Q I am a 45-year-old man and have just completed my annual health screening.
My treadmill results showed that there is a possibility of a blockage in my heart arteries.
I feel completely well and I hardly ever fall sick. However, I am a bit concerned as I am getting older. Is there something I can do about this?
A First, you should be congratulated for respecting your health and having a medical check to rule out the possibility of worrying heart disease.
Blockages due to the accumulation of cholesterol plaque in the walls of the heart arteries cause heart attacks, which are potentially fatal.
An exercise treadmill test provides your doctor with general information about how well the heart copes with exercise. It may detect an underlying problem that is not present on the resting electrocardiogram (ECG) test, which is a recording of the electrical heart pattern.
As the body works harder during exercise, the working muscles require more oxygen, so the heart must pump more blood.
The test can show whether there is a reduction in blood supply to the heart or whether any abnormal heart rhythms develop with exercise.
A positive result is reported when certain electrical changes occur on the continuous ECG monitoring that suggest the possibility of a blockage in the heart's blood supply.
Of more concern would be if you actually develop chest discomfort during the treadmill test.
A positive result gives your doctor a starting point to think further about the health of your arteries, though it is not conclusive.
Treadmill tests are a good - but not perfect - screening tool, so please do not panic over your results. Not all patients who have a positive stress test have heart disease.
Your doctor will often refer you to a specialist.
The specialist will likely conduct more definitive tests and these may be done in the clinic.
Several options are available, such as an exercise stress test with ultrasound imaging, which is more sensitive and captures images of the pumping capacity of the heart while exercising.
If you have risk factors, such as being a smoker, having high blood pressure or elevated cholesterol, or having a strong history of heart disease in your family, another possibility is to have a computed tomography (CT) scan of your heart arteries.
The CT scan provides high-resolution pictures and will accurately reveal the presence or absence of any severe blockages.
If blockages are detected, the treatment options can be discussed with your cardiologist.
These may range from medication to procedures to unblock the arteries.
However, the tests may also reveal that your arteries are completely free of any cholesterol build-up.
Then you can be confidently reassured that the treadmill test is misleading and you are at low risk of a heart attack.
Brought to you by
DR ROHIT KHURANA
Director and senior consultant cardiologist at The Harley Street Heart & Cancer Centre
