Doctors have many different ways to check the heart’s function.
The heart is a complex muscle. Like a car engine, it has multiple parts and connects to key organs around it. Both an engine and a healthy heart require all parts to do their job, or trouble can ensue.
“[The heart] has chambers, it has valves, but it also has its own electrical system,” says Paul Knoepflmacher, MD, clinical instructor in medicine at The Mount Sinai Hospital. “It also has blood vessels in it, and any of these components can go wrong and have problems.”
That means a single test may not be able to fully diagnose heart disease, or the extent of it. To get the most accurate picture and treatment game plan, doctors have a variety of tests to examine the heart’s function and the effectiveness of each of the heart’s individual components.
While doctors have a lengthy list of tests to choose from, your doctor won’t use every single one. “You really direct the tests to the patient’s needs,” says Nieca Goldberg, MD, medical director at NYU Langone Health, Joan H. Tisch Center for Women’s Health.
Tests to Diagnose Heart Disease
Your doctor may want to test for heart disease if you have symptoms of heart disease or have significant risk factors like high blood pressure or high cholesterol. These are some of the tests they may use.
An EKG (electrocardiogram) records the electrical activity of the heart and its contractions. EKGs are used for any patient who’s showing symptoms of heart disease, like fatigue or shortness of breath, according to Satjit Bhusri, MD, cardiologist at Lenox Hill Hospital.
An echocardiogram might be used if your EKG results are abnormal. “An echocardiogram is basically a test that uses sound waves to get an image of the heart,” says Dr. Knoepflmacher. (It’s similar to an ultrasound that pregnant women get to see their baby in the womb.) It gives doctors a good look at how blood is flowing in the chambers and valves of the heart.
A stress test measures how well your body handles a workload by monitoring its activity during and after exercise, according to the American Heart Association (AHA). You will walk or run on a treadmill under the supervision of a doctor, and an electrocardiography machine will measure your heartbeat.
A nuclear stress test lets doctors see photos of your heart after exercise using a special camera.
A stress echocardiogram compares ultrasound pictures of the heart before and after exercise, according to Michelle Weisfelner Bloom, MD, cardiologist at Stony Brook University Medical Center.
A coronary angiogram (or cardiac catheterization) uses dyes to take X-rays of the arteries, according to AHA. A thin catheter is inserted into an artery from your groin or arm, and up to the heart. A special dye in the catheter lights up the arteries and makes them visible on the X-ray. This test can “determine if there’s a blocked artery that needs opening,” says Dr. Goldberg. If a major blockage is discovered during a coronary angiogram, an angioplasty may be done, which is a procedure in which a balloon is inserted to the blockage and expanded to open up the artery. After that, doctors may insert a stent (a wire mesh tube) to keep the artery open after the procedure.
A cardiac CT scan is another way to check the health of your arteries. It takes X-rays of the heart and blood vessels to check for calcium buildup in the arteries. Using a measuring system called a “calcium score,” doctors can predict your risk of having a heart attack and assess how aggressive treatment should be, according to AHA.
A cardiac MRI is “the best way we know to tell what the pumping function and relaxing function is of the heart,” says Dr. Weisfelner Bloom. It also gives a good image of the walls of the heart. “With a cardiac MRI, we can also diagnose myocarditis, which is an infection of the heart,” says Dr. Weisfelner Bloom.
If your doctor requests certain tests to diagnose your heart symptoms, it’s a good idea to get informed. You want to understand “what the test is about, what it’s used for, and why your doctor has recommended it,” says Dr. Weisfelner Bloom. As always, asking your doctor plenty of questions can empower you to make the best choices for your healt
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The heart is obviously a pump.
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It's a muscle that pumps.
00:00:05,503 --> 00:00:09,396
It has chambers, it has valves, but
it also has an electrical system.
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It's got its own wiring, and
it also has blood vessels in it.
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And any of these components
can go wrong or have problems.
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And the tests that we do look for
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different problems within
these components of the heart.
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There's a whole menu of the tests.
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And just like when you
go into a restaurant,
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you don't order the whole menu.
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And when you're taking care of a patient,
you don't order the whole menu of tests.
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You really direct
the test to the patient's
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An EKG is a test that looks at
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the electrical rythmn of the heart.
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And there's so
much that we can tell from an EKG.
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An EKG is necessary for
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anybody who has signs and
symptoms of heart disease.
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And that's anything from fatigue,
shortness of breath, to chest pain, or
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physical signs of heart failure.
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If you have an abnormal EKG,
one thing you would do is
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An echocardiogram is basically a test
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which uses sound waves to
get an image of the heart.
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And it is helpful in looking at blood
flow within the chambers of the heart,
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the valves, and
just in general how the heart is pumping.
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A stress test is a general test that we
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use when we're worried that the person
might have coronary artery disease.
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There's a stress test that has a patient
walking and then running on a treadmill.
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There's also one where you can
run a treadmill, and then you can
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look at pictures in a camera, which is
called a nuclear treadmill stress test.
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There's something called
a stress echocardiogram
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which is ultrasound pictures
of the heart at rest.
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And then after you exert yourself on
a stationary bicycle or a treadmill, for
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A cardiac catheterization is also
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known as coronary angiography.
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That's the test where we can take X-ray
pictures of your coronary arteries,
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the arteries that supply your heart
muscle to determine if there's a blocked
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artery that needs opening.
There are also a couple
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of other imaging tests that
we sometimes use in patients.
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There's something called a cardiac CAT
scan or a cardiac CT that actually is
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a different way of looking to see whether
there's blockages in the arteries.
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There's also something called a cardiac
MRI, that is the best way we know to tell
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what the pumping function and
the relaxing function is of the heart.
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And also a really good way to know whether
all of the walls look okay in the heart.
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With a cardiac MRI,
we can also diagnose myocarditis,
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which is an infection of the heart,
and other things like that.
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It's very important that patients educate
themselves and do as much information
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gathering before a test to understand
exactly what the test is about.
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What's it's used for, and
why your doctor has recommended it.
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Cardiac computed tomography (multidetector CT, or MDCT). Dallas, TX: American Heart Association, 2016. (Accessed on April 13, 2018 at http://www.heart.org/HEARTORG/Conditions/HeartAttack/SymptomsDiagnosisofHeartAttack/Cardiac-Computed-Tomography-Multidetector-CT-or-MDCT_UCM_446370_Article.jsp#.WtENDJM-fVo.)
Coronary artery disease. Dallas, TX: American Heart Association, 2017. (Accessed on April 13, 2018 at http://www.heart.org/HEARTORG/Conditions/More/MyHeartandStrokeNews/Coronary-Artery-Disease---Coronary-Heart-Disease_UCM_436416_Article.jsp#.WtD3n5M-fVo.)
Echocardiogram - echo. Dallas, TX: American Heart Association, 2017. (Accessed on April 13, 2018 at http://www.heart.org/HEARTORG/Conditions/HeartAttack/DiagnosingaHeartAttack/Echocardiogram---Echo_UCM_451485_Article.jsp#.WtD-WJM-fVo.)
Heart CT scan. Washington, DC: U.S. National Library of Medicine. (Accessed on April 13, 2018 at https://medlineplus.gov/ency/article/007344.htm.)
Heart disease: symptoms, diagnosis, treatment. Bethesda, MD: National Institutes of Health. (Accessed on April 13, 2018 at https://medlineplus.gov/magazine/issues/winter09/articles/winter09pg25-27.html.)
Nuclear stress test. Washington, DC: U.S. National Library of Medicine. (Accessed on April 13, 2018 at https://medlineplus.gov/ency/article/007201.htm.)
What is a coronary angiogram? Dallas, TX: American Heart Association. (Accessed on April 13, 2018 at https://www.heart.org/idc/groups/heart-public/@wcm/@hcm/documents/downloadable/ucm_300436.pdf.)
What is a stress test? Dallas, TX: American Heart Association. (Accessed on April 13, 2018 at https://www.heart.org/idc/groups/heart-public/@wcm/@hcm/documents/downloadable/ucm_300453.pdf.)