Safety First Before Beginning An Exercise Regimen

Posted on February 1, 2016

Cardiac Tests are recommended for:

  • High performance sports participants
  • People starting to work out, especially men over 40 and women over 50

In 90 percent of adult victims of sudden cardiac death, two or more major coronary arteries are narrowed by fatty build-ups. When sudden death occurs in young adults, other heart abnormalities including drugs and medications are more likely causes. Adrenaline released during intense physical or athletic activity often acts as a trigger for sudden death when these abnormalities are present.

For young athletes, the idea of screening for potentially deadly heart abnormalities in athletes before embarking on a career in competitive sports has been debated for years. Electrocardiograms (ECGs) pick up too many “normal irregularities” that result as the body adapts to the demands of competitive sports, leading to unnecessary alarm and needless investigations. Opponents also have questioned the cost effectiveness of testing. The latest study published by Dutch researchers in British Journal of Sports Medicine shows that ECG alone can detect athletes with potentially deadly cardiovascular disease. In addition, those with cardiomyopathy or Marfan’s syndrome require at least an echocardiogram.

Symptoms that require cardiology assessment include chest pain, irregular heartbeat, severe shortness of breath or unexplained fainting spells.

Screening tests can find diseases early when they are easier to treat. Based on scientific evidence, preliminary testing should include testing for risk factors of obesity (based on BMI) , blood pressure, cholesterol and diabetes. Cholesterol should be checked regularly starting age 35, especially for those with family history of heart disease, high blood pressure, diabetes and those who smoke. Blood pressure should be checked every 2 years.

Age is a major risk factor for cardiovascular disease. Amongst adults age 20-29, the prevalence of Coronary heart disease is 15.9 percent for males and 7.8 percent for females. The lifetime risk of developing CHD after age 40 is 49 percent for men and 32 percent for women. (Lancet. 1999;353:89–92.) For those who have 2 or more risks including lack of exercise or smoking, additional tests are useful.

These additional tests include hsCRP, carotid ultrasound and calcium score and have been proven to better determine risks of cardiovascular disease. These are all non-invasive, office based tests offered in the cardiology clinic. High-sensitivity C-reactive protein or hsCRP is a blood test measuring inflammation of the arteries to predict chance of stroke or heart attack. Carotid ultrasound measures the thickness of the main artery to the brain to detect presence of atherosclerosis. It is almost as predictive as all the other risk factors combined. Calcium score measures the calcium deposits in the coronary arteries. It is very much like an X ray. It is normally offered to people with risk factors who are deciding whether to embark on aggressive exercise or to start exercise. If calcium score is low, then little or no CAD is likely present. If calcium score is moderate or high, heart attack risk is high and medications should be considered before starting exercise.

In general, men over 40 and women over 50 should check with their doctor before doing vigorous activity. Those with known cardiovascular diseases should consult their existing cardiologist. Most older adults, regardless of age or condition, will do just fine in increasing their physical activity to a moderate level. If you are between the ages of 65 and 75 and have ever smoked (100 or more cigarettes during your lifetime), you need to be screened once for abdominal aortic aneurysm, which is an abnormally large or swollen blood vessel in your abdomen.


Lim Ing Haan Cardiology Clinic
3 Mount Elizabeth #04-02
Singapore 228510

Clinic Hours
Mon-Fri : 8.30am - 5.00pm
Sat : 8.30am - 12.30pm