Cardiac Tests Can Reveal a Wealth of Information
If your doctor suspects you have heart disease, you may be advised to undergo cardiac tests to diagnose your condition. These tests range from simple, non-invasive screenings to more involved procedures that may include the use of high-tech imaging equipment.
“Typically, these tests are ordered in response to symptoms such as chest pain, shortness of breath (with or without exertion), and an inability to exercise for the amount of time or at the intensity level that is typical for an average person of your age and general condition,” explains Joy Gelbman, MD, a cardiologist at the Weill Greenberg Center.
Getting started
An evaluation of your heart health starts with an examination that includes noninvasive checks of your blood pressure and pulse rate. Your doctor will listen to your heart with a stethoscope. Blood work that measures your cholesterol, blood glucose, and other markers also is needed. A simple chest X-ray also may be ordered.
If there are concerns about your risk of a heart attack or stroke, or whether you may have a heart condition, such as coronary artery disease (CAD), valve disease, atrial fibrillation (AFib, an abnormal heartbeat, or arrhythmia), or heart failure, a combination of tests will be necessary.
WHAT YOU CAN DO
If you’re going to have a cardiac test:
➤ Talk with your doctor about why the test has been ordered and what information it will re-veal.
➤ Find out how you should prepare for the test. For example, it’s possible you should not take certain medications or eat anything prior to the test.
➤ Tell your doctor if you have had an allergic reaction to radioactive dye in the past. This could mean you won’t be eligible for certain screenings, such as a nuclear stress test.
Common cardiac screenings
The following cardiac tests are among the most frequently ordered when more information about your heart is needed.
❤ Electrocardiogram (ECG). An ECG is a painless, brief test that measures the electrical activity of your heart. For the test, you’ll lie down and have small electrodes placed on your chest, legs, and arms. The electrodes record how fast your heart is beating and whether the rhythm of your heartbeat is consistent or irregular. An ECG also helps measure the strength and timing of electrical signals as they move throughout your heart.
ECGs help diagnose conditions such as AFib (irregular heartbeat) and heart failure (which occurs when the heart is weakened and can no longer pump blood effectively). A patient who arrives at a hospital with chest pain is given an ECG to help determine whether she is having a heart at-tack.
❤ Heart rhythm monitor. Sometimes a cardiac test is inconclusive, and a follow-up screening is necessary; this is particularly common with abnormal heart rhythms, which may occur occasionally, and not necessarily when you are at your doctor’s office.
“Sometimes, if the patient is not having symptoms at the time of an ECG, we will arrange a more extended heart rhythm monitor to try to ‘capture’ an episode,” Dr. Gelbman says. A heart rhythm monitor (Holter monitor) is a small device similar to an ECG that is worn while you do everyday activities.
❤ Stress tests. ECGs also can be done while you exercise in your doctor’s office, usually on a treadmill or stationary bicycle; this is the most common type of stress test. Stress tests are conducted to see how your heart responds to the burden of physical exertion. Stress tests also are used to identify areas of reduced blood flow and/or parts of the heart that may have been dam-aged by a
heart attack.
“The most common non-invasive tests performed for diagnosis of coronary disease are stress tests,” Dr. Gelbman says. “All stress tests involve ‘stressing’ the heart in some way, either with exercise or a pharmacologic agent, and then assessing for changes pre- and post-stress that might indicate a blocked artery.”
If you are unable to exercise, a chemical may be injected into your bloodstream to widen your coronary arteries and increase blood velocity, simulating the way your heart would respond to exercise.
Another type of stress test is a stress MRI (magnetic resonance imaging, which uses radio waves) to evaluate blood flow through the arteries and check for blockages.
A nuclear stress test may be ordered if a standard stress test is unable to identify the cause of symptoms. This exam uses a radioactive dye that is injected into your blood vessels and special im-aging equipment to better highlight blood flow and heart function.
❤ Coronary calcium scan. If you have serious risk factors for heart disease, including high cholesterol, high blood pressure, obesity, a history of smoking, and/or advanced age, your doc-tor may recommend a test that can detect calcium deposits (calcification) in your coronary arteries. A coronary calcium scan, which is conducted using special X-ray machines, should be done only if you are already at a moderate-to-high risk for a heart attack. If a scan shows significant calcification, your doctor may suggest an aggressive treatment plan to lower your risk of a heart attack.
❤ MRI and PET. High-tech imaging can provide doctors with crucial details about the structure of your heart and the health of your heart tissue.
A standard cardiac MRI is done while you lie still in a large MRI machine. It can help diagnose CAD and heart attack damage, and may also reveal congenital heart problems (defects present since birth), tumors, and pericarditis, an inflammation of the membrane surrounding the heart.
In a similar test, a positron emission tomography (PET) scan, a radioactive chemical, or “tracer,” is injected into your bloodstream. A special computer then creates a 3-D im-age of the tracer in your heart from dozens of thin-slice images.
“Cardiac MRI and PET are being used more and more in specific scenarios, but they are generally not the first tests ordered to diagnose coronary disease,” Dr. Gelbman explains. These tests are usually done once some form of heart disease has been diagnosed.
❤ Cardiac catheterization. “The gold standard for the diagnosis of coronary dis-ease is a coronary angiogram, also known as cardiac catheterization,” Dr. Gelbman says. During this test, a catheter is inserted into an artery in your groin and guided up to your heart. Radioactive dye is injected into the catheter and travels to your coronary arteries.
“This provides a direct visualization of the your heart,” explains Dr. Gelbman. “The benefit is that it is an actual picture of the arteries.” One significant advantage of this procedure is that, if blockages are found in the coronary arteries, an angioplasty immediately can be performed to open up the blood vessels, since the catheter is already in place.
A non-invasive alternative to a cardiac catheterization is a computerized tomography (CT) coronary angiogram, which uses powerful X-rays to look at blood flow to the heart. A CT angiogram may be advised for people with moderate CAD risks.
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