Top 5 tests for your heart health

In this video, I will tell you what I think are the top five tests to monitor your heart health. If it's your first time here on my channel, welcome. My name is Hafiz and I'm a cardiologist training in London. I created this channel to increase awareness of heart disease and to tell you how you can improve your heart health. If that interests you, then click the subscribe button and the bell icon so you're up to date with all my videos. So let's start with the first test for your heart. If you don't know your blood pressure, then this is the first test you need to do. Blood pressure is the pressure of blood in your arteries. Your arteries are the vessels that carry blood from your heart to your brain and the rest of your body. You need a certain amount of blood pressure to get the blood moving around your body. Your blood pressure naturally goes up and down throughout the day and night and it's normal for it to go up while you're moving about. It's when your overall blood pressure is always high, even when you are resting, that you need to do something about it. The medical term for high blood pressure is hypertension and it means that your blood pressure is always too high. This means your heart is working harder when pumping blood around your body. Hypertension is the biggest risk factor for heart disease and it's a really common condition. It affects one in four people in the world and because it's not something you can feel, most people don't even know they have high blood pressure. The best way to check your blood pressure is to measure your blood pressure at home. I've done an entire video showing you step by step how to measure your blood pressure at home and I'll link to it somewhere on the screen. A validated blood pressure device costs around £20 if you live in the UK and you can purchase it online or from your local pharmacy. I recommend measuring your blood pressure at home as it's not affected by a phenomenon called white coat hypertension. This is when your blood pressure is deceivingly high when measured by a healthcare professional in a clinical environment. It affects 30% of the population so it's fairly common. You can avoid this by measuring your blood pressure at home so you know your numbers as blood pressure is the strongest risk factor for heart disease. The second test I would recommend is an electrocardiogram or an ECG. This is a simple test that measures the electrical activity of your heart. It's performed by attaching stickers to your chest, arms and legs so that the electrical current is conducted through the leads. 10 small sticky patches called electrodes are put on your arms, legs and chest. These are connected by wires to an ECG machine which picks up the electrical signals that make your heart beat. This electrical activity is recorded and printed onto a paper. This is an example of an ECG and this is my ECG. An ECG can help detect problems with your heart rate or heart rhythm. The whole test takes only a few minutes and is completely painless. It's always a good idea to have a copy of your ECG stored on your phone so that if you have another ECG in the future we have a reference to compare to. There have been advances in miniaturizing ECG equipment, particularly for long-term ECG recording. The term wearables now describes, for example, a tightly fitting t-shirt with ECG electrodes built in so that it can be worn during sporting or other daily activities while an ECG is recorded. Other devices record only a single lead of an ECG using a mobile phone. They may be useful for a patient with an intermittent problem so they can record the event easily when it occurs. The remaining three tests are all blood tests and all of these tests can be done as point of care testing, meaning from a finger prick test. The first point of care blood test is a cholesterol profile. Knowing your cholesterol level is really important as high cholesterol is another important risk factor for heart disease. Cholesterol is a fatty substance in your blood. Cholesterol is really important for your body to function. It's a key ingredient that your body needs to make hormones like estrogen or testosterone. Without cholesterol you can't make vitamin D from sunlight and it also helps create bile acids so you can digest fat. So your body needs cholesterol to survive. Cholesterol is mainly made in your liver. The rest, around 25% or so, comes from your diet. Cholesterol travels throughout your bloodstream by binding to a protein and this complex is called a lipoprotein. There are two types of lipoprotein, LDL and HDL. LDL stands for low density lipoprotein and is sometimes referred to as bad cholesterol. The job of LDL is to transport cholesterol from the liver and take it to the rest of your body. It's called bad cholesterol because it can build up inside your arteries that causes them to narrow and lead to a heart attack or stroke. Generally speaking we aim to keep it below 1.8 or 70 milligrams per deciliter. On the other hand HDL or high density lipoprotein carries excess cholesterol away from your arteries and back to the liver where it is broken down and removed from the body. So ideally you need a high level of HDL and low LDL. There is also a third component to cholesterol called triglycerides. This is the most common type of fat in your body. It's essentially converted sugars. If your triglycerides are high this can also cause heart disease irrespective of your total cholesterol. Elevated triglyceride levels greater than 2.3 millimoles per liter especially when HDL is low is a risk factor for cardiovascular disease and is independent of total cholesterol. So all these three components make up your total cholesterol. If you don't know your cholesterol the first step is to get your cholesterol checked especially if you're over 30 years old. A cholesterol profile gives you a breakdown so not just your total cholesterol but like blood pressure cholesterol numbers should be assessed in light of all your other risk factors. Your cholesterol target is likely to differ compared to someone else. Generally speaking we aim to keep your total cholesterol below 5 millimoles per liter your LDL below 3 and HDL 1 or above. The next test is LP little a. LP little a stands for lipoprotein little a. LP little a is a small cholesterol-rich protein that is made in the liver. Levels of LP little a is genetically determined so you are born with it. High levels of LP little a is common affecting one in five people that's 20% of the population. Studies have shown that elevated LP little a levels increase cardiovascular risk in the general population and in people with familial hypercholesterolemia. High levels of LP little a increases risk of stroke and heart attacks. People with elevated LP little a may have two to four times increased cardiovascular risk compared to people with low LP little a. LP little a is pro-inflammatory, pro-atherogenic and pro-thrombogenic meaning the arterial walls become inflamed and more susceptible to clot formation and therefore being clogged up. The structure of LP little a is unique in that it has a shell made up of LDL cholesterol attached to a protein known as apo a. Apo a has a structural similarity to plasminogen, the precursor to plasmin, so may competitively inhibit the conversion of plasminogen to plasmin. Plasmin degrades fibrin blood clots so with less plasmin to break down fibrin, fibrin levels increase promoting thrombogenesis. Because of its structure LP little a combines the potential atherogenic risk associated with LDL cholesterol and the potential thrombogenic risk attributed to apo a. Most people have lipoprotein little a in the range of 5 to 30 milligrams per deciliter. Cardiovascular risk starts to rise at 13 milligrams per deciliter and rises more steeply at 15 milligrams per deciliter. Currently levels of LP little a greater than 50 milligrams per deciliter is considered pathological. The fifth and final test I recommend is getting your HbA1c level tested. HbA1c is what's known as glycated hemoglobin. This is something that's made when the sugar in your body sticks to your red blood cells. Your body can't use the sugar properly so more of it sticks to your blood cells and builds up in your blood. Red blood cells are active for around two to three months which is why the reading is taken quarterly. A high HbA1c means you have too much sugar in your blood. The HbA1c test measures the amount of blood sugar attached to your hemoglobin. The accuracy of the HbA1c test can be affected by other medical conditions especially conditions that affect the red blood cells such as hemolytic anemia, sickle cell anemia and thalassemia. If you have a condition that affects your red blood cells talk to your doctor about what other tests will be more accurate for you. An HbA1c test is also used to diagnose diabetes and to keep an eye on your levels if you're at risk of developing diabetes. There are different target HbA1c levels for people at risk of developing type 2 diabetes. If you've been told you're at high risk your target should be below 42 millimoles per mole. So to recap the top five tests that I think you should do to monitor your heart health are measure your blood pressure, have an ECG, get your cholesterol profile, alveolar and HbA1c checked. Have you had any of these tests? What was your experience? Tell me in the comments below. Thank you for watching and I'll see you in the next video.