Coronary heart disease - a subset of cardiovascular disease - is the number two killer. It is the failure of the coronary arteries or vessels supplying oxygen to the heart and surrounding tissue. Coronary heart disease (also known as coronary artery disease) is expected to afflict more people at a younger age as we become more sedentary and develop unhealthy eating habits.

Coronary heart disease is known to develop over a long time and can go undetected in the early stages as there may be no symptoms. For some patients, the onset of a major heart attack with its attendant complications is the first and only symptom of coronary artery disease. This can be avoided if more patients, especially those with known risk factors, keep track of the status of their heart health.

What is heart health assessment?

Heart health assessment plays an important part in the early diagnosis and treatment of heart disease. This is especially important for people who do not seem ill.

"This is because cardiovascular risk factors could be detected, allowing for earlier therapy," explains Dr Paul Chiam, Consultant Cardiologist at the National Heart Centre Singapore. "Early heart problems (if any) could also be picked up. Treatment - including lifestyle modification - can help to prevent or delay complications".

A basic assessment is relatively pain-free, except for routine blood taking. The assessment usually begins with a medical history review and a detailed physical examination. It also includes tests such as the ECG (electrocardiogram), chest x-ray, and fasting lipid and glucose profiles to evaluate basic cardiac status and risk profile.

The results will help to determine if the risk factors for heart disease - such as high blood pressure, diabetes or elevated cholesterol levels - are present.

Besides cardiovascular risk factors, early heart conditions such as underlying heart artery blockages can be picked up. Early intervention can prevent the condition from becoming worse.

Who can do the screening?

A family physician or GP can provide most of the basic screening. He or she may refer patients to a cardiologist for further tests, such as an exercise stress test, based on clinical findings from the basic screening.

Who should have heart health screening?

The recommended age to start assessing heart health for most people is around 40-45 years.

For people with strong family history of heart disease, they should perhaps start earlier, at around 35 years old.

As for the frequency of the check-ups, Dr Chiam says, "Depending on the patient's clinical history and the risk profile, the doctor may recommend that a checkup by done every one to five years."

What are the tests for heart disease?

1. Blood tests - This analyses cholesterol levels, kidney and liver function and diabetes mellitus. It can also confirm if you are having a heart attack if you are experiencing chest pain

2. Electrocardiogram (ECG) - Identifies abnormal heart rhythm and evaluates if symptoms of chest discomfort are due to heart disease.

The patient will be asked to lie on a bed and electrodes will be placed on his chest, arms and legs. These electrodes help to detect the electrical activity of the heart. Patient can breathe normally during the procedure, but should avoid moving or talking to prevent distortion of test results. This test takes about 5 to 10 minutes.

3. Chest x-ray - Diagnoses abnormalities in cardiovascular and pulmonary systems - heart, lungs and blood vessels.

4. Exercise Stress Test - This assesses the response of the heart to increased workload and demand for blood supply during exercise or exertion (pictured above).

Electrodes are placed on the patient's chest for ECG monitoring before the test. The patient's ECG and blood pressure will be taken at rest. Patient will then be asked to walk on the treadmill machine. The speed and gradient of the slope will increase every 3 minutes to stress the heart gradually.

During the test, patient's blood pressure, heart rate, ECG and general condition will be monitored closely. Patient should inform the doctor to stop the test at any time if they are feeling tired, unwell or unable to continue. The procedure takes up to 1 hour, inclusive of preparation time.

5. Calcium Score on CT scan - Detects the amount of calcification in the coronary arteries. This test detects coronary artery disease at an early stage when there are no symptoms and helps to determine its severity.

The technologist begins by positioning you on the computed tomography (CT) examination table, usually flat on your back. Straps and pillows may be used to help you maintain the correct position and to hold still during the scan.

Electrodes for ECG will be attached to your chest to monitor your heart beats. This makes it possible to record CT scans when the heart is not actively contracting.

Patients are asked to hold their breath for a period of 10 to 15 seconds while images are recorded. You may also feel a little warm upon injection of the contrast, which should subside after a short while.

When the examination is completed, you will be asked to wait until the technologist verifies that the images are of high enough quality for accurate interpretation.

This article was contributed by National Heart Centre Singapore (NHCS) and is part of a new series on heart health.