The American Heart Association recommends beginning heart disease prevention at an early age, as evaluating risk factors early and taking steps to reduce them can lead to a greater chance of living a long and healthy life. In addition, while heart disease is the number one cause of death for both men and women, men not only have a greater risk of heart attack but also have heart attacks earlier in life. So now that we have your attention, let’s discuss what heart disease is, what its risks and symptoms are, and some common heart disease tests used to diagnose the condition.
What Is Heart Disease?
The term “heart disease” is actually an umbrella term that’s used to describe a range of conditions that affect the heart. These include:
- Coronary artery disease
- Peripheral artery disease
- Carotid artery disease
- Congenital heart disease
Risks of Heart Disease
While certain risk factors for heart disease can’t be changed—including age, sex, and family history—most can be modified or even prevented. These include:
|High blood pressure||Stress|
|Lack of physical activity||Heavy drinking|
According to the Centers for Disease Control and Prevention, approximately 47% of Americans have at least one of the three main risk factors for heart disease:
- High blood pressure
- High cholesterol
And according to the American Heart Association, at least 68% of people aged 65 or older with diabetes die of some form of heart disease.
Symptoms of Heart Disease
The type of heart disease you have will determine the type of symptoms you experience. Some of these conditions and their associated symptoms include:
- Arrhythmias: Encompassing conditions such as atrial fibrillation and atrial flutter, arrhythmias may present with syncope (fainting), lightheadedness, dizziness, shortness of breath, or tachycardia or bradycardia (fast or slow heartbeat).
- Atherosclerotic disease: Diseases of the vessels may present with chest pain or pressure; shortness of breath; pain in the neck, upper abdomen, or back; or pain or numbness in the extremities.
- Heart defects: Structural abnormalities of the heart may present with cyanosis (bluish skin) or leg or abdominal swelling.
- Cardiomyopathy: Diseases of the heart muscle may present with shortness of breath, lower extremity swelling, fatigue, arrhythmia, dizziness, or syncope.
- Valvular heart disease: Diseases of the heart valves may present with shortness of breath, fatigue, chest pain, syncope, arrhythmia, or lower extremity swelling.
If you have any of these symptoms, especially chest pain, shortness of breath, or syncope, seek medical assistance immediately. Your health care provider will need to speak with you about your symptoms and personal and family medical history and perform a physical exam.
Based on your symptoms and findings, your health care provider may also choose to perform a series of both noninvasive and invasive tests to further determine what type of heart disease you have.
Noninvasive (and Minimally Invasive) Heart Disease Tests
Depending on the severity of your condition, noninvasive tests will generally be performed first. This may begin with a chest x-ray to identify any overt abnormalities in the shape or size of your heart, lungs, or blood vessels and then progress to other, more specific tests based on the results of the x-ray images.
Some of the more common noninvasive tests health care providers use to assess symptoms and determine the type of heart disease present are:
- Cardiac stress test
- Computed tomography
- Magnetic resonance imaging
An electrocardiogram (ECG or EKG) is the most commonly used test to screen for heart problems. This test uses small electrodes attached to the chest (and sometimes the extremities) to measure the electrical activity of the heart. While an EKG is a painless procedure that takes only a few minutes to perform, its results can quickly show irregularities in heart rate and rhythm and indicate whether a heart attack has taken place in the past or is currently in progress.
An abnormal EKG may indicate that further testing or treatment is warranted. For example, Holter monitoring, a test involving a portable device worn (usually) for 24 to 48 hours as well as a continuous EKG may be recommended to investigate irregularities in heartbeat. And if your EKG results show evidence of a current heart attack, emergency cardiac intervention may be recommended.
Just as the EKG is the heart test most likely to be performed first, an echocardiogram, or echo, is a complementary test that’s likely to be one of the first tests recommended in the face of abnormal EKG results. But unlike the EKG, an echo is an ultrasound and uses sound waves to image the heart.
If an EKG detects an abnormal rhythm, an echo can be used to evaluate for underlying structural abnormalities. And if an EKG detects a possible heart attack, an echo can help identify the extent of the damage.
Cardiac Stress Test
There are actually several kinds of cardiac stress tests that can be classified as either noninvasive or minimally invasive. However, all stress tests are designed to measure how your heart responds to stress, and each falls into one of two broad categories:
- Exercise stress test
- Pharmacologic stress test
During an exercise stress test, you’re asked to exercise on a treadmill or stationary bike while your heart rhythm and rate are monitored. A basic exercise stress test measures your heart’s response to physical exertion using an EKG, while an exercise nuclear test uses an injection of a radioactive substance to enable imaging of your heart. And yet another version of the exercise stress test, known as the stress echo, uses an echocardiogram to image your heart.
Similar to exercise stress tests, pharmacologic stress tests monitor your heart’s response to stress, but instead of using exercise, these types of stress tests use injections of medication that mimic the effects of exercise on the heart. These tests also use either nuclear or echocardiographic imaging.
Cardiac computed tomography is a noninvasive test that uses a CT scan to image the arteries of the heart to determine if they’re blocked or narrowed by a buildup of plaque. This test is also sometimes referred to as a coronary calcium scan, as the CT uses the presence of calcium deposits in plaque to determine the level of blockage. The amount of calcium detected is then converted to a calcium score, which corresponds to the severity of coronary artery disease found.
Magnetic Resonance Imaging
Cardiac magnetic resonance imaging, or cardiac MRI, is a noninvasive test that uses magnets and radio waves to generate detailed images of the structures in and around the heart. Cardiac MRI can be used to evaluate blood flow through the heart to determine whether any arteries are blocked or whether portions of the heart have been damaged by a heart attack.
Invasive Heart Disease Tests
Some heart disease tests are more invasive than others. Two of the more common types of tests that fall into this category are:
- Cardiac catheterization
- Electrophysiology study
Cardiac catheterization is an imaging procedure that is performed under sedation. It can be used by your health care provider to confirm the presence of heart disease and ascertain the need for further intervention. Because of the small risk of complications, your health care provider will usually perform noninvasive tests such as an EKG or stress test before moving on to this invasive procedure.
To perform a cardiac catheterization, a flexible tube called a catheter is inserted into a blood vessel in the wrist or groin via a plastic introducer sheath. The catheter is then threaded through the vessel until it reaches the heart.
Once the tip of the catheter reaches the heart, a coronary angiography is then performed. To conduct this test, radioactive dye is injected into the catheter, and x-ray images are taken as the contrast material moves through the heart and its major vessels.
If any blockages are detected, percutaneous coronary intervention, or coronary angioplasty, may then be performed. During this procedure, a tiny balloon is inserted and inflated at the site of the blockage to help widen the artery. Afterward, a wire mesh tube known as a stent is often placed in the artery to help keep it from narrowing again.
However, angioplasty and stent placement are not always successful, and when this occurs, coronary bypass may be recommended.
If you have a history of syncope, have been noted to have an arrhythmia or risk of sudden cardiac death, or are simply in need of certain cardiac procedures, your health care provider may choose to perform an electrophysiology (EP) study.
Like a cardiac catheterization, an EP study also makes use of a catheter placed inside the heart. However, the catheter used in an EP study employs a specialized electrode to measure the electrical activity within the heart and determine the site of the abnormality.
With potential complications such as heart failure, stroke, and heart attack, it’s important to take heart health seriously.
To reduce your risk of heart disease, making a commitment to healthy lifestyle choices and managing current medical conditions are great starts. And if you have questions about next steps or symptoms you’d like to discuss, your health care provider can help guide you to the right treatment plan for you.