Dr Ydelise Rodríguez Pichardo

The aim is to estimate your overall cardiovascular risk and act on the factors that raise it: high blood pressure, dyslipidaemia (abnormal cholesterol), diabetes, smoking, obesity and a sedentary lifestyle. It allows individual treatment targets to be set and the right moment to start drug treatment to be decided, in order to prevent myocardial infarction, stroke and heart failure.

Aimed at reaching a precise diagnosis when there is a symptom or a finding, and at defining the corresponding treatment. It covers the assessment of chest pain, dyspnoea (breathlessness), palpitations, syncope or a murmur, the indication of whatever further tests each case requires, the adjustment of drug treatment and the assessment of whether an interventional procedure is warranted.

An overall assessment of cardiovascular status in people with no symptoms or with non-specific ones. Its value lies in detecting, at an early stage, high blood pressure, arrhythmias, murmurs, electrocardiographic abnormalities or a previously unknown high cardiovascular risk — conditions that often run silently for years.

Periodic monitoring of established heart disease: heart failure, ischaemic heart disease, valve disease, arrhythmias or pulmonary hypertension. It allows clinical progress, response to treatment and the appearance of complications to be assessed, and medication to be adjusted so as to maintain stability and reduce hospital admissions.

It records the electrical activity of the heart and is the first-line test in practically every cardiac assessment. It reports the rhythm and heart rate, and detects arrhythmias, conduction disorders (blocks), signs of ischaemia or previous infarction, chamber enlargement and changes secondary to drugs or electrolyte disturbances.

Echocardiography is one of the most useful tests and the one that provides the most information about your heart. It measures the size of the chambers, including the aorta, determines the strength of the pumping action (ejection fraction), shows the overall structure and assesses the blood flows within the heart (Doppler mode) to establish how the heart valves are working, among much other information.

This test assesses the contractility of the heart muscle and the valve flows directly, both at rest and under cardiac stress. It is useful for investigating exertional symptoms in people unable to perform a conventional exercise test, for grading the severity of certain valve conditions, as well as ventricular function on exertion.

Complete initial blood tests aim to assess your general health and, in particular, your cardiovascular health. They are among the general tests that give the most information about your overall state of health, and they are especially useful in the diagnosis and follow-up of metabolic conditions. Their results shape the treatment targets, both in lifestyle and in the adjustment of medication.

It assesses the heart’s response to progressive exercise. It reports real functional capacity and how blood pressure and heart rate behave on exertion, and detects inducible ischaemia (a shortfall in blood supply that only appears as demand rises), exercise-related arrhythmias and limiting symptoms. It is also useful for risk stratification and for guiding exercise prescription.

Continuous electrocardiographic recording during ordinary activity. Its main value is in documenting arrhythmias that occur intermittently and therefore do not appear on a standard electrocardiogram: atrial fibrillation, ectopic beats, paroxysmal tachycardias or pauses. It also allows symptoms —palpitations, dizziness, syncope— to be correlated with the heart rhythm at that precise moment.

Blood pressure recording over 24 hours, including overnight. It is the reference test for confirming a diagnosis of hypertension and for assessing how well treatment is controlling it. It identifies white-coat hypertension, masked hypertension and the absence of a night-time fall in blood pressure (non-dipper pattern), which carries a higher cardiovascular risk.

Cardiac CT assesses the coronary arteries non-invasively and quantifies coronary calcium, a risk marker. Cardiac MRI characterises the muscle in great detail: it measures ventricular volumes and function and detects fibrosis, inflammation (myocarditis) or infiltration, information that is decisive in the study of cardiomyopathies. They are requested on clinical grounds and carried out in hospital.

Coronary angiography directly visualises the inside of the coronary arteries and determines the site and severity of any obstruction. When a lesion is significant, it can be treated in the same procedure by angioplasty with stent implantation, restoring blood flow to the heart muscle. It is indicated from the clinic and carried out in a referral hospital.

It analyses the heart’s electrical system from inside the chambers to establish the mechanism and the exact origin of an arrhythmia. Once the focus or circuit responsible is identified, ablation can eliminate it, with the possibility of a definitive cure in arrhythmias such as AV nodal re-entrant tachycardia, atrial flutter or certain accessory pathways. It is indicated from the clinic and carried out in a referral hospital.

A procedure aimed at restoring sinus rhythm —the heart’s normal rhythm— in arrhythmias such as atrial fibrillation or flutter. Its purpose is to improve symptoms and functional capacity when the chosen strategy is rhythm control. It requires adequate anticoagulation beforehand and, at times, ruling out clots with a transoesophageal echocardiogram; the indication is weighed on an individual basis.