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Heart Tests -- Simple to Sophisticated

From Upper Valley Medical Center

How healthy is your heart?  Most Americans assume their heart is in pretty good shape until something happens to tell them otherwise, such as severe pain in the chest, inability to exercise without shortness of breath…or a heart attack.  Heart disease is the number one killer of both men and women in this country, often striking without prior warning. 

Based on studies of the blood vessels in young persons who died of other causes, doctors know that heart disease often develops at a young age, silently laying the groundwork for a disabling or fatal heart attack several decades later.  The ideal, of course, is to know what’s happening inside the heart and blood vessels so that problems can be headed off early.  And there are numerous tests--some simple and others technologically sophisticated--that can do just that.  One of the easiest and most effective is one that your doctor or nurse probably performs every time you visit, whether the problem is heart-related or not--a reading of your blood pressure.

Elevated blood pressure (anything greater than 120/80) can be a sign of early developing heart disease.  And, if left uncontrolled, it causes irreversible damage to both the heart and blood vessels.  Fortunately, blood pressure is easily controlled with diet, exercise and medications.
High cholesterol may be an even more important risk factor for heart disease, and cholesterol testing is recommended at least once every five years for adults age 20 and over and more frequently after age 50.  A complete lipid profile-measuring LDL, HDL and triglycerides-can be accomplished with a simple blood test, preceded by several hours of fasting.  When cholesterol is mildly elevated, a change in diet is recommended.  When it’s significantly elevated, or if other risk factors exist, a doctor may prescribe cholesterol-lowering medications. 

Doctors know that damage to arteries (atherosclerosis) involves tissue inflammation that damages blood vessels and leads to the accumulation of fatty blockages.  One indication of inflammation is a high level of C-reactive protein (CRP), which can also be measured through a blood test.  When high CRP is found, however, there is no certain way to lower it and recent research indicates that this marker may not reveal much beyond what is known about high cholesterol, hypertension or excess weight-risk factors that are usually found in conjunction with high levels of CRP.

Testing the Arteries

Heart Test ImageWhile these blood tests provide a good idea of what is taking place in the blood vessels, it is now possible, through CT scan and ultrasound technology, to get actual images of the arteries and determine how much narrowing has taken place or how much calcium is present in coronary arteries--a more direct indication of disease than cholesterol or blood pressure.  For persons at high risk of cardiovascular disease, there also are other tests to measure the health of blood vessels.  One uses a computer analysis to measure arterial elasticity -- how well the blood vessels are able to relax and contract in response to the flow of blood.  Blood pressure taken at rest and then during exercise is another indication of arterial function.  A steep rise in blood pressure during exertion can be a sign of reduced elasticity.  Measuring blood pressure in the leg as well as the arm (ankle/brachial index) is one way to detect vascular disease in the lower body. 

When there is a strong suspicion of coronary heart disease, there are tests a physician can use to focus more directly on the heart itself, its rhythms and its pumping action.  Uncontrolled blood pressure can strain the left ventricle of the heart leading to a thickening of the ventricle walls and a weakening of its pumping action.  This is known as left ventricular hypertrophy (LVH), and is known to be a precursor to heart failure.
One of the most common tests to evaluate the functioning of the heart is a resting electrocardiogram (EKG).  It involves placing electrodes on the skin of chest, arms and legs though which a doctor can monitor and record heart rhythms. If abnormalities are found, a left ventricular ultrasound can measure the diameter, mass and wall thickness of the ventricle.  For a person who is experiencing symptoms of heart disease, a normal resting EKG may lead to an exercise stress test-an electrocardiogram performed on a treadmill or a stationary bicycle.  This test can determine if there are blockages that are keeping the heart from getting sufficient blood flow during physical activity. 

Another approach uses a Holter monitor, a small portable recording device worn on the belt and hooked up to electrodes that record the heart’s electrical activity over a 24-hour period with normal daily activity.  A person who has had unexplained palpitations or fainting might wear a Holter monitor to help diagnose the problem and monitor the effectiveness of medications

A nuclear medicine stress test uses a mildly radioactive substance, injected into the body to track blood flow and pinpoint areas of the heart getting insufficient blood flow.  It is more accurate than the standard exercise stress test. 

The gold standard for assessing blockages in coronary arteries is cardiac catheterization/ angiography.  This is usually performed after an EKG has already indicated insufficient blood flow to the heart.  A catheter is inserted into an artery in the groin or arm and guided to the heart through images projected on a video monitor.  Contrast material injected through the catheter makes it possibly to view any abnormalities so the doctor can identify which arteries are affected and determine whether balloon angioplasty or surgery is required for treatment. 

There are many other tests, each with its own specific role in diagnosis and treatment.  With technological advances, new tests are constantly being introduced.  As valuable as these tests are, the major tools in defeating this major killer remain the same: a health-conscious public who understand the value of diet, exercise and control of blood pressure and cholesterol. 

To learn more about promoting your own heart health, talk to your doctor or call the professionals at the UVMC Cardiac Rehab program, (937) 440-4675.
This information is provided by the health care professionals of Upper Valley Medical Center.  It is intended for educational purposes and should not be used as a substitute for the care of a physician.  Please contact your doctor for specific advice and/or treatment of health conditions. 

UVMC’s Cardiac Catherization laboratory provides safe, reliable testing to help detect the presence of coronary artery disease and provide information cardiologists use to proscribe treatment.  Today’s technological advancements have made possible many important tests for helping to diagnose heart disease risks.  However, individuals still hold the key to minimizing their cardiovascular health risks through healthy lifestyle habits such as regular exercise, proper nutrition, stress control and not smoking.  The health professionals at the UVMC Cardiac Rehab program help cardiac patients stay on track with optimal health after heart attack or cardiac disease.  To learn more, feel free to call (937) 440-4675.