Sudden Cardiac Death (SCD) is a silent killer that can strike without warning, often in individuals who appear to be in good health. While traditional risk assessments focus on blood pressure, cholesterol, and diabetes, these alone may not be sufficient to detect hidden heart risks. In this article, we will explore a comprehensive range of heart health tests, including standard screenings, advanced imaging, and specialized blood tests, to help detect potential cardiovascular threats before they lead to fatal events.
1. Standard Heart Health Tests
A. Electrocardiogram (ECG)
What it does:
- Measures the electrical activity of the heart.
- Detects arrhythmias (abnormal heart rhythms), conduction disorders, and signs of ischemia (lack of blood supply).
Why it’s important:
A standard ECG can help detect silent electrical disturbances that may lead to sudden cardiac arrest, such as prolonged QT syndrome, atrial fibrillation, and Brugada syndrome. However, it provides only a snapshot of the heart’s activity and may not detect intermittent arrhythmias.
Who should get it?
- Anyone with palpitations, dizziness, fainting, or chest discomfort.
- Those with a family history of sudden cardiac death.
- Routine screening in individuals with risk factors like hypertension, diabetes, or hypercholesterolemia.
B. Echocardiogram (ECHO)
What it does:
- Uses ultrasound to create images of the heart’s structure and function.
- Assesses heart size, muscle thickness, and valve function.
Why it’s important:
An echocardiogram is essential for detecting structural abnormalities that can contribute to sudden death, such as hypertrophic cardiomyopathy (HCM) or heart failure with reduced ejection fraction (HFrEF).
Who should get it?
- Individuals with unexplained breathlessness, chest pain, or a history of fainting.
- Athletes and young individuals with a family history of heart disease or sudden death.
2. Advanced Coronary Risk Tests
A. Coronary Artery Calcium Score (CACS)
What it does:
- A specialized CT scan that detects calcium deposits in the coronary arteries.
- Measures the degree of plaque buildup in the arteries.
Why it’s important:
The higher the calcium score, the higher the risk of a heart attack. A score of 0 indicates minimal risk, while a score above 100 suggests significant plaque burden. This test is especially useful for individuals with normal cholesterol but a strong family history of heart disease.
Who should get it?
- Middle-aged adults with borderline risk factors for heart disease.
- Individuals with a strong family history of coronary artery disease (CAD).
B. CT Coronary Angiography (CCTA)
What it does:
- A non-invasive imaging test that provides a detailed view of the coronary arteries.
- Identifies narrowed arteries, soft plaques, and blockages.
Why it’s important:
Unlike traditional cholesterol tests, CCTA reveals whether plaques are forming in the arteries before symptoms appear. It also identifies high-risk “soft plaques” that are prone to rupture, leading to sudden heart attacks.
Who should get it?
- Individuals with borderline cholesterol but a strong family history of heart disease.
- People with chest discomfort, unexplained fatigue, or borderline ECG changes.
C. Holter or Patch Monitoring
What it does:
- Provides continuous ECG monitoring over 24 hours or longer.
- Detects intermittent arrhythmias that may not appear in a resting ECG.
Why it’s important:
Holter monitoring is crucial for detecting silent arrhythmias such as atrial fibrillation, ventricular tachycardia, or heart pauses that can increase the risk of SCD.
Who should get it?
- Patients with unexplained fainting, palpitations, or dizziness.
- Individuals with a family history of sudden cardiac death.
3. Atherosclerosis Progression Analysis (FNATS Test)
The FNATS test is a specialized blood test that assesses oxidative stress, inflammation, and endothelial dysfunction—all of which contribute to cardiovascular disease progression.
A. What Does FNATS Measure?
- Oxidized LDL (oxLDL): Indicates oxidative damage to blood vessels, which can trigger plaque rupture.
- F2-Isoprostanes (F2-IsoPs): A marker of oxidative stress that damages arterial walls.
- Homocysteine: High levels increase the risk of blood clots and arterial stiffness.
- Myeloperoxidase (MPO) & LP-PLA2: Indicators of plaque instability, which increases the likelihood of rupture and sudden cardiac events.
B. Why is FNATS Important?
This test helps identify individuals with hidden cardiovascular risk factors that may not show up on routine cholesterol or blood sugar tests. It is particularly useful for those with:
- Borderline cholesterol levels but a strong family history of heart disease.
- Unexplained fatigue, shortness of breath, or borderline blood pressure.
- A desire for early cardiovascular risk assessment before symptoms appear.
C. Who Should Consider FNATS?
- Individuals with a strong family history of early heart attacks or sudden cardiac death.
- People with borderline cholesterol and normal ECG but a high inflammatory burden.
- Those looking for a more personalized approach to heart disease prevention.
⚠ However, FNATS is not a substitute for imaging tests like CACS or CCTA. It is best used alongside other cardiovascular assessments to get a complete picture of heart health.
4. Should Everyone Get a Coronary Angiogram?
A coronary angiogram is an invasive test that directly visualizes the coronary arteries by injecting contrast dye. While it is the gold standard for diagnosing severe blockages, it is not necessary for everyone.
When is a Coronary Angiogram Recommended?
✅ Individuals with persistent chest pain or exertional breathlessness.
✅ Patients with abnormal stress test or CCTA findings.
✅ Survivors of heart attacks or sudden cardiac arrest.
For low-risk individuals, non-invasive tests such as CACS and CCTA should be done first.
5. How to Reduce the Risk of Sudden Cardiac Death?
Even with normal test results, proactive prevention is key:
- Control traditional risk factors – Maintain healthy blood pressure, cholesterol, and blood sugar levels.
- Choose the right tests – Advanced screening can detect hidden risks.
- Monitor symptoms – Fatigue, dizziness, or palpitations should not be ignored.
- Adopt a heart-healthy lifestyle – Diet, exercise, and stress management reduce inflammation.
- Understand family history – If close relatives had early heart disease, early screening is crucial.
Conclusion: Early Detection Saves Lives
Sudden cardiac death is often preventable with the right screenings. While traditional tests like cholesterol and blood pressure measurements are important, advanced diagnostic tests provide a deeper look into hidden cardiovascular risks.
If you have concerns about your heart health, consult your doctor to determine the best screening approach for you. Taking action today can help prevent a life-threatening cardiac event in the future.
Dr Teoh - Family Medicine Specialist, Stem Cell & Immune Therapy 