Pre-fitness Training Cardiac Risk Assessment

Provocative testing (stress testing/treadmill testing) can be useful in assessing people’s cardiac status prior to undertaking a training programme. This can be helpful in identifying any cardiac conditions that might prevent safe exercise, and in providing people with reassurance for the training that lies ahead.

Pre-exercise screening is used to identify people who may have medical conditions which put them at a higher risk of an adverse event during physical activity. This involves taking a history from the patient about their lifestyle, symptoms and risk factors, as above, but includes provocative exercise testing, to determine their heart’s response to exercise, and an echocardiogram to exclude structural heart disease. Please allow a minimum of one hour for this assessment.

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Cardiovascular Risk Assessment

A doctor or nurse will ask if you have any current lifestyle risk factors that increase your risk of developing a cardiovascular disease. These include smoking, body weight, diet, degree of physical activity and alcohol consumption. Your blood fats and sugar will be checked, and your blood pressure will be measured. A score is calculated based on several of these risk factors, your age and gender. An adjustment to the score is made for certain other risk factors such as strong family history and ethnic origin.

There are many different calculators. The Framingham calculator has been used for a long time but many health professionals are moving over to QRISK®2. This is more accurate and takes into account many other factors such as whether you have a condition called atrial fibrillation or kidney disease.

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Secondary Hypertension Screening

Hypertension (high blood pressure), remains a very common, but very treatable risk factor for heart, kidney and stroke disease. Most of the time, it is primary, i.e. it has no obvious underlying cause. If it occurs in younger people, or is severe or difficult to control, then it is more likely to be secondary, i.e. have an underlying cause, usually kidney disease or a problem with the hormones that control salt and water content in the body. These can be identified and treated.

To diagnose secondary hypertension, you will have a history and examination performed, and we will arrange a 24 hour blood pressure monitor, to assess for true blood pressure elevation (as opposed to ‘white coat hypertension’), and an echocardiogram, to assess whether blood pressure has damaged your heart.

We will also check other markers to pinpoint the cause of your high blood pressure. These could include:

  • Blood tests, to check your potassium, sodium, creatinine, fasting blood glucose, total cholesterol and triglycerides, and other chemicals in your blood to help make a diagnosis.
  • Urinalysis, to check your urine for markers that could show if your high blood pressure is caused by another medical condition.
  • Ultrasound of your kidneys. Since many kidney conditions are linked to secondary hypertension, an ultrasound of your kidneys and kidney blood vessels will be required. In this non-invasive test, a cardiac physiologist will run an instrument called a transducer over your skin. The transducer, which produces sound waves, measures how the sound waves bounce off your kidneys and arteries and sends images created by the sound waves to a computer monitor.
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