Which Heart Test Is Right Or Wrong For You
BY STEVE NUBIE
Not all heart tests are created equal, some can pinpoint a condition while others can miss it.
I’ve had two open-heart surgeries. One month before my first surgery I had a stress-test as part of a company physical. The doctor told me I was in great shape. A month later I was diagnosed with a failing heart valve due to a congenital condition, and an aneurysm on my ascending aorta. I told the cardiologist I had a stress test and everything was fine. He said it was a miracle I survived the stress test without a heart attack and it was the wrong test for my condition.
Know your heart condition
During the course of a routine physical a physician should ask you about your family history and any conditions you have had to assess your heart health and risk for heart disease. That was obviously missing in my routine company physical, but a few questions would have revealed that my family did in fact have a history of heart disease and I had some risk factors due to diet and lack of exercise.
This could have led to some simple and fundamental tests that would have carefully and methodically diagnosed my heart condition. Don’t let this happen to you. Here are some key steps to managing and understanding your heart health.
- A clear and comprehensive Physical
Don’t get coy with your doctor. Tell him or her everything about your family’s health history and any signs or symptoms you’ve noticed about your heart health. If they’re doing their job they’ll supplement this information with a blood test for heart health conditions, take your blood pressure, listen to your heart and possibly suggest additional tests. These tests should be measured and appropriate to your health and potential risk factors.
You should be clear and specific about your diet, medications, exercise regimen and any symptoms that you notice or suspect. Be open and honest. Doctors are scientists and detectives and they need to know the facts.
- Blood tests
The standard blood test to assess heart health is the lipid profile. This measures your cholesterol levels to determine if there is any problem related to plaque buildup that could affect your arteries and blood circulation. Other tests evaluate creatinine levels and potassium and sodium levels. These tests evaluate kidney and liver function which could be affected by a heart condition, and the level of electrolytes in your system affecting your overall nervous system which manages heart rhythm.
- The ECG or EKG
An electro-cardiogram is a snapshot of your heart rhythm. But it’s only a snapshot. It’s a confusing test for most of us. It takes a technician five minutes to apply various monitors to parts of our body, but the test itself takes about 5 to 10 seconds. It can detect an abnormality if obvious and present but sometimes misses arrhythmia due to a variety of factors.
- The Holter Monitor
A Holter Monitor is worn on your belt. It has a variety of monitors applied to your chest and back that are stuck on much like you would experience with an ECG. The difference is that a Holter Monitor tracks your heart rhythm over a long period of time ranging from 24 to 72 hours. This expands the “snapshot” of a 5 to 10 second ECG to better assess any rhythmic or heart arrhythmia issues you may have
Your cardiologist may suggest a course of treatment including drugs to manage your heart arrhythmia or an implant to manage the rate or your heartbeat.
- The echocardiogram
This is a non-invasive test that doesn’t require any surgical procedures that essentially captures your heart and its valves in action. It’s another precursor test to determine if more invasive procedures and tests should follow.
It takes about 30 minutes and you essentially lie on a bed while a technician uses a smooth probe to show the function and functionality of your heart. This is recorded and then evaluated by specialists to determine your heart’s condition.
- Cardiac catheterization or Angiogram
This is a mildly invasive procedure. It’s designed to evaluate blockages in the coronary arteries that will be visible on x-rays, and to determine if parts of your heart that are fed by the blocked or narrowed arteries may be weakened or damaged from lack of blood.
This test involves the insertion of a tube into a vein or artery in your groin or arm. A longer tube called the “guide catheter” is then inserted. You are conscious during this procedure but sedated. Video X-rays record the results. Eventually a contrast material is injected to better display the performance of your arteries and heart chambers. This also tracks blood flow, heart vessel condition and your valve functions.
This test is sometimes performed as a precursor to other heart procedures like a valve implant to determine if a heart bypass might be necessary. Open-heart surgery is a serious operation and if there are other heart-health issues that can be solved surgically, the time to do it is when the chest is open.
Due to its somewhat invasive nature you should have someone drive you home after the test.
- The CT or CAT scan
A CT or CAT scan is an abbreviation for cardiac computerized tomography. It’s essentially an X-ray on video in 3-dimensions. It presents a high degree of X-ray penetration. A CT scan delivers 600 times the number of X-rays you would receive from a traditional X-ray of your chest.
The procedure requires you to lay on a table and you are the moved into a large tube that rotates around your body. A lead shield is placed around your groin area and the procedure is quite loud. You will be able to hear communication from the technician running the test and at times you will be asked to hold your breath up to 30 seconds.
Typically, you will also be hooked up to an IV and a contrast will be injected into your bloodstream to highlight certain parts of your cardiovascular system. This is an iodine based contrast so if you’re allergic to iodine or shellfish you should make sure the physician ordering the test is aware of this condition.
- Cardiac magnetic resonance imaging (MRI)
Given the high exposure levels of X-rays from a CT scan the MRI has emerged as the test of choice for a 3-dimensional view of the heart and cardiovascular system. It’s similar to a CT scan in the sense that you lie on a table and are moved into a large rotating tube, but the procedure is based on magnetic imaging rather than X-ray imaging.
A contrast solution may also be a part of this test so the same attention should be paid to any allergic reactions. There will also be times when you will be asked to hold your breath. Usually a computerized voice tells you how long and when to both hold your breath and when to “exhale” or “breathe.”
- The Stress test
A stress test puts you on a treadmill with numerous monitors attached to your body. You will begin by walking at a slow pace but the pace and the incline of the treadmill will increase during the test.
It’s designed to evaluate how your heart responds to the stress of physical exercise, how the blood supply is affected by plaque buildup in your arteries, and to determine the amount and kind of exercise that’s best for you.
As I mentioned earlier, this test has some risks and the technician will usually be alert to this before the test begins. You can quit or stop the test at any time, and if you feel you are experiencing any strange or unknown symptoms you should suspend the test immediately.
After the test is concluded you will be asked to lie down and your recovery from the test will be further evaluated.
- The MUGA test or Multiple-Gated Acquisition Scanning
This test involves the injection of a radioactive substance called a radionuclide. If you’re concerned about that you should definitely discuss it with your doctor or cardiologist.
The test is designed to evaluate how well the heart chambers are working, how well the heart is supplied with blood and whether some part of the heart has been damaged due to a heart attack.
A video is recorded of the test and according to the American Heart Association there are no side-effects from the injection of radionuclides. Here again, if you’re concerned bring it up with your physician.
- The Tilt-table test
This is a somewhat obscure test that most people don’t hear about. It’s designed to assess the cause of fainting-spells and whether or not those events are caused by a heart condition.
The test puts you on a table that is raised or lowered from 30 to 60 degrees to evaluate your response. You are hooked up to multiple monitors to measure blood pressure, electrical impulses and oxygen levels.
This is a tough test. Some people do fine, some pass out. Ask your physician or cardiologist if you have any doubts.
This is a long test and takes one to two hours. You’ll also have an IV to manage conditions and you’ll be awake for the duration of the test. Someone to drive you home after the test might be a good idea.
This heart stuff is tough. I know and I’ve not only experienced it but have written about it extensively not as a doctor or surgeon, but as a patient. If you or your physician determine you have a heart condition, ask a lot of questions. With luck and some determined investigation, you’ll be able to work with your doctor to plan a good path to tests, diagnosis and treatments.