If you notice a change in your exercise tolerance, it may be related to your heart. Perhaps your breathing becomes labored walking up a flight of stairs, or your morning run is interrupted by discomfort in your chest. These symptoms could be related to a number of medical conditions, including the most common type of heart disease: coronary heart disease (CHD), also called coronary artery disease.
According to the American Heart Association, CHD accounts for one in seven deaths in the United States. It is caused by plaque buildup inside the arteries that supply oxygen to the heart. Symptoms may develop when significant narrowing occurs within an artery and compromises the heart’s blood supply.
If your doctor suspects you have CHD and refers you to a cardiologist, the first step will be a review of your medical history and other risk factors, as well as a physical exam. Depending on your symptoms, there are a variety of tests the cardiologist can use to make a diagnosis. Staci Milosavljevic, MD, a cardiologist who practices at the Drexel Town Square Health Center, explains some of the most common noninvasive diagnostic tests for coronary heart disease.
12-Lead Electrocardiogram (ECG or EKG)
An EKG is a depiction of a person’s cardiac rhythm and is one of the most common diagnostic tests used to evaluate the heart in a doctor’s office.
“The EKG can determine whether the heart’s rhythm is normal, as well as show changes suggestive of coronary or other heart disease,” Dr. Milosavljevic said.
Transthoracic Echocardiogram
An echocardiogram is a comprehensive ultrasound exam that provides images of the beating heart from different views. These images allow the cardiologist to visualize all four chambers of the heart and the heart valves.
“An echocardiogram provides important information in assessment of the overall structure and function of your heart and may identify pathology such as an enlarged or thickened heart, weak pump function, stiffness of the main pumping chambers of the heart or valvular heart disease,” Dr. Milosavljevic said. “Findings such as globally reduced heart-muscle function or regions of depressed muscle function may be consistent with the presence of CHD.”
In some cases, a cardiac MRI may be recommended and can be a valuable diagnostic tool, not only in the assessment of CHD, but also in many other types of heart disease.
Stress Test
A stress test is used to evaluate the performance of the heart during exercise, when the heart muscle is working harder and needs more oxygen.
“If there is a supply-demand mismatch, this may be due to CHD,” Dr. Milosavljevic said.
During a stress test, the patient exercises, usually on a treadmill, as long as he or she can. There is continuous monitoring of the EKG and blood pressure as the intensity of the exercise increases. Cardiac imaging is performed at rest and again with exercise. If you are unable to exercise, a pharmacologic stress test may be recommended, which means that medication will be used to challenge the heart instead of exercise.
There are a number of different imaging options used in stress testing, including echocardiography, nuclear SPECT and cardiac MRI. “An echocardiogram may identify a new area of weakness in the heart muscle with stress or new global reduction in heart function, suggesting limitation in blood flow due to CHD,” Dr. Milosavljevic said.
Your doctor will choose the stress test that is best for you and your heart.
Based on your symptoms and the results of noninvasive testing, your doctor may recommend additional, more invasive testing for further evaluation and treatment of CHD, along with medical therapy.
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This article was originally published on February 27, 2018.
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