Heart Screening: What Your Tests Are Really Telling You (And Why Follow-Up Matters More Than You Think)
Most people imagine that heart disease arrives with dramatic symptoms — crushing chest pain, sudden collapse, shortness of breath, dramatic moments that are impossible to ignore. But what I see in clinic every week is almost the opposite. Most people who come to see me look completely well on the outside. They exercise, run businesses, support families, and live busy, high-performing lives. They function normally. They look normal. And yet somewhere beneath the surface there is a steady, persistent uncertainty. They don’t come because they’re unwell; they come because a quiet voice inside them says, “I should check my heart. I don’t feel unsafe… but I don’t feel fully safe either.”
What’s remarkable is how often the real reason emerges only at the end of the consultation. After we’ve discussed symptoms, lifestyle, family history, and examination findings; after reviewing their ECG or previous tests; after the clinical part is complete — that is when people pause, take a breath, and finally say what’s truly on their mind. They say things like, “Inder… what if something is happening silently inside me?” Or, “My friend had a heart attack at fifty-two. He exercised. He seemed completely fine. Could that be me?” Or, “I’ve had tests before, but I’ve never felt completely reassured.” And sometimes they say the quietest, most honest fear of all: “I just want to make sure I’m here for my family.”
These fears are not irrational. They’re not dramatic. They’re simply human. They come from a place of responsibility, not panic. And they tend to arise in people who have built meaningful lives – people with children, careers, commitments, companies, teams, and loved ones. People who cannot afford to be complacent about their health. And, importantly, people who feel they have too much to lose.
The difficulty is that our current heart-screening landscape often makes these fears worse. The system is not malicious — but it is fragmented. Most people begin by searching for “heart screening” online, only to be greeted by a series of packages called Silver, Gold, Platinum. These may sound reassuring but they are not designed around the individual. They are generic lists of tests rather than clinically reasoned investigations. Your heart is not a package. Your risk is not determined by marketing labels. True, meaningful cardiac assessment requires context: your genetics, your lifestyle, your age, your metabolic profile, your personal history, and your story.
Even when people book one of these packages, the experience is often scattered. An ECG might be done in one place, blood tests somewhere else, and a CT scan in a completely different location. The results then land in separate silos. There is rarely a clinician who sees the entire picture end-to-end. So patients leave with data – a series of numbers, ranges, charts, and images – but no interpretation. No understanding of what it all means for them. No explanation of how their risk behaves as they age. And no clarity about what they should do next.
This is why so many patients say, “I’ve had everything checked… but I’m still not reassured.” Because reassurance doesn’t come from data alone. It comes from understanding, from interpretation, and from continuity. And the truth is that “normal” test results, when interpreted in isolation, do not always mean “safe.”
A normal ECG is comforting but it does not rule out coronary artery disease. The ECG is a snapshot of the heart’s electrical activity. It can detect abnormal rhythms, previous heart attacks, and conduction issues, but someone can have substantial arterial narrowing while their ECG looks completely normal. The echocardiogram – the ultrasound of the heart – gives wonderful information about how the heart pumps, how the valves operate, and how the chambers look, yet it cannot tell us whether the coronary arteries are developing plaque.
A calcium score, which detects hardened plaque, tells us about lifetime exposure to risk. A high score means the arteries have been stressed over many years; a low or zero score is reassuring but does not exclude early, soft plaque. That early plaque may still be dangerous, especially for individuals with inflammation or genetic predispositions. A CT coronary angiogram – CTCA – is one of the most revealing non-invasive scans we have. It shows the arteries directly, mapping soft and calcified plaque, narrowing, and early disease. But even CTCA is only part of the picture because no scan can replace clinical judgement and contextual interpretation.
Some of the most powerful insights come from biomarkers – the blood tests that most people have never even heard of, let alone measured. ApoB, for example, tells us how many cholesterol-bearing particles are circulating that are capable of forming plaque. Even with “normal” cholesterol, a high ApoB level can reveal elevated risk. Lipoprotein(a), which is wholly inherited, can quietly raise risk even in fit, active, health-conscious people. High-sensitivity CRP gives us insight into inflammation — the biological irritation that accelerates plaque formation. HbA1c shows us your average blood sugar levels, which profoundly affect cardiovascular risk. When combined with a full lipid breakdown and other metabolic markers, these tests can reveal imbalances long before symptoms arise.
All of this – the imaging, the biomarkers, the conversation, the context – matters. But there is one part that almost no one talks about, and it is perhaps the most important part of all: the follow-up.
A single set of results can only tell you so much. A snapshot ECG or blood test gives a momentary view. But the heart does not operate momentarily. Risk evolves with time. Biology changes. Stress changes. Sleep changes. Weight changes. Ageing changes everything. The earliest signs of risk often appear not in the initial test but in the trend.
This is why the real protection lies not in the assessment, but in the continuity that follows it. An ECG today compared with an ECG next year is far more powerful than either alone. A calcium score performed now and repeated in five years can show whether plaque is stable or progressing. ApoB, hs-CRP, and other biomarkers gain depth and meaning when tracked over time. Follow-up allows us to see patterns – and patterns are how early disease reveals itself.
A better approach to heart screening does not start with a package. It starts with a conversation. A proper, unhurried discussion where a consultant listens to your concerns, your fears, your lifestyle, your family history, and your intuition. Then the correct tests are chosen – not based on a menu, but based on your story. The results are then brought together into a coherent picture, explained carefully, in language you understand. And finally – and this is the most important step — you are given a plan. A strategy that evolves with you. A plan that adapts as your biology shifts and life moves forward. A plan that includes ongoing review, because that is where the real insight lies.
Heart screening should not leave you with a stack of numbers and a vague sense of unease. It should leave you calmer. Clearer. More in control. More informed about your risks and your strengths. More empowered to make the decisions that protect your health long term.
If this article resonates with you – if you recognise your own quiet questions somewhere within it – know that you’re not alone. Many of the people I see carry similar thoughts. And you do not need to solve everything at once. You simply need the right first step: a thoughtful, personalised assessment, and a clear plan for the long term.
Your heart is the engine behind everything you do. Taking care of it is one of the most important investments you will ever make.
Key Takeaway for Patients
Most people who worry about their heart aren’t unwell – they’re just unsure. And that uncertainty is completely normal. Modern heart screening is about more than doing a few tests; it’s about understanding how your heart is behaving today and how it’s likely to behave in the future.
An ECG, an echocardiogram, or a calcium score can each give useful information, but no single test tells the whole story. The real power of screening comes from combining the right investigations with proper specialist interpretation and ongoing review.
Your heart changes as you age. Your risks change too.
This is why follow-up matters more than the first appointment.
A personalised, consultant-led approach can turn fear into clarity, and uncertainty into a long-term plan that evolves with you – calmly, safely, and thoughtfully.
