BY: June Cheong

Sudden death by cardiac arrest can never be totally prevented, but don't panic just yet.

National University Hospital's consultant cardiologist Seow Swee Chong said: "Despite the media publicity, the true incidence of sudden death is low.

"Sending low-risk individuals for a whole battery of sophisticated tests is probably unnecessary and not cost-effective."

He added that a physical examination with an electrocardiogram (ECG), together with a detailed medical history, is
adequate for most. Men are more prone to heart-related ailments. And older men, in particular, are usually concerned with heart health.

However, the recent deaths of two national servicemen highlight the need for even young people to get their hearts checked.

Raffles Hospital's consultant cardiologist Antono Sutandar recommends those below 40 years old to go for a blood test and ECG as well as screening tests for conditions such as hypertension and diabetes once every one to two years.

Dr Goh Ping Ping, chief and senior consultant of Changi General Hospital's cardiology department, said: "The tests for heart disease really detect disease that has been present for some time and has progressed significantly.

"For the general population, it makes more sense to detect and treat risk factors like high blood pressure, diabetes and obesity to prevent the development of heart disease."

"Such non-invasive tests are relatively cheap, widely available in polyclinics and GP clinics and should be done annually.

Dr Goh said: "The key to preventing coronary artery disease is through lifestyle modification. It is never too early to start adopting a heart-healthy lifestyle."

Exercising regularly, maintaining a healthy weight, quitting or avoiding smoking and eating a healthy, balanced diet are the mainstays of a lifestyle beneficial to heart health.

Middle-aged men, post-menopausal women, smokers and Indians are most susceptible to coronary artery or heart disease.

The ECG is usually the first test used by doctors to screen for heart disease. It gives an overview of the heart and can also pick up some of the congenital heart disorders that may result in sudden cardiac death.

If there are symptoms which point to coronary artery disease, an exercise stress test, which is 70 per cent accurate, is then conducted to see how the heart responds to physical exertion.

More sensitive and specific tests like echocardiograms and carotid intimal thickness can be conducted if the results of the ECG and exercise stress tests prove abnormal.

The former is done at rest before exercise and again at peak heart rate and uses ultrasound to take images of the heart's internal structures, size and movement. The latter utilises ultrasound to assess the blood flow of the arteries which supply blood from the heart through the neck to the brain.

Of course there can be too much of a good thing. The New York Times raised the alarm last month on Americans' penchant for medical innovations and blanket testing.

The paper reported that more than 150,000 Americans spent more than US$100 million (S$136 million) on CT scans last year, a new technology dogged by lack of evidence of its medical benefits to patients.

Dr Sutandar, who does not recommend the CT scan for most, said that the ECG stress test is sufficient if one's results are normal.

This article was first published in Mind Your Body, The Straits Times on July 9, 2008.