Heart Disease Testing
Tests & Diagnosis For Heart Disease

Heart Health Pictures of Heart Tests

Exercise Stress Test

Exercise Stress Test

Heart Disease Testing

Contents

How Is Heart Disease Tested?
Electrocardiogram (ECG or EKG)
Ambulatory Electrocardiography (AECG)
Stress Testing
Echocardiogram
Computed Tomography (CT, CAT Scan)
Heart Catheterization
Heart Biopsy
Electrophysiology (EP) Study



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What is Blood?

How Is Heart Disease Tested?

As technology advances doctors have access to a wider range of medicals tests which can be used to diagnose heart disease in a safe and efficient manner. In cardiology (the medical specialty of treating heart disorders), cardiac (heart) tests help to confirm a clinical diagnosis as well as help predict a patient's survival chances (prognosis). They can also help a doctor determine the best course of treatment for a patient. That said, no scientific test has yet replaced the first and most important step of diagnosis: that is the physical examination combined with taking a complete medical history.

The Physical Examination: During the exam a doctor will carry out a visual inspection of the patient. For example they may notice a clue which suggests an overactive thyroid which could be responsible for a rapid heart beat. A particular type of growth on the eyelids could indicate high cholesterol levels and prominent neck veins could be indicative of heart failure and an excessive load on the right side of the heart. A blue tinge on the nails or tongue may be a sign of lack of oxygen in the blood. Next the physician places his hands on the patient's heart, feeling for the heart beat. Some loud heart murmurs can even be felt without the use of a stethoscope. Any palpations (fluttering's) felt in the belly area could indicate liver enlargement or an active ulcer. Next the doctor uses a procedure known as tapping or percussion. Placing one hand on the patient they use the other to tap on top. As solid and hollow areas of the body sound different, the tapping can help determine if any of the organs are enlarged. It also helps to diagnose fluid in the chest or abdomen. Finally the doctor uses a stethoscope to listen to the patient's heart beat, lungs and blood vessels. Any abnormal sounds are clues to the presence of heart disease.

Cardiac Tests: Deciding which type of diagnostic test is best can be difficult and advice can differ from doctor to doctor. There are non-invasive tests which do not involve inserting needles, fluids or instruments into the body. And there are invasive ones which range from a simple blood test to the insertion of a tube or scope and procedures such as open-heart surgery. Tests which are considered the gold standard for diagnosing heart diseases are not always appropriate for everyone. For example a cath (coronary angiography) is the gold standard for testing for coronary artery disease (CAD). Yet sometimes if a patient has stable (not worsening) CAD their doctor may manage their symptoms with medications rather than performing a cath because it is an invasive procedure with risks.

What Are The Types of Heart Disease Tests?

Electrocardiogram (ECG or EKG)

An electrocardiogram or ECG is a diagnostic tool which measures the electrical activity of the heart. Interpretation of those results can help diagnosis a wide range of heart diseases. An ECG is most commonly used for diagnosing a heart attack. When a heart attack has damaged an area of the heart, that area will have difficulties regulating concentrations of salt with every heart beat. This can be picked up by the ECG. It can also diagnosis previously undetected heart attacks. Although it may sound strange, almost one in three heart attacks go unnoticed by the patient. As a result, it is not uncommon for a specialist who is performing an ECG to uncover evidence of previous heart attacks. After a heart attack the damaged muscle cells become scar tissue and are no longer electrically active. An ECG can also be used to diagnose heart rhythm disturbances (heart arrhythmia). It can even show up conditions unrelated to the heart such as asthma and pulmonary embolism (a blot clot in the arteries of the lungs). An ECG is often recommended to patients who show symptoms such as chest pain (angina attack), dyspnoea (breathing difficulties), unexplained fainting spells and palpitations. During an ECG test, up to a dozen adhesive electrodes are stuck to specific locations on the arms, chest and legs. The test is completely painless and takes just a minute or two to perform once the electrodes are in place.

Ambulatory Electrocardiography (AECG)

Ambulatory electrocardiography (AECG) are portable ECG devices which are worn by patients for monitoring over a time period - longer than is possible with a traditional ECG. There are two categories of AECG recorders: those that continuously record for 24 to 48 hours and intermittent recorders which are used for weeks or months at a time. The Holter Monitor is a continuous recording device which may be used to monitor heart problems such as arrhythmias. It will record the electrical impulses of the heart for 24 to 48 hours, as opposed to a few second snapshot by traditional ECG. For symptoms which are even more intermittent, an Event Monitor might be recommended. It can record a patient's heart intermittently for longer periods of time (weeks and months). There are 2 basic types of event recorders, those that record when activated by the patient in response to symptoms and those that record the ECG in a continuous manner. A doctor will advise the patient which type of monitor is more suitable. Generally patients who have had a complete loss of consciousness and are not able to attach or activate an event recorder will be given a holter monitor. Those with transient symptoms which occur less frequently than every day will be given an event monitor.

What Are My Chances of Heart Problems? See: Heart Disease Statistics. Also, know your risks: Risk Factors for Heart Disease.

Stress Testing

Patients with suspected heart disease may be submitted to a stress test to evaluate the heart’s ability to cope with increased demands. The results can help diagnosis the presence of heart disease. There are many different types of 'stress' tests, most often they involve some form exercise such as walking on a treadmill, stationary bike riding or performing arm exercises. Another type of stress test involves the use of chemicals. These chemicals are administered intravenously and make the heart work harder or dilate the heart's blood vessels. Both types of tests are usually monitored by either an ECG, echocardiogram or a highly technical PET image scan. Exercise stress tests are a non-invasive way to demonstrate cardiovascular disease (CDV). They can also help categorize patients who have already had a heart attack into high risk and low risk groups. For example a patient who can walk 15 minutes on a treadmill before developing chest pain (chest pain in women) has a better long-term prognosis (likely to live longer) than a patient who develops pain after 2 or 3 minutes. As coronary heart disease in women develops on average 10 years later than in men, some tests may be more appropriate for elderly women than others.

Exercise Stress Test
An exercise ECG is the most common type of exercise stress test. The patient has ECG electrodes attached to their skin while exercising. They walk on a treadmill that changes speed and inclines following a strict protocol. The test will report on heart rate, blood pressure, vital signs, symptoms and recovery times. Patients with physical handicaps due to age or bad arthritis for example are usually evaluated with different methods, such as chemical stress tests.

Chemical Stress Tests
A chemical stress test (also known as a pharmacological test) combines the effects of a chemical administered by injection with an imaging method. Dobuamine is one medication used for example and causes the heart to pump faster. If it is administered the results are monitored with an imaging machine, such ‘stress-echo’. This medication needs to be used with caution in patients at risk of dangerous abnormal heart beats and CAD. Other compounds used include vasodilators; these are medications (such as Persantine) which dilate the heart's blood vessels. If there are blockages in the arteries, blood is less likely to flow through during stress conditions. When at rest enough blood can usually get past blockages. Occasionally a nuclear stress test (also known as a nuclear heart scan or radionuclide myocardial perfusion imaging) will be performed. This test is performed in addition to the stress test and involves injecting radioactive agents (radionuclide) into the blood stream which are then monitored. The agents follow blood flow and can be picked up with PET (positron emission tomography) or SPECT scans (single photon emission computed tomography - any blockages will be more easily noted. Nuclear imaging provides a sort of information which neither exercise echocardiograms nor exercise ECG’s alone can.

In most medical centers women complaining of typical heart disease symptoms such as chest pain, are less likely to receive stress tests than men complaining of the same problems. Women's hearts seem to respond differently to men during stress tests. Very often women who show signs of heart disease on a stress test turn out to have very healthy hearts while women who show no signs of problems turn out to have blocked arteries. This high rate of false positives and false negatives may be attributed to the fact that the tests were only developed and validated on men.

Echocardiogram

An echocardiogram is a non-invasive diagnostic procedure (also known as an 'echo') used for taking detailed images of the heart (see pictures of the human body to locate the heart). It uses ultrasound technology to take images of the heart and surrounding tissues. The picture is more detailed than an X-ray but no radiation is involved. The procedure is painless and lasts about 30 minutes. The technician sticks electrodes to the patients body, this is to record their heart rate (ECG). Then a doppler or transducer which is covered in gel is applied to the chest. It sends out sound waves towards the heart, which bounce back and are recorded in images on a screen. The technician asks the patient to hold their breath at intervals and to roll onto different sides. The patient will be able to hear their blood flow through the heart. An echo is usually taken to confirm the diagnosis of heart disease after a physical examination. It may also be ordered to evaluate abnormal heart murmurs, unexplained chest pains, shortness of breath and palpitations. It is an important tool in particular for the diagnosis of heart failure.

Computed Tomography (CT, CAT Scan)

This is an imaging technique which takes multiple X-rays by rotating around the body and uses a computer to convert them into 3-D images. Two different types of CAT scans are used for assessing cardiac problems. The first is the coronary artery calcification (CAC) score. This procedure tests for the level of calcium deposits in the coronary arteries. The higher the levels, the higher the risk of heart disease. If no calcification is noted it is very unlikely that CAD is present. The second test is called a CT angiography. This involves injecting contrast agents into the blood stream. Any blockages in the arteries are more likely to show up in a scan and the heart muscle can be viewed more easily. It is less invasive than the other alternative diagnostic test - heart catheterization - but it is also less accurate. Another problem with cardiac CAT scans is that they expose the patient to radiation, although newer methods are reducing this exposure.

Heart Catheterization

A cath or cardiac catheterization (also called heart catheterization) procedure involves inserting a long thin hollow tube into a blood vessel to view the arteries. Very often the term 'cath' is commonly used to refer to one type of test - the coronary angiography. There are however in fact a number of different catheterization procedures for different purposes.

Coronary Angiography
This is the most common cath procedure and the considered the gold standard for diagnosing CAD. It is usually recommended when a stress test has revealed blockages in the arteries or when a stress test was negative (every test has its limits) but the doctor still suspects heart disease. It can also be used for treatment purposes. During a coronary angiography a catheter is inserted into an artery either in the arm or the groin. Dye is injected which helps to visualize any blockages in blood flow. This is an important test for doctors in deciding whether coronary heart disease needs more treatment.

Left & Right Heart Catheterization
Sometimes a cath is inserted directly into either the left or right heart chambers to directly view the heart's cavities and to measure pressures.

Heart Biopsy

Biopsies are necessary for the accurate diagnosis of some types of heart disease and for monitoring patients after heart transplants. They are taken using a right heart catheterization procedure and essentially involve snipping a piece of heart muscle tissue for lab testing. Biopsies are only usually required in severe heart disease cases where the cause is unknown and treatment options depend on a specific diagnosis. Patients who have had heart transplants need to have regular biopsies to check for rejections. Identifying a rejection early is crucial because certain drugs can be used to limit damage to the transplanted heart.

Electrophysiology (EP) Study

Abnormal heart rhythms are usually checked with ECG’s. However some problems require an invasive procedure for diagnosis. An EP study usually involves a right heart catheterization. The cath has the ability to stimulate the heart with small amounts of electricity and to measure the heart's response. This procedure is useful for understanding complicated heart rhythm disturbances.

Where Can I Get Tested?

Your doctor can refer you to a cardiologist or will give you a list of chest pain clinics in your area.

Other Tests

Calcium score test: screening for heart disease with CT scans.
C-reactive protein test: A blood test to screen for inflammation.
Vascular screening: screening for warning signs of stroke.

  Related Articles on Heart Disease Tests

For more heart-health, see the following:

Home Cardiac Exercise Program / Cardiac Rehab Exercise Program

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