"I feel fine" is the most common reason people give for skipping cardiovascular screening. It's an understandable instinct — why seek medical evaluation for a problem you don't know you have? But it misunderstands a fundamental characteristic of the diseases we screen for: their defining feature is the absence of symptoms, right up until the moment they cause a catastrophic event.
By Emanuel Papadakis, RDCS, RVT
Medically reviewed by Dr. Glenn Gandelman, MD, MPH, FACC, FASE — Board-Certified Cardiologist
January 2025
✓ARDMS Certified Sonographer
✓ASE Member — Echo Standards
✓IAC Accredited Cardiologist
✓Board-Certified Cardiologist Review
The most common reason people avoid cardiovascular screening is also the most understandable: they feel fine. No symptoms. Normal blood pressure at their last checkup. A slightly elevated cholesterol their doctor said to watch. This reasoning is exactly how the majority of heart attacks and strokes happen to people who never saw them coming.
How 'Feeling Fine' Becomes a Crisis
Atherosclerosis, the buildup of plaque inside artery walls, is a disease of decades. It begins in the third and fourth decade of life in most Americans, progresses silently through middle age, and produces symptoms only when an artery is substantially narrowed or a plaque ruptures. By the time you feel something, the disease has typically been developing for 20 to 30 years.
Studies consistently show that more than half of first heart attacks occur in people with no prior cardiovascular diagnosis, a reality underscored by CDC heart disease data. They were not unwell. They were not being treated for heart disease. They simply had not been screened with tools capable of detecting subclinical disease. The risk is even higher for those with a family history of heart disease.
Feeling well is not the same as being well. Standard annual physicals check blood pressure and order lipid panels. They cannot detect plaque in your arteries, early valve dysfunction, or reduced cardiac output. These require imaging.
What Standard Care Cannot Tell You
Your primary care physician has limited time and a broad mandate. Annual wellness visits cover many body systems simultaneously, not deep cardiovascular investigation. A blood pressure reading tells you about pressure at one moment. A cholesterol panel measures lipids in the blood. Neither tells you what is happening inside your arterial walls.
The information that matters, including plaque volume, arterial wall thickness, valve function, and ventricular efficiency, requires ultrasound imaging. This is the gap that cardiovascular screening addresses. It is not redundant with what your doctor does. It is additive.
What the Evidence Shows
The USPSTF recommends one-time AAA screening for men 65 to 75 who have ever smoked. This recommendation is based on evidence that screening in this population reduces AAA-related death by 43 percent. The evidence is strong enough that Medicare covers this screening, because the cost of a ruptured AAA vastly exceeds the cost of detection and elective repair.
The same logic applies broadly to cardiovascular screening. Detection before symptoms means treatment when intervention is less complex, less costly, and more effective. A carotid duplex that finds 70 percent stenosis leads to a stenting or endarterectomy procedure. The stroke that results from missing that stenosis leads to emergency hospitalization, intensive rehab, and often permanent disability.
What Each Scan Reveals That Routine Care Misses
›Echocardiogram: ejection fraction, valve function, wall motion, and diastolic pressure, none of which appear in bloodwork
›Carotid ultrasound with IMT: the only noninvasive test that directly measures atherosclerosis in the brain main supply arteries
›AAA screening: detects aortic aneurysms before rupture, a condition with no symptoms and a 50 to 80 percent fatality rate upon rupture
›Venous duplex: identifies deep vein thrombosis before it travels to the lungs
›Arterial duplex: detects peripheral artery disease, which triples the risk of heart attack and stroke
Preventive screening is not about expecting to find something. It is about knowing your baseline, detecting problems early when options are broadest, and giving your physician real data to work with. BlackPoint brings hospital-grade cardiovascular ultrasound to your home. $397 per scan, no referral required.
