Why You Might Need a Heart Test
The stethoscope is an iconic medical device with which physicians can quickly get a sense of your heart’s condition. They can hear the heart’s rhythm, which should be consistent and without skipped or extra beats. They also can discern among the whooshing sounds; some of which are normal, while others suggest potential valve problems. Listening to the lungs, physicians can detect the sound of fluid, which can be a sign of heart failure.
As helpful as the age-old medical device may be, it can’t diagnose specific problems, but it can signal that further testing is needed. In addition, certain symptoms (e.g., coughing, shortness of breath, fatigue), personal risk factors (e.g., high blood pressure, high cholesterol, diabetes), and family heart-health history are considerations for ordering heart tests. Though primary care physicians can and do order these tests, they typically refer patients to cardiologists.
To follow are the most commonly ordered tests, what they reveal, and why they might be needed. Physicians usually start with noninvasive tests.
Echocardiogram
This test uses ultrasound (sound waves) that show the shape, size, position, and motion of cardiac structures. For example, it can reveal if heart valves are leaky (regurgitant) or narrowed (stenotic). “When a patient is short of breath, which is a common concern, the first test we do is an echocardiogram,” explains cardiologist Boris Arbit, MD, UCLA Division of Cardiology. “We can see how heart valves are opening and closing. With older people, one of the most common valve abnormalities is aortic stenosis, which may be the reason for shortness of breath.”
Electrocardiogram
Also called ECG or EKG, an electrocardiogram measures the heart’s electrical activity. Painless electrodes placed on the chest and connected to the device reveal how fast the heart is beating and the timing and strength of the heart’s electrical signals. EKGs help diagnose conditions such as arrhythmias (abnormal heart rhythms).
The heart is a pump with strong, muscular walls that contract and relax in a coordinated way to push blood throughout the body. Organs rely on the oxygen-rich blood pumped out of the heart. The heart has four chambers; two upper chambers called atria, and two lower chambers called ventricles. Valves situated between the chambers open and close to direct blood flow through the heart and out to the body without allowing it to back up. The heart must squeeze forcefully to pump blood out but also must relax between beats to properly refill. If any part of this highly-tuned system is damaged or malfunctioning, problems, such as heart failure, can result.
Exercise Stress Test
This test measures how well your heart is working during physical exertion. This test involves the use of an EKG while walking on a treadmill or riding a bicycle. The stress test measures heart rate, and evaluates breathing, blood pressure, and level of fatigue. It also may trigger symptoms such as chest pain, shortness of breath, or lightheadedness during physical activity, suggestive of coronary artery disease (CAD). “A stress test can show evidence that the heart is not getting good blood supply,” says Dr. Arbit. “Depending on the results, the next step may be an angiogram.”
Cardiac Catheterization/Angiogram
Cardiac catheterization and cardiac angiogram are terms that basically refer to the same process—a minimally invasive procedure used to identify blockages and narrowing in the arteries. It is the gold standard for diagnosing heart disease. An angiogram is an x-ray movie that shows blood flow, which is made possible by injecting a contrast dye though an intravenous line (IV). Cardiac catheterization refers to the process of placing the IV into the groin or arm though which a smaller tube (catheter) is guided to the heart. An added benefit of this procedure is that if blockages are found, they can be treated at the same time.
There are also other tests that reveal the status of heart function. For example, a Holter monitor is a heart rhythm monitor that may be ordered when an EKG is inconclusive. This small device is worn while doing normal activities, usually for 24 hours. Magnetic resonance imaging (MRI) is used to diagnose CAD, reveal heart attack damage, tumors, and pericarditis (inflammation of the membrane surrounding the heart). Positron emission tomography (PET scan) involves the injection of a trace amount of radioactive material into the bloodstream, after which a special computer creates a 3D image of the heart. MRI and PET are typically ordered to gain more insights into already diagnosed heart disease.
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