Why should you get a comprehensive cardiovascular screen?

You love exercise.  That’s great!

You are part of a growing number of Americans who seriously care about their health.  You may already be engaged in sports activities, or maybe you plan on doing so in the near future.  Whether you are a competitive athlete or a week-end warrior, physical activity immensely benefits your health, mental and physical—including cardiovascular health.

Image attribution: Mike Baird

You are probably aware, however, that even with the best health habits, cardiac and vascular complications can and do occur. Despite its tremendous health benefits, exercise does not always prevent heart disease.  At times, physical activity can actually trigger a heart attack, vascular injury, or sudden cardiac arrest in susceptible individuals.  Sudden cardiac death is a national epidemic that is the leading cause of death among athletes, even those who are entirely asymptomatic until tragedy strikes.  In fact, unsuspected cardiovascular disease is the No. 1 cause of exercise-related fatalities in all age groups, causing more death than trauma.

We are here to complement your healthy embrace of life. We offer our expertise to reduce the chance of unforeseen complications.  We go beyond the standard approach to cardiovascular prevention, which is usually limited to a routine physical and a blood cholesterol level.  

We aim to answer the following two questions you may have:
1) Is it safe for me to exercise or play sports?
2) How healthy is my cardiovascular system?

Our approach focuses on trying to detect heart and vascular conditions in their early stage, before complications occur.  We employ robust non-invasive tools that provide invaluable information about the health of your heart and arteries.  In addition, we give hands-on attention to your needs, taking into account your individual circumstances, so we can cooperate as a team to optimize your health and well-being.

Standard approach in adults

In adults, the current approach to screening is limited to a routine physical, measuring blood cholesterol levels, and promoting healthy diet and exercise.  Unfortunately, blood cholesterol levels poorly predict one’s risk of sudden death, and diet is not a silver-bullet approach to prevention.

3 out of 4 patients hospitalized with coronary disease have normal cholesterol levels. American Heart Journal, 2009

Standard approach in youth

In athletic youth, the current standard is a simple physical examination. Specific cardiac tests are not routinely obtained, even though most conditions that lead to sudden cardiac arrest in high school and college athletes can be detected by non-invasive diagnostic tests.

Most young athletes who die suddenly have undiagnosed structural heart disease. European Heart Journal, 2012

While the medical, public health, and insurance communities continue to debate the health care costs of the standard approach to screening for heart disease, a growing number of specialists and grassroots organizations are advocating more comprehensive cardiovascular screening. Such is the approach the Athletic Heart of San Francisco also advocates.

We offer reasonably-priced, individualized, in-depth screenings to detect unsuspected cardiac problems and promote the safe practice of sports!

Our cardiac evaluations are performed under the direct supervision of our founding cardiologist, Dr. Michel Accad, who brings to the evaluation his personal, hands-on attention. Tests provided may include:

• Cardiovascular history and physical examination
• 12-lead electrocardiogram
• Echocardiogram
• Exercise stress test
• Advanced heart rhythm monitoring
• Ambulatory blood pressure monitoring
• Pulse wave analysis

Additionally, we may order tests conducted at other facilities, such as:

• Coronary calcium scoring
• Cardiac MRI
• Cardiac angiography (CT or invasive)
• Genetic testing

In case of need, we can refer for treatment of serious cardiac disease at the best medical centers locally or nationwide.

Sport-specific knowledge for individualized care

While training and exercising, you are frequently pushing your body to the limit.  Because your heart is “smart,” it undergoes specific adaptation to the demands of physical activity.  Such adaptations can be subtle and must be carefully distinguished from similar changes that occur as a result of heart disease.

The American College of Cardiology (A.C.C.) has created a Sports and Exercise Cardiology Section to promote core clinical competency in this new field, which includes a sport-specific knowledge-base to facilitate specialized individualized care.  Dr. Accad is both a fellow of the A.C.C. and a member of its Sports and Exercise Cardiology section.

The good news is that most conditions that lead to exercise-related cardiac complications can be detected by a comprehensive, non-invasive evaluation.  If we detect such a condition, then we can take the appropriate measures to avoid or reduce the chance of future problems.  In such cases, our goal is to assist you in making short- and long-term return-to-play decisions.

For the athlete with pre-existing heart disease

It is increasingly recognized that people with established and well-treated heart disease can exercise more intensely and competitively than commonly believed. If you have been treated for heart disease and wish to engage in, or resume intense athletic activity, we are happy to offer our consultative advice.

For the seasoned ultra-endurance athlete

There is some concern that ultra-endurance sports performed for many years may, in certain cases, lead to cardiac complications such as atrial fibrillation, or possibly even cardiomyopathy (disease of the heart muscle).  This is a new area of investigation that we are following closely.  If you fit in that sport category, you may wish to obtain a consultation with us to perform a baseline evaluation of your heart and establish a monitoring routine.

If you have symptoms

Symptoms of cardiovascular disease include chest pain, shortness of breath, palpitations, light-headedness, fainting, and a decline in the ability to perform at a prior level of effort.  If you are currently experiencing any of these signs, we urge you to contact your doctor as soon as possible, or to make an appointment with us for a formal consultation.

For the couch potato!

Although we love sports cardiology, we don’t discriminate on the basis of athletic prowess! You may need some encouragement to begin an exercise program, but most importantly you may need to be reassured that you can do so safely. Our program is equally valuable, whether you do a 100-meter dash in 10 seconds or 10 minutes.

The cardiovascular disease and conditions below can be discovered before they cause any symptoms.  Some of them are present at birth but remain silent for years.  Others are acquired.  They can be present even without a family history of heart disease.

• Coronary Artery Disease
• Hypertrophic Cardiomyopathy
• Arrhythmogenic Right Ventricular Cardiomyopathy
• Aortic Stenosis and Bicuspid Aortic Valve Disease
• Aortic Aneurysm
• Dilated Cardiomyopathy
• Congenital Heart Defects
• Long QT Syndrome and Ion Channelopathies
• Hypertension
• Valvular Heart Disease
• Wolff-Parkinson-White Syndrome

Most of these conditions can be detected with the non-invasive tests we offer.  In the majority of cases, a firm conclusion can be reached on the basis of the examination, ECG, echocardiogram, and/or stress test.  In adults, we frequently also recommend a simple and relatively inexpensive cardiac CT scan that can detect the presence of early plaque build-up in the coronary arteries.

We do our best to come up with a definitive conclusion that will not unnecessarily constrain your activity nor expose you to excessive risk of complications.  Rarely, if the initial tests are inconclusive, additional tests or perhaps a period of observation may be required.

• The Athlete’s Heart Blog is Dr. Larry Creswell’s website.  It provides a wealth of information for athletes about heart-related matters.
• The Society for Heart Attack Prevention and Eradication (S.H.A.P.E.) aims at raising awareness among doctors and hospitals about the value of a screening strategy to detect cardiovascular disease early, before complications occur.
• Heartfelt Cardiac Projects is a Southern California non-profit organization that offers low-cost community-based cardiac screenings.  It was established by Holly Morrell and dedicated to her 6 family members who lost their lives to hypertrophic cardiomyopathy.
• 44 for Life is a Pennsylvania-based advocacy organization that aims at raising awareness about sudden cardiac arrest.  It was established by former NCAA Basketball champion, Bo Kindle, in memory of his friend Hank Gathers who died on the court of sudden cardiac arrest related to hypertrophic cardiomyopathy.
• The EP Save a Life Foundation is a San Diego-based organization that offers free community-based cardiac screenings.  It was established in memory of Eric Paredes, a teenager who died of sudden cardiac arrest in 2009.
• No More Broken Hearts–read our blog entry about this new local organization started by Victoria Dupuy in honor of her late husband Dean who, at age 46, unexpectedly collapsed while playing hockey and subsequently died of coronary artery disease.
• Cardiac Athletes is an online support group for athletes with heart disease. It includes a very large forum where athletes from around the world compare notes.
• Simon’s Fund is a non-profit organization in the Philadelphia area dedicated to raising awareness about sudden cardiac arrest in children.  Simon’s Fund promotes community screening programs.
• Via Heart Project is a California-based organization that equips schools with automated external defibrillators (AED’s) and provides ongoing training and maintenance to ensure that proper and prompt response is available in the event of a cardiac arrest.  The organization also promotes community-based cardiac screenings for youth.
• The Sudden Cardiac Arrest Foundation is a national non-profit organization dedicated to raising awareness and educating the public about sudden cardiac arrest.
• Parents Heart Watch is a national network of parents, families, and organizations dedicated to reducing sudden cardiac arrest in youth.
• Hypertrophic Cardiomyopathy Association (H.C.M.A.) is a grassroots organization focused on preventing sudden cardiac arrest through early detection of this condition which is a common cause of death among athletic youth and young adults.