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Diagnostic Tools for Assessing Cardiac Risk

Diagnostic Tools for Assessing Cardiac Risk
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By Steve Nubie

There are a variety of tests and procedures to assess various forms of heart disease. Here’s how to know which ones are right for you.

Anyone at risk for heart disease, or is showing signs of heart disease should work with their doctor to do various tests to assess both the potential and the treatment for cardiovascular conditions. These test vary in costs from $8 to $2,000 so you should make sure your insurance covers the cost of the test. Your doctor’s office will often check this for you.

As a prelude to any cardiovascular tests you doctor will ask you a series of questions. This includes any symptoms you may have, your family’s medical history related to heart disease, diabetes, high-blood pressure, stroke and other conditions. They’ll also ask about your behaviors related to exercise, diet, smoking, alcohol consumption and other lifestyle choices you have made. In addition, they will review your medical history, current and past medications, and perform some routine tests in the office to evaluate your need for additional tests and the type of tests.

You should always answer any questions as accurately and honestly as you can. Doctors are scientists and the more facts and information they have, the better they can diagnose any conditions and recommend treatments.

Typically heart tests begin rather simply. If the early tests begin to show markers or indicators for a cardiovascular condition, additional tests will be ordered to isolate the specific condition and align a treatment plan that’s best for the patient.

Most of these tests are fairly simple and non-invasive although some more advanced tests could involve the injection of dyes, the insertion of catheters or even the injection of nuclear isotopes to create a clearer picture of what is going on with your cardiovascular system. Anytime a doctor orders a test for you, you should ask about the procedure, any risks, what the test will show, and ask why the doctor is ordering it.

Here is a list of tests that follow a general pattern from preliminary to specific. Most people don’t need to have all of these tests, but patients with acute heart conditions will have many of them throughout the course of their treatment.

Preliminary Tests

Preliminary tests are fairly simple, don’t take a significant amount of time and are not invasive, meaning they don’t require the insertion of catheters or dyes to perform the test. These tests are sometimes all that is required to recommend a course of treatment, or they may indicate the need for further tests to identify a more serious condition.

1. Blood Tests

Blood tests are often the first step in any pattern of testing procedures. Various types of tests or panels are ordered by the doctor to check a variety of factors evident in a blood sample. The blood is drawn from your arm or the top of your hand and one to five small vials of blood will be drawn depending on the number of panels the doctor has ordered. These panels will determine the following:

  • Lipid panel to assess cholesterol levels of HDL, LDL cholesterol and Triglycerides.
  • Glucose panel to evaluate blood sugar and insulin performance related to prediabetes or Type 2 diabetes.
  • Iron levels related to anemia.
  • Protein panel to assess proteins in your bloodstream. A past heart attack that you may not be aware of would have released proteins into your bloodstream as heart muscle cells die. This test will reveal if you had one of these “silent” and unnoticed heart attacks.
  • Cardiac Calcium Scoring measures the amount of calcium in your bloodstream as an indicator of potential plaque accumulation in your arteries and heart valves.
  • Other panels can be ordered for bacterial or viral conditions that your doctor suspects as a potential factor affecting your overall cardiovascular health.

2. Electro-cardiogram or EKG

An EKG is a curious and effective test that measures and records on a graph the heart’s electrical activity in addition to how fast the heart is beating and its rhythm. It’s curious in the sense that it takes a technician about 5 minutes to tape electrodes to your body and about 10 seconds to do the test. It is painless and gives your doctor a snapshot of heart function in addition to the overall strength and timing of electrical signals passing through the heart.

3. Holter monitoring. 

If your EKG or any of your symptoms indicate any issues with your heart’s electrical activity or rhythm, you may be asked to wear a Holter monitor for 24 to 72 hours. It’s a small recording device that clips to your belt and is connected to electrodes that have been taped to your body. It’s essentially a long-term EKG but instead of a 10 second snapshot, it monitors your hearts performance over one to three days. It will show irregularities in your heart rhythm (arrhythmia) that the EKG might have missed, but symptoms seem to indicate.

4. Chest X-Ray

A chest X-ray is another snapshot that is easily performed. It will give your doctor a general picture of your heart, blood vessels and lungs. It’s a test often used to assess heart failure, aneurysms, enlarged heart and lung disorders.

The results from these preliminary tests may encourage your doctor to recommend changes in behaviors and diet, or recommend a statin to reduce cholesterol or other medications to manage any preliminary cardiovascular condition that can be treated without surgery. However, just because your doctor orders more advanced tests doesn’t mean you are an automatic candidate for surgery. They may simply want to confirm the state of a patient’s condition or make sure the symptoms are not indicating something more serious.

Advanced tests

These tests tend be of longer duration and involve the use of special equipment. They tend to be more expensive so double check with your insurance and your doctor to determine if the test is necessary. Usually when a doctor orders these types of tests they have a good reason to request it. It’s also true that no single test can accurately pinpoint many cardio-vascular conditions.

5. Echocardiography

Echocardiography is a non-invasive procedure that takes about 30 to 45 minutes. It used ultrasound waves to create a video recording of your heart and surrounding blood vessels to show your heart function in real-time. There are various types of echocardiograms.

  • Carotoid Intimal Medial Thickness test

This test is an ultrasound, echocardiogram of the left and right carotoid arteries in your neck. These are the arteries that provide blood to your brain. It is designed to measure the thickness of the arteries’ lining as a way to diagnose coronary artery disease caused by a buildup of plaque. With this test a technician will rub a clear lubricant on your neck and then move an ultrasound probe up and down along the sides of your neck to record the condition and thickness of your carotoid arteries. It takes about 15 to 20 minutes.

  • Echocardiogram

This is another ultrasound test that is performed on your chest, specifically around the area of your heart. It records a video of all of your heart functions. It is used to evaluate a number of functions including overall heart function, valve function and potential regurgitation, size and diameter of arteries and ascending aorta for diagnosis of aneurysms, other areas your doctor may have indicated, and includes sound recordings that can also indicate conditions and performance of the heart.

This test takes 30 to 40 minutes and once again a clear lubricant is applied to make it easier for the technician to slide the ultrasound probe across your chest area. Some patients state that the pressure exerted on the skin and muscle cause some discomfort at times. This is simply the technician trying to maneuver the probe to get the best picture.

6. Stress Test

A stress test involves walking or running on a treadmill with a variety of electrodes attached to a patient’s body to monitor heart function before, during and after various levels of exercise. If someone is not physically capable of performing the exercise an injection can be administered to simulate the affects of exercise on the heart. There are essentially two types of stress test.

  • Stress Echocardiography

This test adds the element of ultrasound echocardiography to the usual treadmill test. It involves and echocardiogram of the heart before and after the test in addition to the other diagnostics received from the electrodes attached to the patient’s body. It helps to assess blood flow and isolate blockages in the patient’s arteries in addition to the diagnostics from the standard stress test. The total duration is 45 minutes to an hour.

  •  Standard Stress Test

This test is performed without the echocardiogram before and after the test. Electrodes will be attached and you will be asked to walk on a treadmill. The incline of the treadmill will be gradually increased and the speed of the treadmill may be accelerated as well. The technician will consistently ask you how your are doing while continuing to monitor your heart function. At any time you ask the technician to stop the test. After the treadmill exercise you will often be asked to lie down for a few minutes to assess your recovery from the exercise and assess your heart function. The treadmill time varies from 10 to 15 minutes and the total time for this test is 30 to 45 minutes.

All stress tests are typically designed to assess abnormal changes in heart rate, blood pressure, shortness of breath or chest pain and any abnormal changes in heart rhythm or electrical activity.

There are other stress test variations that your doctor may design depending on your physical condition, heart health and the specific result they are looking for. This includes the injection of a stimulant to mimic the affects of exercise if you have trouble walking or are unstable. It could also involve the injection of low dosage, radioactive isotopes for a Nuclear Profusion Study which uses the isotopes to identify specific conditions related to coronary artery disease.

7. Cardiac magnetic resonance imaging (MRI).

This test uses magnetic imaging to capture a 3-dimensional view of your heart and surrounding arteries in real time. It is designed to assess overall heart function, heart size, potential aneurysms, and coronary artery blockages. It involves lying on a table that is then moved into a large tube where a circle of magnets will move around your chest area to capture the images. It can be a highly claustrophobic environment so let your doctor know if that’s a problem. It is also quite loud so you may be offered earplugs. You will also be instructed to hold your breath for 10 to 20 seconds from time to time.

It is not an invasive procedure although sometimes a doctor will order it with and without contrast. The contrast is injected into your through an IV about halfway through the test. It is a dye that is iodine based to highlight certain areas of your heart and arteries. If you are allergic to iodine (a shellfish allergy is a typical indicator of this condition) let both your doctor and the technician know this. You will most likely be asked this on a form that you fill out before the test. The length of an MRI can vary from 30 minutes to three hours for an advanced MRI sometimes known as an MRA or a Magnetic Imaging Angiogram. An MRA always has contrast and looks specifically at the bodies blood vessels to evaluate coronary artery disease.

8. Cardiac Computerized Tomography (CT Scan).

Commonly known as a “cat” scan, this test is similar to an MRI except X-rays are used for imaging instead of magnetic resonance. It shows some level of detail that an MRI might not capture and usually involves the injection of the iodine based dye during the test. It tends to be shorter in duration in most instances (15 to 20) minutes, but the same cautions apply to allergies to iodine and claustrophobia although the main part of a CT scan is usually a short ring around the body rather than a long tube.

If you are concerned about X-ray exposure or have had numerous X-rays recently, discuss this with your doctor. Some reports put a CT Scan at up to 600 times the X-ray exposure of a standard chest X-ray. As a result, many doctors are recommending MRI’s unless there is a level of detail required that an MRI can’t capture.

9. Coronary Angiography and Cardiac Catheterization

This test is commonly referred to as an Angiogram and is one of the most invasive tests. You will mildly sedated and given a local anesthetic usually in your groin area or sometimes your arm. A catheter is inserted into a blood vessel and threaded through the coronary arteries to the area of your heart. A dye is then injected and a video X-ray is recorded to assess the movement of blood through your heart and the arteries to your heart. This is another test specifically designed to assess coronary artery disease.

The total time for the test takes 2 to 3 hours and is treated like a minor surgical procedure. There is no pain due to the local anesthetic but you will be asked to restrict physical activity for a few days. You will also be able to observe the test on a screen while it is performed. This test is performed by a cardiologist.

Understanding the Results

No matter who performs your tests, they will never give you an indication of the outcome. There are legal reasons for this and the discipline of medical practices. Only your doctor can sit with you and tell you the results after they have analyzed the conclusions from the tests. At that time you should ask questions and take notes:

  • What were the results in both medical and layman’s terms?
  • What are the implications of these results?
  • Will I need more tests as a result?
  • What additional tests or treatment will I need at this time?
  • Do you have a final diagnosis?
  • What are you prescribing based on these results (if anything) and what are the side-effects or risks?
  • What is the prognosis? (recovery and end result)
  • How should I follow up?

There are other tests that are a bit more obscure that may be designed for rare or unique conditions, and new testing procedures consistently show up. If you are getting a test that you haven’t seen listed in this article, simply ask your doctor what it’s all about.

Many times, these tests are designed to eliminate the possibility of a condition or verify that your symptoms are innocent or the result of some other condition that is not necessarily cardio-vascular. Regardless, its good to know your status and to be able to either rest-easy, or take a deep-breath and prepare for a course of treatment.









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