cardiologists come across are:
- In coronary heart disease: oppressive chest pain.
- In heart failure: dyspnea (shortness of breath), leg swelling, discomfort lying down.
- In arrhythmias: rapid heart palpitations, dizziness, sudden loss of consciousness, orthostatic hypotension, bradycardia.
- In hypertension: tension headaches, pain in the forehead and neck, choking sensation.
The results of the following tests, together with coronary artery disease risk factors, will help determine and prescribe further tests.
Typically, the starting point for evaluating a patient’s cardiovascular status is to conduct an electrocardiogram and ultrasound. Subsequently, by performing other tests, the patient’s prognosis is obtained.
- Cardiac ultrasound
- Exercise stress test
- Ambulatory blood pressure monitoring (MAPA)
- Holter monitor
- Tilt table test
By performing these tests, the team of cardiologists at Hospital Ochoa Marbella can detect diseases that the patient was unaware of, including but not limited to:
- Angina pectoris
- Atrial fibrillation
This simple test is used to measure the heart’s electrical activity, heart rate and rhythm.
It is very useful for detecting some types of arrhythmias such as atrial fibrillation, which occurs when a resting heart’s normal rhythm accelerates (tachycardia) or slows down (bradycardia). Echocardiograms can also detect other heart issues, such as blood vessel blockages or problems with the heart valves.
Electrons are very sensitive, and their alteration is easily observable in the presence of myocardial infarction or angina pectoris, thus permitting the physician to easily locate these heart disorders.
A cardiac ultrasound is able to draw a two-dimensional image of the heart in which its anatomical characteristics, blood flows, etc. can be observed. It allows physicians to analyse the organ’s structure, such as the size of the chambers and walls, as well as their adequate movement.
Ultrasounds can also identify issues related to the heart valves, such a heart murmurs. This disorder is often of little consequence, but other times it is indicative of more serious health issues, such as valvulopathy that requires surgery.
In short, an ultrasound is typically the best way to identify a wide variety of health disorders, including hypertrophic cardiomyopathy, dilated cardiomyopathy, and other alterations in the mobility of the cardiac muscle.
Exercise stress test
An exercise stress test helps show how well a heart works during physical activity. It is generally performed on patients who report dyspnea (shortness of breath), palpitations or chest pain.
The test consists of monitoring a patient while they run on a treadmill. The patient is hooked up to equipment that monitors the heart, and the speed and incline of the treadmill is gradually increased every three minutes in a standardised fashion.
Heart rate, breathing, blood pressure and electrocardiogram numbers are monitored and compared throughout the test, including when the patient is at rest before the exercise.
The heart has a sizeable cardiac reserve, which refers to the difference between the rate at which the heart pumps blood and its maximum capacity for doing so. In fact, a person may have coronary lesions below 70% and yet their electrocardiogram at rest may not reflect any alteration, but when subjected to a stress test, any issues become apparent as the cardiac output increases.
Depending on the results, doctors will be able to determine whether the patient has any cardiological or respiratory issues.
Exercises stress tests are not recommended for people with a medical history of the following:
- Severe anemia.
- Pulmonary embolism.
- Aortic dissection.
- Pulmonary arterial hypertension (PAH).
- Chronic debilitating diseases.
- Acute thrombophlebitis.
- Intoxication by particular cardioactive drugs.
Ambulatory blood pressure monitoring (MAPA)
This device measures a patient’s blood pressure every 30 minutes for 24 hours, and then calculates the average. Sometimes, patients display signs of White-Coat Hypertension (WHC), which is when they exhibit high blood pressure in a clinical setting only. A MAPA device helps determine whether a patient is experiencing nothing more than anxiety during their clinic visit, or whether the blood pressure is sustained throughout the day and thus perhaps symptomatic of a larger health issue.
The Holter monitor measures the electrical activity of the heart 24 hours a day. The patient wears it on his chest, and it records data which is used to detect any abnormal variations such as arrhythmic events or tachycardias.
It is often used on people who report heart palpitations or a loss of consciousness without apparent cause.
Tilt table test
A tilt table test is a medical procedure often used to diagnose dysautonomia or syncope. It is typically performed on younger patients who experience dizziness or light-headedness as a result of a drop in blood pressure.
The patient lies on, and is tied to, a special table, and their blood pressure and heart rate are monitored every 5 minutes by means of an electrocardiogram. After a period of rest, the table and patient are tilted 70° and remain in this position for up to 1 hour.
Sometimes, vasodilator drugs will be administered in order to lower the patient’s blood pressure and heart rate, and thereby increase susceptibility to the test. The patient is closely watched at all times by the cardiologist, and should the patient faint, the collected data will offer a detailed record of how the syncope occurred.