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August 12, 2020

Diagnosis and Tests for Heart Diseases

Introduction

When an individual is affected by heart disease, it could be any heart disease that is affecting the heart i.e. coronary artery disease and arrhythmia. As per the Centers for Disease Control and Prevention (CDC), heart ailments are considered to be affecting 1 in 4 deaths in the US (United States) every year. It’s is one of the major factors for death in men and women.

Depending on the condition of heart disease, the physician decides the tests required for heart disease. In any kind of heart disease, the doctors will majorly do a physical examination and collect details on your “personal and family medical history” details before conducting any tests.

Symptoms for heart illness

These include:

  • Syncope i.e. faint kind of feeling
  • Heart-beats increase or decrease
  • The tightness of the chest
  • Pain in the chest
  • Breathlessness
  • Instant swelling observed in the legs, feet, ankle or abdomen

Any of the above-mentioned symptoms are observed, it is important to book an appointment with the physician. Early diagnosis or treatment is important to decrease the risk of dangers such as heart attack or stroke.

Physical Examination and Blood Tests

For the diagnosis of heart ailments, the physician will conduct a sequence of “test and evaluation.” Few of these tests would also be used for the screening of heart illness before some detectable symptoms are developed. Your “Heart Rate” and “Blood Pressure” is also examined.

Blood Tests would also be mentioned by the doctors to be done. Like the test for cholesterol, as it measures the fat content and cholesterol in the bloodstream. To decide the harm of heart illness and heart attack, the physician may use these tests. For a blood test, a sample is taken from the vein.

To get a total check of your cholesterol levels, there are four kinds of fat in the blood.

  • Total Cholesterol: It is the complete cholesterol present in the body.
  • LDL Cholesterol i.e. Low-Density Lipoproteins: It is termed as “bad cholesterol.” Excess of this causes the fat to deposit in the arteries, causing a decrease in the flow of blood. This results in a heart attack or stroke.
  • HDL i.e. High-Density Lipoproteins: It is termed as “good cholesterol.” It takes the LDL Cholesterol away and cleans the arteries from any deposits or blockages.
  • Triglycerides: This is also a kind of fat present in the bloodstream. If there is an excess of triglycerides, it could be due to diabetes, smoking and excess intake of alcohol.

To examine the signs and symptoms of inflammation, the doctor will ask to check for the signs of inflammation by doing a test named “C-Reactive Protein.” The conclusion of the test for fat levels and inflammation are used by the physician as a risk/danger for heart disease.

Blood will be taken to identify the damage of heart or a heart attack, which is determined by the levels of protein in the blood that are not normal. The particular proteins for these blood tests include Creatine Kinase (CK), Creatine Kinase –MB (CKMB), Myoglobin, Cardiac Troponin or Cardiac Troponin T. If these proteins are present in the blood, they depict heart attack. But they are also found in other muscles. These proteins are not particularly only for heart-related issues/disease.

Non-invasive tests for heart illness

There could be extra tests demanded by the doctors apart from the completion of physical examination and blood tests. The tests to be done here are those that include tools that do not break the skin or physically are inserted in the body.

Pulse Check

This test is done to check the number of heartbeats every minute. This checks whether the pulse is proper or no and recognizes the power of the pulse. The pulse is checked by the doctor or nurse or by the person himself/herself.

Blood Pressure

This measurement is taken by the physician, nurse or a “healthcare assistant.” While doing blood pressure, two recordings would be recorded:

  • Systolic Pressure (upper reading): This reading is recorded in the blood vessels when there is a contraction of the heart and it pressures the blood out into the arteries.
  • Diastolic Pressure (lower reading): This recording is recorded, once the heart is filled up with blood again.

Depending on the activity throughout the day, the blood pressure varies. During the time of taking blood pressure, if it increases it is termed as the “White Coat Effect.” It is important to relax while the blood pressure is being taken. Inform the person who is taking the blood pressure, if you on any prescribed medicines. At some point in time, monitoring of blood pressure is required through-out the day, important to either go for 24-hour ambulatory monitoring or home monitoring.

Electrocardiogram (ECG):

In this test, the ECG studies the electrical signals, and guides the physician to identify abnormalities in the rhythm of the heart, heart structure, and heart attack. In this test, tiny sticky dots and wire leads are attached to the chest, arm, and legs. To the ECG Machine is attached the leads, that documents the electrical impulses. This test is recorded on paper. ECG would be done either at rest or when performing any exercise or work-out.

24 hour or ambulatory electrocardiogram:

Here the electrodes are connected to the small box and then connected to the belt. This belt is worn for approximately 24 hours while performing the daily routine. Through-out the day, the ECG will be monitored and records any irregularities through-out the day. The patient also needs to document all the symptoms faced by the patient. Once done, this could be studied by a cardiologist or electrophysiologist.

Holter Monitoring:

It is a device that is easily movable, required to record the constant ECG for 24 to 72 hours. It is used to identify the abnormalities in the rhythm that will not be found during a normal ECG examination.

Echocardiogram:

This is defined as an “echo”, it is an ultrasound scanning done for the heart. In this case, the heart image is formed using a “high-frequency sound wave.” To the undressed chest, a jelly will be applied and an expertized investigator examines the chest to get a visibility/outlook of the heart. This helps study the heart size, the contractions, and relaxations of the heart muscles and the working pattern of the valves of the heart.

Stress-Test:

Also known as Exercise Tolerance Test (ETT) or treadmill test. This is the same as an ECG but documents the heart’s activity as it works hard to like for example while walking on the treadmill. This will document the response of the heart to the exercise.

Nuclear Cardiac Stress Test:

This test is termed as “exercise thallium scan”, “A dual-isotope treadmill” or an “exercise nuclear scan.” A small amount of radioactive product named” tracer” is put into your blood-stream. It reaches the heart and produces energy. From the out of the body, there are special cameras that take a photo of the energy. These images are then checked by the physician to see the flow of blood to the muscles of the heart and the way there is pumping of the blood from the heart while testing and doing any exercise or work-out. This also helps to see the physician if there is any damage or harm to the muscles of the heart.

Tilt Test:

While lying and standing, the physician detects the blood pressure and heart rate in this test. This test is used to analyze the symptoms such as blood pressure or heart rate. In this test, the individual is asked to lie down on a table, which moves from a horizontal to vertical movement. When this movement happens, the patient’s heart rate, blood pressure and oxygen levels are monitored. This test will help the physician to identify whether the symptom that occurred was due to heart illness or any other illness. This test would be done in an electrophysiology department, as an outpatient appointment.

Chest X-Ray:

In this case, tiny amounts of radiation are used to form the images of the patient’s chest, inclusive of the heart. It assists the physician to identify/decide the factor for breathlessness or pain in the chest.

CT (Computerized Tomography):

This scan makes use of various “cross-sectional images”, of the individual’s heart. Various kinds of CT scans will be used by the physician to identify heart illness/conditions. For example: check the deposition of calcium in the coronary arteries. Either there would be a use of coronary CT angiography for checking of deposition of fat or calcium in the arteries.

MRI (Magnetic Resonance Imaging):

Images are created of the inner body using large magnets and radio waves. While taking the MRI of the heart, an expert generates photos of the blood vessels and heart when it beats. Once the test is done, the physician uses the photos to identify various illnesses or conditions like diseases of the heart muscles and coronary artery disease (CAD).

A few of the times, non-invasive techniques do not provide enough answers, the doctor might have to make use of the invasive techniques to identify the heart conditions. In invasive techniques, they make use of tools that enter the body physically like needles, tube or scope.

Coronary Angiogram and Cardiac Catheterization:

This is done either at the time of heart attack or after that. A few times it is also termed as “cardiac catheterization.” A catheter or tiny tube is placed in the artery in the individual’s groin (place of your hip in the middle of the person’s stomach and thigh), arm or wrist by giving anesthesia i.e. local one. The catheter is pushed into the artery until it extends to the heart. This will not be felt. A dye (special one) is injected in the artery, with this an X-Ray is taken of the heart. This results in a feeling of hot and flush for some seconds or time. This also depicts the way and how good is the pumping of the heart.

This will help the physician to come to a conclusion related to which treatment is a better option. A few times, it would be a better option to directly go for a coronary angioplasty since you are already in the laboratory doing the coronary angiogram and tubes are in their location. The heart specialist will talk to you about the method before moving ahead and it depends on the patient and the family whether to move ahead or no with the procedure. Reasons for a test is to evaluate to see if the plaque is narrowed or blocked the arteries, which is known as coronary angiography. This helps to get an idea about doing percutaneous coronary intervention (PCI) such as coronary angioplasty which includes stent for the opening of the blocked arteries, to measure blood pressure, for the evaluation of muscles of the heart and functions of the valve, helps to identify the best treatment for heart diseases.

Electrophysiology Study:

If the rhythm of the heart is not regular it might be asked by the doctor to conduct a study, to identify the factors and the plan of action for treatment. In this condition, the doctors put/inserts the electrode catheter via the blood vessels in your heart. The electrodes are used to pass electric signals to the heart and generate a map of the activity of the electrical signals. By giving medicines or treatment the physician helps to get back the normal rhythm of the heart.

The time to visit a physician

Do visit a physician if you identify or doubt any sort of heart issues. Causes that lead to an increased risk of heart ailments/diseases:

  • Family history for heart conditions/ailments
  • Smoking history
  • Overweight/Obesity
  • Diet is very poor
  • Age

As mentioned initially the physician will ask to check for blood tests or various other tests to identify problems for heart or blood vessels. This guides the physician towards identifying the heart conditions and formulate a plan of action or treatment.

Heart Attack and Stroke are the complications of heart conditions. Early identification and treatment plan can help decrease the risk of heart conditions. If any issues do have a conversation with your physician. They guide the identification of heart condition symptoms and keep yourself heart-healthy.

References

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2491048/
  2. https://www.ncbi.nlm.nih.gov/pubmed/12875110
  3. https://cardiologyres.org/index.php/Cardiologyres/article/view/667

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