It turns out that these indicators in the physical examination are all about "heart", and they are all mastered at once

It is the physical examination season again. When facing the physical examination report, everyone hopes that they can "remain calm in the face of praise or criticism, and watch the flowers bloom and fall in front of the courtyard; they have no intention of staying or leaving, and just follow the clouds rolling and unfolding in the sky". However, it is inevitable that they will feel uneasy, as if they are carrying "fifteen buckets - ups and downs".

This article will interpret the results of cardiovascular disease in the physical examination report to relieve the concerns that may arise from not understanding their clinical significance. It will also provide some suggestions for further examination, diagnosis, and treatment.

Related indicator 1: Weight and body mass index

The specific reference values ​​will be listed in the physical examination report. For those who are significantly overweight, if they also have high blood pressure, and the blood pressure is stubborn and difficult to control with medication, you need to be alert to whether they have obstructive sleep apnea. Sleep breathing monitoring can be performed to check for related conditions.

Related indicator 2: Blood pressure

When the systolic blood pressure is greater than or equal to 140 mmHg, and/or the diastolic blood pressure is greater than or equal to 90 mmHg, it indicates that the measured blood pressure is too high.

As for how to diagnose hypertension, when to start antihypertensive drug treatment, and the target value for blood pressure reduction, it is recommended to go to the Department of Cardiology, especially the hypertension clinic for diagnosis and consultation.

Related indicator 3: blood lipids

We must focus on two indicators, namely triglycerides (TG) and low-density lipoprotein cholesterol (LDL-C) (as shown in the red box in the figure below). The analysis of the results of other indicators should be left to professionals.

The test results of triglycerides (TG) are greatly affected by food. It is recommended to eat a light diet 3 days before the test and eat less high-fat foods. If the test result exceeds 1.7, it is considered to be elevated. If it exceeds 3.0-3.5, it is recommended to take medication. If it is between 2.3-3.0, you can control your diet for 1 month and then retest; if the retest is still above 2.3, you also need to take medication.

Elevated low-density lipoprotein cholesterol (LDL-C) is the most important factor causing atherosclerosis. The traditional single "reference value" has little clinical guidance value, which means that we should not take it lightly just because LDL-C is "within the normal range". In recent years, many physical examination reports will give the target value that LDL-C needs to be controlled to under different physical conditions (see the red box in the figure below). For example, for healthy people, LDL-C can be within 3.4; for patients who have been diagnosed with coronary heart disease, especially those who have had stents implanted, it is recommended that LDL-C be controlled to below 1.6; and for patients who have had myocardial infarction or cerebral infarction, it is recommended that LDL-C be further controlled to within 1.4.

Many people also pay attention to the indicator of lipoprotein (a) [Lp(a) in English]. Because it may also be related to atherosclerosis. However, there is currently a lack of drugs that can specifically reduce this indicator. Recently, limited data have shown that small molecule lipid-lowering drugs may have a certain effect on reducing Lp(a), but more clinical studies are needed to further confirm it.

Related indicator 4: electrocardiogram

(1) Sinus bradycardia

First of all, the word "sinus" means that the electrical activity of the heart originates from the sinoatrial node, which is the "headquarters" of the heart circuit. This is normal. If our heart rate is less than 60 beats per minute, the physical examination report will diagnose "bradycardia". However, whether sinus bradycardia has clinical significance requires specific analysis.

In recent years, more and more scholars believe that the ideal heart rate for adults under awake and resting conditions is 55-70 beats/minute; 50-80 beats/minute is also relatively appropriate. Therefore, if the heart rate is within 50-59 beats/minute when awake during the day, although it is diagnosed as "bradycardia", as long as there are no symptoms such as dizziness, chest tightness, palpitations, and fatigue, no special treatment is required.

However, if the dynamic electrocardiogram shows that the average heart rate is less than 50 beats/minute and there are symptoms related to bradycardia; or if long intervals of more than 2 seconds occur during the day when the heart is awake, it is a pathological state and further diagnosis is recommended. A pacemaker implant may be needed to solve the problem of bradycardia.

(2) Sinus arrhythmia

Common in young people. Usually no special treatment is required.

(3) Left deviation of the electric axis

If there is no special indication in the echocardiogram, no special treatment is required

(4) First degree atrioventricular block

If asymptomatic, no specific treatment is usually required.

(5) Complete right bundle branch block/complete left bundle branch block

If the condition has been diagnosed before, no special treatment is generally required; if it is a new condition, electrolyte and myocardial enzyme tests should be completed as soon as possible to rule out acute myocardial ischemia.

(6) “ST-T changes”

If there are symptoms of chest tightness or chest pain, coronary angiography should be performed as soon as possible; if there are no symptoms, echocardiography and exercise stress electrocardiogram are recommended to rule out myocardial ischemia and cardiomyopathy.

Related indicator 5: Chest CT

(1) Aortic/coronary artery calcification

If a chest X-ray or chest CT shows aortic/coronary artery calcification, it indicates that the aorta or coronary artery has vascular sclerosis and calcium is deposited on the vessel wall. This result does not mean that the aortic/coronary artery disease is very serious.

However, if there are obvious symptoms such as chest tightness and chest pain, aortic CTA and coronary artery CTA/coronary angiography are required to further clarify the severity of aortic/coronary artery lesions.

(2) Pericardial effusion

Chest CT scan is more likely to diagnose "pericardial effusion". At this time, echocardiography should be performed for further verification, because echocardiography is the gold standard for diagnosing pericardial effusion. If echocardiography does not indicate pericardial effusion, no special treatment is required.

Related indicator 6: Echocardiography

(1) Micropericardial effusion

Under normal circumstances, there is also a small amount of fluid in the pericardium, which acts as a lubricant. Therefore, if the volume of pericardial effusion is less than 4 mm, no special treatment is required. You can observe first. Recheck after 3 months. If the volume of effusion has not increased significantly, it can be ignored.

(2) Left ventricular diastolic dysfunction

At present, the detection rate of left ventricular diastolic dysfunction is relatively high. If there are obvious symptoms such as chest tightness and shortness of breath, further examination is required to clarify the cause. If there is no history of hypertension, diabetes, valvular disease, etc., and echocardiography does not indicate myocardial hypertrophy, cardiomyopathy, myocardial amyloid degeneration, etc., but only indicates left ventricular diastolic dysfunction, you can observe first and then recheck after 3 months.

(3) Micro/mild/moderate valvular regurgitation

Everyone's heart has 4 valves: mitral valve, tricuspid valve, aortic valve, and pulmonary valve. Trace/mild regurgitation of any valve does not require special treatment. If it is moderate regurgitation, a re-echocardiogram is required after 3-6 months to see if the regurgitation volume has increased.

(4) Mild/moderate valvular stenosis

Mild stenosis of any valve does not require special treatment. If it is moderate stenosis, a repeat echocardiogram should be performed after 3-6 months to see if the stenosis has worsened.

Related indicator 7: Carotid artery plaque

Carotid artery sclerosis/carotid plaque is a common positive result in adult physical examinations. Everyone is worried that once the plaque falls off, it may cause cerebral stroke if it blocks the cerebral artery with blood flow.

The harm of carotid artery plaque depends on two factors: one is the area ratio of the plaque occupied by the blood vessel lumen (the degree of stenosis), and the other is the nature of the plaque.

If the degree of stenosis is less than 50%, it is mild stenosis; 50%-69% is moderate stenosis; 70%-99% is severe stenosis. Severe stenosis may be completely occluded. Mild stenosis generally does not cause obvious symptoms such as dizziness. For severe stenosis, interventional treatment may be considered.

Whether drug treatment is needed depends on the nature of the plaque. During B-ultrasound examination, the nature of the plaque will be described as: hyperechoic, isoechoic, hypoechoic and mixed echoic. Hyperechoic plaques are relatively stable because they contain a lot of calcium, corresponding to "hard plaques"; isoechoic plaques are mostly simple fibrous plaques; and hypoechoic and mixed echo plaques are mostly unstable plaques.

It is generally recommended that if the degree of carotid artery stenosis exceeds 50% and/or the plaque is unstable, long-term oral antiplatelet drugs (aspirin or clopidogrel) and statins are required.