The heart gives little warning, and gives it late. Many cardiovascular conditions progress for years without symptoms, and by the time they appear there is already an established problem. That is why preventive cardiology makes so much sense: an electrocardiogram, a blood test and a careful examination are enough to map out someone's risk and act on it before anything happens. Here is when a heart check-up is worthwhile, what it involves and how to prepare.
When is a heart check-up worthwhile?
You do not need to have heart disease to see a cardiologist. The most common reasons for an appointment are:
- Symptoms: chest pain or tightness on exertion, breathlessness that is new for you, palpitations, dizziness or blackouts, swollen ankles.
- Regular sport, particularly if you are taking it up after 35 or competing.
- Known risk factors: high blood pressure, raised cholesterol, diabetes, smoking, obesity or a sedentary life.
- A family history of sudden cardiac death, of heart attack before 55 in men or 65 in women, or of inherited cardiomyopathies.
- Something picked up elsewhere: an occupational ECG, a blood test, a driving licence medical or a pre-operative assessment.
If the problem is severe, persistent chest pain, especially with cold sweating, breathlessness or pain spreading to the arm or jaw, this is not a matter for a booked appointment: call 112 straight away.
What a cardiology assessment includes
History and examination
The most important part, and the one nobody should skip: personal and family history, symptoms, medication, lifestyle, blood pressure and listening to the heart. Everything that follows is decided here.
Electrocardiogram (ECG)
A few painless minutes recording the electrical activity of the heart at rest. It picks up arrhythmias, signs of a previous heart attack, enlarged chambers and conduction problems.
Echocardiogram
An ultrasound scan of the heart that shows how the walls move, how the valves work and how strongly the heart contracts (the ejection fraction). It is painless, takes about twenty minutes, and is the key test for murmurs, heart failure or long-standing high blood pressure.
Stress test (exercise ECG)
You walk on a treadmill or pedal a bike at a gradually increasing pace while your ECG, blood pressure and symptoms are recorded. It shows how the heart responds when it is asked to work: it detects ischaemia and arrhythmias that only appear on exertion, and it measures your real functional capacity. For athletes, it is the sound basis for setting training zones.
Holter and ambulatory blood pressure monitoring
A small recorder worn for 24 or 48 hours while you go about your normal day. A Holter monitor is the way to catch palpitations or arrhythmias that come and go; ambulatory blood pressure monitoring shows what your readings really are across the day and night, which is far more reliable than a single measurement in the consulting room.
Our cardiology page sets out the tests available at the centre and how to arrange them.
Athletes: before you start training hard
A sports cardiology assessment looks for the causes of exercise-related sudden cardiac death, which are rare but preventable. Under the age of 35 these are usually congenital or inherited conditions (hypertrophic cardiomyopathy, channelopathies, coronary artery anomalies); over 35, coronary artery disease is the most common cause.
An assessment is advisable before taking up intense exercise, for registered competition, if there is a family history of sudden death, or if you have noticed dizziness, palpitations or disproportionate breathlessness while exercising. A basic assessment — history, examination and ECG — is enough in many cases; a stress test is added depending on your age, the intensity planned and your risk factors.
From 40 to 50 onwards: knowing your numbers
Cardiovascular risk is not calculated from a single figure but from a combination of age, sex, blood pressure, cholesterol and smoking. From 40 in men and 50 in women — earlier if there is a family history — it is worth knowing those numbers and reviewing them every few years. The encouraging part is that almost all of them can be changed:
- Stopping smoking reduces risk more than anything else you can do.
- Moving for 150 minutes a week of moderate activity, even if that is brisk walking.
- Controlling blood pressure and cholesterol through diet, exercise and, when needed, medication.
- Sleeping well, and treating sleep apnoea if it is suspected.
- Watching weight and blood sugar, particularly waist circumference.
Frequently asked questions
How should I prepare for a stress test?
Bring sports clothing and trainers, avoid a heavy meal and coffee in the two or three hours beforehand, and do not exercise hard that day. Never stop medication on your own initiative: if anything needs adjusting, the cardiologist will tell you when the test is arranged.
What should I bring to the appointment?
Photo identification and your insurance card, a list of the medication you take, and any previous reports, blood tests or ECGs. An old ECG to compare against is often worth as much as a new test.
Will my insurance cover it?
We work with more than 40 insurers, and you can check yours on our insurers page. Some tests, such as an echocardiogram or Holter monitoring, may need prior authorisation, and our reception team will help you arrange it.
Booking an appointment
Call 972 30 65 65, write to us through the contact page or use our online appointment portal. We are at Plaça de Catalunya, 5 in Palafrugell, open Monday to Friday from 8 am to 8 pm and Saturday from 9 am to 2 pm, and our staff can attend you in English. Having your heart checked in good time is not alarmism: it is the simplest way to keep doing what you enjoy with peace of mind.
