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  • Tests to Diagnose Blockages to the Heart

     
     
     
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    If you have symptoms that suggest a problem with your heart, your internist will refer you to a cardiologist, a doctor with special training in diagnosing and treating heart conditions.  

    During your appointment with the cardiologist, he or she will review your current symptoms and the status of your health, your blood pressure and cholesterol readings and other test results, your medical history and your family’s health history.

    In addition, your cardiologist may refer you for other tests, including:
    • Stress Test. During a stress test, you will be asked to walk on a treadmill or take medications to make your heart simulate the work it does with exercise. Whether you feel chest pain or other symptoms when your heart is "under stress" may indicate to your doctor the presence of any blockages in the arteries that supply blood to your heart. In addition, the continuous recording from the electrocardiogram (ECG or EKG) taken during the stress test evaluates how electricity flows in the heart and changes consistent with the portion of the heart not receiving enough blood flow.
    • Advanced Imaging. These include an echocargiogram (ultrasound pictures of the heart), nuclear scan, computed tomography (CT) scan, positron emission tomography (PET) scan or magnetic resonance imaging test(MRI). One or more of these tests are usually combined with the ECG to provide images of the heart and often improve your doctor’s ability to identify potential problems. 
    • Angiogram. If your symptoms – and your tests – suggest that you have blockages in the arteries to your heart, your cardiologist may recommend an angiogram.

  • More on Related Diagnostic Tools

    A simple test, called the Ankle-Brachial Index, or ABI, can quickly and painlessly determine if you have P.A.D. The ABI takes 10 to 15 minutes and can be done by your internist with a specialized "Doppler" stethoscope and blood pressure cuff. It involves simply measuring the blood pressure in each of your ankles and in each of your arms. Your doctor then compares the two readings. A normal ABI reading is 1.0 (with a range of .9 to 1.3). If your blood pressure is lower in the ankle than the arm, a blockage is likely present in an artery somewhere between your heart and ankle - and, if so, you have P.A.D. Because it is a simple test, the ABI can be done yearly if needed to determine if blockages are getting worse.

    A chest x-ray produces an image of the inside of the chest showing the bones, heart and blood vessels.  Chest x-rays usually show the chest in two views: from the front and from the side. 

    Although chest x-rays are not as sophisticated as some other diagnostic technologies, they provide information that cannot be obtained in an examination.  For instance, they can be valuable in initially evaluating:

    • The size of the heart. An enlarged heart in which the heart muscles have grown larger due to overwork may suggest heart failure.  A small heart may suggest dehydration.
    • The contour of the heart. Enlargement of a particular chamber or blood vessel may suggest heart failure or other abnormal functioning.  
    • Blood flow to the lungs.  Blood flow that is more or less than normal to the lungs may suggest any of several heart defects or diseases – and indicate the need for more sophisticated tests.

    Is Chest X-Ray Harmful?

    Medical tests, including chest x-rays, should not be ordered unless they can provide information that is not available through simpler, safer methods.  While the exposure to radiation (including x-rays) is worthy of concern, the amount of radiation exposure in a chest x-ray is minimal.  A few x-rays a year is not believed to cause harm.
    To determine the cause of your child’s fainting, your child’s physician may use a number of diagnostic tests. [Link to III.F.4]   Of critical importance to the doctor, however, are details about how fainting episodes happen, how frequently they occur and the symptoms that are observed before and after the episodes.  

    Your child’s doctor may perform one or more the following tests to determine what’s behind the fainting episodes:  

    Electrocardiogram (ECG or EKG).  Abnormalities in heart rhythm, recorded by an ECG even when the child is feeling well, may provide clues to the cause of fainting. 

    Head-up tilt table test.  Used specifically to test for cardioneurogenic syncope, the head-up tilt table test is used to induce fainting.  (A special medication may also be given to enhance fainting.) Lying flat on a table, the patient is tilted to an almost upright position.  If the patient feels dizzy, usually with drop in blood pressure and slowing of the heart (the patient's heart rate and rhythm and blood pressure are constantly monitored during the test), a diagnosis of cardioneurogenic syncope is confirmed.

    24-hour Holter monitor.      This test records the patient's heart rhythm for a whole day in order to catch any abnormalities during routine daily activities.

    Event monitor.  An event monitor is provided to the patient for a month.  If fainting occurs, heart rhythm is recorded and transmitted to the physician via a telephone line. 

    Echocardiography.  This ultrasound test, which creates a moving picture of the inside of the heart, is used to enable physicians to see if abnormalities of cardiac structure or function are the cause of too little blood leaving the heart for the brain.  


    Treatments for Fainting


    Treatment for fainting that results from pulmonary hypertension and left ventricular outflow tract obstruction depends on the cause and nature of these conditions.  Both are severe cardiac diseases requiring extensive testing. 
    Your family doctor or internist may be the first to suspect that you have a heart valve condition.  He or she may detect a heart murmur while listening to your heartbeat through a stethoscope.  A heart murmur is an extra – or unusual – sound heard when the heart beats.  A murmur can be faint or it can create a noticeable whooshing noise. Heart murmur is common – and most murmurs do not indicate a problem.

    If your heart murmur is associated with symptoms of heart valve disease, such as tiredness and shortness of breath, your doctor may refer you to a cardiologist, a medical doctor who specializes in heart disease and treatment.  

    The cardiologist will perform a physical examination and order tests to determine if you have heart valve disease.  If initial tests indicate a valve problem, other tests may be recommended to gather more details about your condition. 

    During the physical exam, the cardiologist will ask you about your symptoms, your medical history and your family’s health history.   He or she will listen to your heart and lungs and examine your feet and legs for swelling that may indicate that they are retaining excess fluid.  In addition, the cardiologist will review your blood pressure and the rate at which your heart beats (pulse.)  

    Tests may be ordered to determine if your heart is working as it should.  Among the tests used to detect heart valve disease are:  
    • Echocardiogram (ec-ho-CAR-dio-gram).  An echocardiogram, or cardiac ultrasound, shows how well your heart is pumping blood, the size and shape of your heart valves and chambers, and if a valve has become narrowed or is allowing blood to flow or leak backwards. 

      An echocardiogram creates a moving picture of your beating heart through the use of sound waves. Sound waves are transmitted toward your chest with a wand.  “Echoes” from the waves that bounce off the heart are converted into pictures of your heart on a computer screen.  (Other tests that use sound waves to detect a heart valve problem include ultrasound and Doppler echocardiogram.)  
    • Transesophageal (tranz-ih-sof-uh-JEE-ul) echocardiogram (TEE).  To get a better image of your heart, your doctor may recommend a TEE.  Medications are given to help you relax as a sound wave wand, positioned on the end of tube, is passed down your throat into your esophagus, the tube from your mouth to your stomach.
    • Electrocardiogram (elec-tro-CAR-dio-gram), or EKG. A simple test usually done in the doctor’s office, an EKG detects and records the electrical activity of your heart. An EKG can reveal an irregular heartbeat, signs of a previous  heart attack and whether certain chambers of your heart are enlarged.
    • Chest X-Ray.  A chest x-ray can show enlarged sections of your heart, fluid in your lungs and calcium deposits in your heart. 
    • Stress Test.  A stress test can show if you have symptoms of heart valve disease when your heart is working hard.  It helps your doctor assess how severe your disease might be. Stress tests involve either exercising or taking medication to make your heart beat fast while images are taken of it. 
    • Cardiac Catheterization (also called angiography).  Your doctor may recommend cardiac catheterization if he or she continues to have questions after seeing your echocardiogram results.  Cardiac catheterization can help assess if your symptoms are due to a valve problem or if they relate to a blockage in your artery, an indication of coronary artery disease.  Ultimately, the catheterization provides detailed information that enables your doctor to develop the best plan for treating your condition.

      Catheterization is performed in a hospital’s catheterization laboratory, or “cath lab.” During cardiac catheterization, you are given medications to relax, but most people remain awake through the procedure.  The injection of medicine to numb the area where a catheter, a small, thin tube, is inserted in a blood vessel is the only discomfort most people feel.

      A thin, flexible tube (catheter) is inserted into a blood vessel in your upper thigh (groin), arm or neck and threaded through the arteries into your heart. X-ray images help the doctor guide the catheter.  Because there are no nerves in the blood vessels, you do not feel the catheter moving through your arteries or experience pain.
    • CT (computed tomogram, or CAT scan). CT scans are used to obtain pictures of the heart chambers and arteries.
    • Cardiac MRI (magnetic resonance imaging).  Cardiac MRI is a non-invasive medical test that uses a powerful magnet, radio waves and a computer to make detailed images of the heart.  Images from a cardiac MRI image can provide more detailed information about valve defects than other tests. Images from a cardiac MRI can help the surgeon plan the heart valve surgery.
    Your child’s physician may use one or more diagnostic tests to assess the heart’s structures, rhythm, blood flow and pumping capacity.  These tests provide valuable information for developing the best plan of treatment.  

    In addition to listening to your child’s heart and lungs through a stethoscope, the physician may recommend one or more of the following tests: