Ask the Expert: What Cardiac Tests Do I Need?
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Today, there are many cardiac tests designed to evaluate your heart health and ensure that your ticker is in good working order or if it needs medical help to function better.
These tests include:
Lipid and metabolic blood tests can spot abnormal levels of cholesterol, as well as certain fats, sugar, and proteins in the blood which indicate your risk of heart disease.
Also called an ECG or EKG, a non-invasive electrocardiogram records the electrical activity of the heart to determine the speed of the heartbeat, heart rhythm, and strength. It also shows the timing of electrical signals moving through the heart. The EKG is used to diagnose heart disease and, in some cases, a previous or current heart attack.
An angiogram will reveal blocked arteries using an X-ray in combination with a special dye injected into the patient.
This test uses sound waves to create a real-time, moving picture of the heart, showing how well the heart chambers and valves are working. An echocardiogram can find poor blood flow, parts of the heart muscle that don’t contract normally, and injury to the heart muscle.
Coronary calcium scoring
A calcium score measures calcified plaque within the arteries, which can help predict heart disease, heart attack, and stroke.
Exercise stress test
After a patient walks briskly on a treadmill, an echocardiogram or nuclear imaging equipment measures how well their heart works immediately after exercise and how much blood flows to different areas of their heart.
During a minimally invasive procedure, tube-shaped devices called stents are placed inside weak or narrowed arteries to improve blood flow and relieve obstructions.
Also known as a cardiac pacing device, a pacemaker is surgically implanted in the chest to control the heartbeat.
In this Q&A, Carl E. Orringer, M.D., a cardiologist and director of preventative cardiovascular medicine for the University of Miami Health System, discusses the most appropriate tests for heart health.
If someone goes to the emergency room with heart attack symptoms, what tests should they have?
Dr. Orringer: They should have an electrocardiogram as soon as possible and should also have baseline blood studies, including troponin (a test that indicates cardiac damage), and other blood studies, including a blood count and standard blood chemistries.
If the electrocardiogram (ECG or EKG) demonstrates a heart attack, they should be promptly taken to the cardiac catheterization laboratory so that a coronary angiogram can be done. This will determine whether a narrowed or blocked artery needs to be opened and stented.
What tests do cardiologists consider the “gold standard” to detect heart disease? What tests are most helpful in managing heart problems such as atherosclerosis?
Dr. Orringer: It depends on the type of heart disease one is trying to assess.
If heart rhythm disturbances are suspected, the first test is an electrocardiogram – in selected patients, a 24-hour or longer monitoring period may be required. When a cardiologist suspects that the patient has heart valve problems, the most appropriate test is an echocardiogram.
If the patient has no history of heart disease but is being evaluated for the risk of possible coronary artery disease, a coronary calcium scoring study may be considered in selected patients.
If the patient is having heart symptoms such as chest pain or shortness of breath on exertion, an exercise stress test, often with additional cardiac imaging, is usually appropriate.
In patients with stents or a pacemaker:
Are specific tests more valuable if they experience heart symptoms or want to gauge their heart health on a follow-up visit to their cardiologist?
Dr. Orringer: If the patient has cardiac stents and is having cardiac-related symptoms, stress testing, accompanied by cardiac imaging, is usually performed.
In patients with a pacemaker, analyzing the pacemaker function, often accompanied by an echocardiogram, may be needed.
If a person is already diagnosed with heart disease:
Are tests such as a chest X-ray or electrocardiogram limited in how well they help doctors manage the patient’s disease?
Dr. Orringer: An ECG is often a good first test to determine whether new problems are present, especially compared to a previous ECG the patient has had. If the doctor suspects heart failure or feels that the lungs need to be evaluated for disease, a chest X-ray may be helpful.
Nancy Moreland is the contributor who compiled the Q&A.