Heart Disease Screening in Bangkok & Thailand: Tests & Prevention

• Heart disease is a leading cause of death in Thailand. Warning signs may include shortness of breath during exercise, chest pain during exertion or difficulty breathing. However, some people may not experience any symptoms at all.
• People aged 35-40 and older should undergo heart health tests at least once a year, in addition to their annual health check-ups.
• Heart disease screening through CT calcium scoring, which uses a computed tomography (CT) scan to detect calcium deposits in coronary arteries, is a highly accurate method. It can indicate the risk of coronary artery disease before the development of symptoms of acute myocardial infarction, which can be fatal.
   

Heart disease is one of the leading causes of death in Thailand. It often develops silently, without noticeable symptoms. While some may experience shortness of breath, chest pain during exertion, or difficulty breathing, others may remain completely unaware. In many cases, early symptoms are misinterpreted as minor issues, delaying timely intervention. Routine screenings are vital for early detection and prevention, particularly for individuals aged 35–40 and above.

Heart health screening involves a range of tests tailored to the individual’s symptoms and guided by the cardiologist’s clinical judgment. Common screening tools include:

An ECG is a simple, non-invasive test that records the heart’s electrical activity as it beats. It helps detect abnormal heart rhythms and signs of heart disease. During the test, small electrodes are placed on the chest to capture the heart’s electrical signals, which are then displayed as a waveform graph.
A normal, steady waveform indicates healthy heart function. However, irregular patterns may suggest problems such as arrhythmias or issues affecting specific areas of the heart. In early cases of reduced blood flow to the heart (myocardial ischemia), the EKG may still appear normal—so repeat testing may be recommended if symptoms persist or suspicion remains high.

ECG testing is suitable for:

• Screening for myocardial ischemia
• Screening for abnormalities such as hypertrophic cardiomyopathy
• Screening for electrical abnormalities in the heart that may result from electrolyte abnormalities, such as high potassium levels or high or low calcium levels
   

CT calcium scoring is a quick, non-invasive scan that measures the amount of calcium buildup in the coronary arteries—the vessels that supply blood to your heart. This calcium, or “plaque,” builds up over time due to the aging and hardening of artery walls, increasing the risk of heart disease.
This test is especially useful for people without symptoms but who may still be at risk. It helps detect early signs of coronary artery disease (CAD) before symptoms like chest pain or heart attacks occur. The scan takes just 20–30 minutes and uses a high-speed CT (computed tomography) machine that captures clear images even while the heart is beating.

What are the benefits?

• Safe, painless, and highly accurate

• Detects early-stage coronary artery disease in people with no symptoms

• Helps guide early treatment with lifestyle changes or medications to prevent heart attacks

Who should consider this test?

• Adults aged 40–45 and older

• People with high blood pressure, high cholesterol, diabetes, or obesity

• Smokers

• Anyone with a family history of heart disease or stroke

Who should avoid this test?

• Pregnant women or those planning to conceive

How to prepare:

• No need to fast
• Avoid coffee, tea, or other caffeinated drinks for 4 hours beforehand
• Refrain from smoking or using tobacco for at least 4 hours before the scan
   

Commonly known as a treadmill test, the Exercise Stress Test (EST) checks how well your heart performs under physical exertion. It helps identify problems with blood flow to the heart or abnormal heart rhythms that may not appear when you're at rest.
During the test, small electrodes are attached to your chest to monitor your heart’s electrical activity (ECG) while you walk on a treadmill. As the intensity of the exercise gradually increases, doctors watch for any signs of chest pain, shortness of breath, irregular heartbeats, or ECG changes—especially when your heart rate reaches 85% or more of its maximum (based on your age).

This test is often used as an initial screening tool to detect:

• Coronary artery disease (due to narrowed arteries)
• Heart rhythm abnormalities (arrhythmias)

If any abnormalities are detected, your doctor may recommend further evaluation or treatment, which could include medication, lifestyle changes, or additional testing like coronary angiography.
Who Should Consider an EST?

• Adults aged 35 and older
• People with high blood pressure, high cholesterol, or diabetes
• Smokers
• Individuals who experience unexplained fatigue or chest discomfort
• Those who don’t exercise regularly or lead a sedentary lifestyle
• Athletes preparing for competition
• People with a family history of heart disease
• Individuals with vascular disease in other parts of the body

How to Prepare for the Test

• Eat only light, easy-to-digest foods (e.g., porridge or rice soup) about 3–4 hours before the test
• Avoid heavy meals and alcohol beforehand
• If you take regular medications—especially for your heart or blood pressure—speak with your doctor about whether to pause them before the test

An echocardiogram—often called a heart ultrasound—is a safe, painless test that uses high-frequency sound waves to create live images of your heart. These images help doctors evaluate the heart’s structure and function in real time.

The test shows:

• How the heart muscle contracts and relaxes
• The size and shape of the heart
• The condition of the heart valves—whether they are narrowed (stenotic) or leaking (regurgitant)
• Signs of fluid around the heart (pericardial effusion), an enlarged heart (cardiomegaly), or congenital heart defect

Although echocardiograms are highly accurate, they do not show the coronary arteries directly. Image quality may also be reduced in people who are significantly overweight or underweight. The test typically takes 30–45 minutes and has no side effects.

Who Should Consider an Echocardiogram?

• Individuals with symptoms such as fatigue, breathlessness, swelling, or suspected heart disease
• People with heart valve issues or those needing follow-up after valve surgery
• Patients with chest pain, possibly linked to reduced blood flow (ischemia)
• Individuals with irregular heartbeats (arrhythmias) or an enlarged heart
• People with congenital heart defects, including those who’ve had corrective surgery
• Patients with long-standing high blood pressure or suspected hypertrophic cardiomyopathy

How to Prepare for the Test

• No special preparation is needed
• You can eat and take your regular medications as usual
• If your echocardiogram is being combined with a stress test (EST), ask your doctor if any medication adjustments are necessary

Cardiac Magnetic Resonance Imaging (Cardiac MRI)

A Cardiac MRI is a non-invasive imaging test that uses magnetic fields and radio waves to create detailed pictures of the heart. It provides valuable insights into the heart’s structure, function, and blood flow—helping diagnose a wide range of heart conditions.

What Can a Cardiac MRI Detect?

This test can help identify or assess:

• Causes of chest pain, tightness, or shortness of breath
• Heart failure and heart muscle diseases (e.g., hypertrophy, myocarditis, tumors)
• Damage from a heart attack or blocked arteries
• Aortic aneurysms and dissections
• Congenital heart defects and post-surgical changes
• Valve problems (narrowing or leakage)
• Inflammation such as pericarditis
• Areas targeted for ablation procedures in arrhythmia treatment

Cardiac MRI is especially useful for evaluating disease severity, guiding treatment plans, and monitoring progress over time. It may also be used when other imaging methods, like CT scans, aren’t suitable.

What to Expect During the Test

Before the MRI:

• Tell your doctor if you are pregnant or have any implanted medical devices (e.g., pacemaker, stent, IUD)
• Let the care team know if you have claustrophobia—options are available to help manage anxiety
• You may bring someone to assist you afterward if needed

During the MRI:

You will lie on a table that slides into the MRI machine. A contrast dye may be injected to improve image quality. The scan usually lasts 30–90 minutes. It’s important to remain still for clear results.

After the MRI:

Most people can resume normal activities immediately. Some may experience a temporary metallic taste, nausea, or dizziness from the contrast agent.

When a Cardiac MRI May Not Be Suitable

• During pregnancy
• For individuals with certain metal implants (e.g., recent coronary stents, cochlear implants, surgical clips)
• If you have metallic fragments in the body or eyes
• For those unable to lie flat or with severe claustrophobia

Tips for Maintaining a Healthy Heart

Keeping your heart healthy starts with simple lifestyle choices:

• Exercise regularly – Aim for at least 30 minutes of aerobic activity, 5 days a week
• Eat heart-healthy foods – Limit fatty, salty, and fried foods; focus on vegetables, fruits, whole grains, and lean proteins
• Stay hydrated – Drink plenty of water throughout the day
• Manage stress – Practice relaxation techniques, mindfulness, or hobbies that help you unwind
• Get enough rest – Ensure you have quality sleep each night

For adults aged 35–40 and older, it’s also important to have a heart health check-up at least once a year in addition to routine physicals. Regular screening helps detect hidden risks and can prevent serious events like sudden cardiac death. Speak with a cardiologist to determine which tests are most appropriate based on your personal health profile.