The CAD - (Coronary Artery Disease) starts in early childhood and remains asymptomatic till the third or fourth decade of life. It means, prior to this, irrespective of exertion, no symptom of the disease occurs, and unless the symptom occurs, the patient, does not seek medical advice. However, tests like resting electrocardiogram (ECG) and/or exercise ECG do help in detecting early asymptomatic cases of CAD.

Besides detection of early hidden cases of CAD, detection of various risk factors responsible for CAD, like high blood cholesterol! uric acid/sugar, etc. is equally important. Those who have a positive family history of CAD, are addicted to smoking, suffer from high blood pressure, are overweight, sedentary workers, have a coronary prone personality / behaviour , women on oral contraceptives, or during their menopausal period, are all open to risk and need a periodic follow-up for the detection of CAD.

By and large, ECG is essentially required of all persons to see whether CAD exists or not. In case a resting ECG is normal, and especially if the person has one of the risk factors, or has a doubtful history of chest pain even in the past, an exercise ECG should also be carried out.

It is important that in all asymptomatic persons both resting and exercise ECGs must be read by a specialist for an early diagnosis of CAD. A wrong label of CAD may prove highly damaging to the person, especially psychologically.

However, if resting and exercise ECGs are normal in a person, irrespective of age, he should not take it for granted that CAD can never manifest itself or does not exist. The disease may still be in infancy so that the blood supply to the walls of the heart is not affected even on exercise, accounting for the normalcy of exercise ECG. However, both resting and exercise ECGs may have to be repeated periodically, especially in high-risk cases, or even in all middle-aged persons, for the detection of CAD at the earliest possible. In case, exercise ECG is negative, and the patient is still suspected of suffering from CAD, or one likes to be very sure of the existence of CAD, or one's profession is such that the elimination of CAD is a must, the next' alternative would be to undergo thallium stress test. Coronary angiography, being an invasive test, cannot be carried out for the detection of CAD in all asymptomatic cases.

It is stressed again that a periodic check-up of the heart/ related factors will go a long way in timely detection of CAD, and many of the conditions/factors may be preventable right in infancy.

It is only with the co-operation of the public, especially those people who are prone to suffer from CAD, or those who have entered middle age, that we can detect CAD in many asymptomatic cases, and save the person concerned from its serious consequences. At least all middle-aged persons or those who are in the risk of getting CAD, must report to their physicians for a check-up as and when advised, so that an early diagnosis of CAD does not remain missed, when the patient is still asymptomatic.