Athletic Heart Q&A

We offer or testing and services irrespective of your exercise habits.  We are cognizant, however, that cardiac screening is particularly beneficial for those who are committed to embracing a healthy lifestyle, including regular exercise.

Athletes do have special needs when it comes to cardiac testing.  Our expertise in that regards differentiates us as the premiere sports cardiology clinic for the San Francisco Bay Area.

We test individuals age 15 and over. There is no upper age limit. If you opt for an in-depth screening, we tailor the tests based on your current capacity for exercise and your needs and intentions (e.g., if you plan to increase your exercise regimen). If you have concerns about your ability to exercise on a treadmill, feel free to call us and we can discuss these over the phone.
Some health policy planners do not encourage advanced cardiovascular screening and believe it is not “cost effective.” We respectfully disagree, but we do think that in order to be beneficial, screening should be performed in a thoughtful and professional manner that takes into account your specific needs and circumstances. “Mass screening” done in a rote or perfunctory manner is indeed likely to be a waste of time and money.

You may wish to read this article recently published by Dr. Accad on the topic.

Dr. Accad makes himself available at no charge to answer any question you may have regarding our services.  Here are general guidelines.

For screening youth and young adults under age 35, our standard package includes the 12-lead ECG and echocardiogram, but we also recommend the optional treadmill stress test. The stress test may detect congenital anomalies of the coronary arteries and will also check overall cardiopulmonary fitness and give clues as to the presence of lung disease. However, if budget is a concern, the screening without the stress test will identify many congenital heart conditions detectable by non-invasive means.

Any man over 40 and any post-menopausal woman should at least consider the coronary health starter kit.  Some people with a strong family history of coronary disease may wish to obtain this kit at an earlier age.  For adults interested in screening that goes beyond simple detection of coronary disease, we recommend our in-depth screening package for adults, which will attempt to detect all kinds of cardiovascular conditions, such as cardiomyopathy and disorders of the heart rhythm.

People with high blood pressure concerns should consider the high blood pressure management program.

If you currently have symptoms (chest pain, palpitations, fainting spells, unusual shortness of breath), we recommend that you start with a cardiology consultation, or that you check with your physician first. A consultation is also advisable if you have preexisting cardiac disease and wish to discuss your exercise regimen.

You may also wish to start with a consultation if you are a seasoned endurance athlete and would like to discuss concerns about the potential consequences of long-term ultra-endurance sports on the heart (atrial fibrillation, fibrosis, etc.), as well as establish a monitoring routine.

A screening session for youth and young adults without the treadmill test takes about 90 minutes.  A screening session that includes a treadmill stress test takes about 2 hours.  Likewise, the high blood pressure evaluation routine takes about two hours.
If a treadmill test will be part of the services, bring comfortable clothing and shoes to walk or run on the treadmill. Women should wear a sport or similar support bra. If possible, avoid using cream or lotion on the chest on the morning of your test. For men, we may use a gentle disposable razor to remove chest hair in the specific spots where the ECG leads are placed.

If you are scheduled for a stress test, we recommend that your last heavy meal be at least 3 hours before your scheduled appointment. You may have a light meal one hour before your appointment. Beverages, including tea and coffee, are OK anytime before your appointment.

Out of respect for those scheduled after you, we ask you to arrive promptly on-time.  If you are delayed more than 10 minutes, we reserve the right to re-schedule your session.

We will ask you to fill out a short registration and consent form when you come in. At the beginning of the session, we will fill out the health history form together as part of your health interview. This allows us to get the most accurate information prior to testing. However, if there are pertinent medical records you would like to show us (for example, recent blood test results), feel free to bring them with you or call us ahead of time so we can discuss them.  If there are pertinent medical records you would like us to obtain from your physician, please contact us as we may ask you to sign an authorization for release of medical information ahead of your visit with us.
Typically, you are first greeted by our registered nurse and doctor Accad who will obtain the initial screening history and cardiac physical, as well as the 12-lead ECG. You then proceed to have the echocardiogram (ultrasound) images of your heart taken, while Dr. Accad reviews your physical and ECG findings. Next, if no concerning abnormalities are detected at this point, you proceed with the stress test portion (unless you have elected Package A without the stress test option).

Our ECG technician will brief you about the procedure and connect you to the equipment. The stress test is conducted by Dr. Accad and takes about 20 minutes to complete. The stress test is graded, which means that it starts slow-and-easy, and progressively gets harder.  We constantly monitor your tolerance to the effort and never go beyond what you can reasonably sustain.  Expect to break a sweat but don’t worry, we provide clean towels and cool drinks at the completion of the test.

The session ends with Dr. Accad reviewing all the findings with you and showing you the ultrasound images on screen.  Any questions are addressed leisurely at this point. For folks in the appropriate age category, part of the discussion focuses on coronary disease prevention in light of your individual findings and situation.

You go home with a copy of your ECG and a DVD copy of your echocardiogram which you can see at home or share with other physicians. Finalized reports are mailed to you after all the measurements have been carefully reviewed and verified. For those who have selected Package B, an additional 15-minute follow-up phone conversation may be scheduled after other out-of-office tests (e.g., lab work, coronary calcium scan) are available for review.

The cardiovascular testing we offer is non-invasive and extremely safe. Echocardiography uses ultrasound waves to obtain images of the heart and blood vessels and has no known appreciable risks. Stress testing is extremely safe. In non-selective retrospective surveys of medical practices (where testing is done primarily on patients with established or suspected active cardiac disease), the risk of a serious complication is less than 1 in 10,000.

We believe the risk in our setting to be much lower, especially as we begin the session with a thorough cardiac history, physical, ECG, and echocardiogram, and our cardiologist is on site conducting the test. In many aspects, we surpass the recommendations for safe stress testing established by the American Heart Association.

Furthermore, if one is to have a cardiac complication during exercise, it stands to reason that a medical office is a better setting for such an occurrence, as compared to the park or the trail.

You can rest assured that all the information obtained during your evaluation remains confidential and is not released to anyone without your expressed consent.
We ask for your credit card information when you schedule a visit and ask for a refundable $200 deposit.  Our cancellation fees are:

  • $65 if you cancel your appointment 12 to 48 hours prior to the scheduled time of your visit.
  • $95 if you cancel your appointment less than 12 hours prior to the scheduled time of your visit.

We kindly request full payment on the day of testing.  We accept Visa, MasterCard or American Express credit cards.

We will gladly assist you in filling out a claim form so you may obtain reimbursement from your health insurance plan.  Please be advised that we do not have contracts with insurance companies and are considered “out of network.”   Also be advised that reimbursement can vary widely depending on the specific terms of your plan, your deductible, and whether your plan will cover advanced screening evaluations.  Medicare beneficiaries should not expect any reimbursement from Medicare or supplemental plans.
Metered-parking is fairly easy to obtain around the neighborhood. Have sufficient coins with you, or you can use the payment option by credit card (via the 800 number marked on the meter, or via the parking phone App). You may also find free street parking West of Franklin Street and East of Larkin Street, about 2-3 blocks from Van Ness Avenue. A few neighborhood parking garages are listed at the bottom of the home page on this website.

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