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Improve Your Understanding of Tests That Assess Heart Function: Several tests provide information about your heart and coronary arteries that can aid in diagnosis and treatment.

If your doctor suspects you have heart disease, he or she may order some tests that will provide information about the structure and function of your heart and your coronary arteries. These tests range from simple, non-invasive screenings to more involved procedures that may include the use of high-tech imaging equipment.

"Typically, these tests are ordered in response to symptoms such as chest pain, shortness of breath, and an inability to exercise for the amount of time or at the intensity level that is typical for an average person of your age and general condition," explains Joy Gelbman, MD, a cardiologist at the Weill Greenberg Center.

Here is a guide to some common tests that are frequently ordered when your heart health is being evaluated.


An electrocardiogram (ECG or EKG) is a test that measures the electrical activity of your heart. For the test, you'll lie down and have electrodes placed on your chest, legs, and arms. The electrodes record how fast your heart is beating and the rhythm, strength, and timing of electrical signals as they move throughout your heart.

ECGs help diagnose conditions such as arrhythmias (irregular heart rhythms) and heart failure, which occurs when the heart is weakened and can no longer effectively pump blood throughout the body. An ECG also can help determine if a patient who is experiencing chest pain and/or pressure is having a heart attack.

Stress Tests

A stress test is conducted to see how your heart responds to physical exertion. Some stress tests also identify areas of reduced blood flow and/or parts of the heart that may have been damaged by a heart attack.

All stress tests involve "stressing" the heart in some way and then looking for any changes that might indicate your heart is functioning abnormally.

There are a few different types of stress tests; the most common type is an exercise stress test. This test is often done in your doctor's office, usually on a treadmill or stationary bicycle. As you exercise, the electrical activity of your heart, as well as your heart rate and blood pressure, are recorded.

If you are unable to exercise, you may be given a drug that causes your heart to mimic how it would function during exercise; this is often called a chemical stress test.

A nuclear stress test may be ordered if a standard stress test is unable to identify the cause of symptoms you are having, such as chest pain, pressure, or tightness. This exam involves injecting a radioactive agent into your blood vessels.

A stress magnetic resonance imaging scan (MRI) uses radio waves to create images that can show blockages in arteries. A stress MRI also can record how your heart functions during exercise.

Heart Rhythm Monitor

Sometimes, an ECG is inconclusive; this is particularly common with abnormal heart rhythms, which may occur occasionally but not necessarily when you are having an ECG. A heart rhythm monitor (Holter monitor) is a small device similar to an ECG that is worn while you do your everyday activities, usually for at least 24 hours. The monitor is more likely to "capture" an episode of irregular heart rhythms.

Coronary Calcium Scan

If you have several risk factors for heart disease, such as high cholesterol, high blood pressure, obesity, a history of smoking, and/or advanced age, but you don't have any symptoms, your doctor may recommend a test that can detect calcium deposits in your coronary arteries. Calcium is one of several substances found in plaque, which can build up and cause arterial stiffness and narrowing. Results of the scan help your doctor determine if you have heart disease and what lifestyle modifications and/or treatment is appropriate.


High-tech imaging can provide doctors with details about the structure of your heart and the health of your heart tissue.

A standard cardiac MRI is done while you lie still in a large MRI machine. It can help diagnose coronary artery disease and reveal heart attack damage, congenital heart defects, tumors, and pericarditis (an inflammation of the membrane surrounding the heart).

In a similar test, a positron emission tomography (PET) scan, a radioactive chemical, or "tracer," is injected into your bloodstream. A special computer then creates a 3-D image of the tracer in your heart from dozens of thin-slice images.

"Cardiac MRI and PET are usually done once some form of heart disease has been diagnosed; they are generally not the first tests ordered to diagnose coronary disease," Dr. Gelbman explains.

Cardiac Catheterization

"The gold standard for the diagnosis of coronary disease is a coronary angiogram, also known as cardiac catheterization," Dr. Gelbman says. During this test, a catheter is inserted into an artery in your groin or arm and then guided up to your heart. Contrast dye is then injected into the catheter and travels to your coronary arteries.

"This provides a direct visualization of your heart," explains Dr. Gelbman. "The benefit is that it is an actual picture of the arteries. But, like all invasive testing, it is not without risk, albeit small." Risks include bruising and bleeding, possible damage to the artery where the catheter is inserted, and an allergic reaction to the dye.

A non-invasive alternative to an angiogram is a computerized tomography (CT) coronary angiogram, which uses powerful x-rays to look at blood flow to the heart. The advantage of a traditional angiogram is that, if blockages are found in the coronary arteries, an angioplasty (inserting and expanding a tiny balloon at the area of the artery that is blocked) and/or stent placement (placing a tiny tube at the blocked area) can be performed immediately to open up the blood vessels.


If your doctor orders a cardiac test:

* Ask your doctor's staff to find out if your insurance will cover the cost, or call your insurance company and ask yourself.

* Have a clear understanding of why the test has been ordered and what it will reveal.

* Find out how you should prepare for the test; for example, you may need to stop taking certain medications or to fast prior to the test.

* Tell your doctor if you have had an allergic reaction to radioactive dye in the past. This could mean you won't be eligible for certain screenings, such as a nuclear stress test.

Caption: An electrocardiogram (above) shows the electrical activity of the heart. A coronary angiogram (below) shows narrowed or blocked arteries.
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Title Annotation:HEART HEALTH
Publication:Women's Health Advisor
Date:May 1, 2019
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