Need for cardiology tests : In diagnosing heart disease, a doctor will first ask you for a description of symptoms and your medical history. Standard medical exam reveals your physical condition. Listening to the heart for swishing or whooshing sounds, collectively known as heart murmurs, may provide important clues about heart trouble. Further cardiology tests are done to find out what is actually happening inside the heart, in case of suspected heart disease.
Cardiology is the study and treatment of disorders of the heart and the blood vessels of the heart. Heart disease relates specifically to the heart, while cardiovascular disease affects the heart, the blood vessels of the heart, or both.
A cardiologist specializes in diagnosing and treating diseases of the cardiovascular system. He will carry out tests and do some procedures to assess the heart condition & also by reviewing a patient’s medical history and carrying out physical examination. Accordingly, they help make decisions about heart surgery, heart catheterization, angioplasty and stenting.
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Coronary heart disease refers to a narrowing of the coronary arteries, the blood vessels that supply oxygen and blood to the heart. It is also known as coronary artery disease. In fact, it is a major cause of illness and death.
Coronary heart disease (CHD) normally happens when cholesterol accumulates on the artery walls, creating plaques. Consequently, the arteries narrow, reducing blood flow to the heart. Sometimes, a clot can also obstruct the flow of blood to the heart muscle.
CHD commonly causes angina pectoris (chest pain), shortness of breath, myocardial infarction, or heart attack. Accordingly a person with heart disease or cardiovascular disease is referred to a cardiologist.
Symptoms that can indicate a heart problem include:
- Shortness of breath
- Chest pains
- Changes in heart rate
- Heart murmur
- Abnormal heart rhythm
- heart attack
- or any other heart problems
Heart diseases that a cardiologist can help with include:
- Atrial fibrillation
- Congenital heart disease
- Coronary heart disease
- Congestive heart disease
- High blood cholesterol and triglycerides
- Hypertension / High blood pressure
- Ventricular tachycardia
An interventional cardiologist may carry out procedures such as angioplasties, stenting, valvuloplasties, congenital heart defect corrections and coronary thrombectomies.
The tests you’ll need to diagnose your heart disease depend on what condition your doctor thinks you might have. No matter what type of heart disease you have, your doctor will likely perform a physical exam and ask about your personal and family medical history before doing any tests. Besides blood tests and a chest X-ray, tests to diagnose heart disease can include:
Chest X-ray gives the cardiologist information about your lungs and the heart’s size and shape.
Echocardiogram / ECG:
An electrocardiogram (ECG or EKG) is a test that measures the electrical activity of the heartbeat. It provides an ultrasound picture that shows the structure of the heart chambers and surrounding areas, so as to show how well the heart is working.
Echocardiography can measure how well the heart is pumping blood, known as cardiac output. It can detect inflammation around the heart, known as pericarditis. It can also identify structural abnormalities or infections of the heart valves.
An ECG also gives two major kinds of information. First, by measuring time intervals on the ECG, a doctor can determine how long the electrical wave takes to pass through the heart. Finding out how long a wave takes to travel from one part of the heart to the next shows if the electrical activity is normal or slow, fast or irregular. Second, by measuring the amount of electrical activity passing through the heart muscle, a cardiologist may be able to find out if parts of the heart are too large or are overworked.
During ECG the machine receives tiny electrical impulses that the beating heart makes and records them in a zigzag pattern on a moving strip of paper.
This exercise test shows the changes of heart rhythm when resting and exercising. It measures the performance and limitations of the heart.
Cardiac Catheterization and Angiogram:
A cardiac catheterization is a procedure that allows the cardiologist to get direct information about the blood pressures and patterns of blood flow within your heart. An angiogram is an X-ray movie that’s taken while contrast, a special fluid that’s visible by X-ray, is injected into a cardiac chamber or major blood vessel.
Cardiologists usually perform angiograms during catheterization. This is done by injecting special fluid, called dye or contrast, through the catheter into a blood vessel or a chamber of the heart. Sometimes doctors can treat a heart defect during the cardiac catheterization. This is called an interventional or therapeutic catheterization. These treatments include opening up a hole in the wall between the upper chambers, opening up a blocked valve or vessel, plugging off the unnecessary vessel or closing unnecessary holes in the heart.
MRI – Magnetic Resonance Imaging:
Magnetic resonance imaging is another way to take clear pictures of the heart and measure heart function. The MRI uses painless magnet waves to evaluate the heart and the blood vessels connected to the heart and lungs.
Cardiac MRI can reveal various heart diseases and conditions, such as:
- Coronary heart disease
- Damage caused by a heart attack
- Heart failure
- Heart valve problems
- Congenital heart defects (heart defects present at birth)
- Pericarditis (a condition which inflames the membrane, or sac, around your heart)
- Cardiac tumors
MRA – Magnetic Resonance Angiogram:
MRA of the heart is a type of MRI scan that uses a magnetic field and pulses of radio wave energy to provide pictures of blood vessels inside the heart. Coronary angiography is a procedure that uses contrast dye, usually containing iodine, and x ray pictures to detect blockages in the coronary arteries that are caused by plaque buildup.
An angiogram of the heart, a coronary angiogram, is the “gold standard” for the evaluation of coronary artery disease (CAD). Coronary angiogram is used to identify the exact location and severity of CAD. Angiographic images accurately reveal the extent and severity of all coronary artery blockages. For patients with severe angina or heart attack (myocardial infarction), or those who have markedly abnormal noninvasive tests for CAD (such as stress tests), the angiogram also helps the doctor select the optimal treatment. Treatments may then include medications, balloon angioplasty, coronary stenting, atherectomy, or coronary artery bypass surgery.
CT – Computerized Tomography of the Heart:
The CT scan uses multiple X-ray images to take an X-ray movie of the heart and lungs without placing catheters into the circulation. Like the MRI, this test sometimes takes clearer pictures than an angiogram.
TEE – Transesophageal Echocardiogram:
A transesophageal echocardiogram is a special type of ultrasound movie of the heart that produces much clearer pictures than a standard echo-cardiogram that’s performed on your chest. Your cardiologist may recommend a TEE when the standard echocardiogram isn’t clear enough to make the suspected diagnosis or if you are having heart surgery so the surgeon and anesthesia team have more information to guide treatment after surgery. The TEE also helps the surgical team determine whether the procedure has been successful or if additional repair is needed prior to leaving the operating room.
Holter monitor is a way to record every beat of your heart for 24 hours. Your cardiologist may recommend a Holter monitor to make sure that you aren’t having any dangerous heart rhythms that might need more treatment. A Holter monitor is a small recorder that is attached to your body by stickers similar to those used to make an electrocardiogram (ECG). You will keep a diary of events during the 24-hour period that you wear the monitor. This record will help the doctors know when you are active, sleeping or having any symptoms that might be caused by a heart rhythm problem. Accordingly, a technician will process the information from the recorder for your cardiologist to review.
Calcium Score Test:
Heart KYC (Know your Calcium) score is a test that measures the amount of coronary artery calcium (CAC). Coronary artery calcium is the calcium (Ca) that is deposited within the abnormal plaques caused by damage to the lining of the arteries. In simple words it means heart blockage test calcium score.
The coronary artery calcium score plays an important role in diagnosing cardiovascular disease. This test is also known as coronary calcium scan, calcium scan test and Cardiac CT for calcium scoring. This test is performed by taking a special computed tomography (CT) scan of the heart. In general, the scan shows the amount of hardening of the artery wall. With this scan it is possible to estimate the risk of a heart attack in the next 5–10 years. To sum up, high calcium score indicates high risk of a heart attack.
Ca score test is the single best risk predictor for coronary artery disease currently if compared to other tests like blood cholesterol levels, ECG, echo and stress tests. Given that, higher the Ca score, the more is the chance of a cardiac problem in the next 5-10 years. Depending on the amount of Ca score, measures have to be taken to reduce risk and to stabilize the plaques in the coronary arteries with a combination of sensible eating, exercise and medications.
Your doctor will use the calcium score to decide whether you are at low, normal or high risk and guide you to reduce your risk. Accordingly, he would advise for changes in diet, exercise, controlling blood pressure and diabetes, stopping smoking and reducing cholesterol in the blood.
Your blood offers many clues about your heart health. For example, high levels of “bad” cholesterol in your blood can be a sign that you’re at increased risk of having a heart attack. Similarly, other substances in your blood can help your doctor determine if you have heart failure or are at risk of developing plaque deposits in your arteries (atherosclerosis).
It’s important to remember that one blood test alone doesn’t determine your risk of heart disease. In general, there are many different types of blood test to diagnose certain heart related symptoms. The common ones are:-
- Full Blood count (FBC) – This test measures the levels of red blood cells, white blood cells and platelets. It also measures the haemoglobin.
Lipid profile – Cholesterol level, HDL, LDL & triglycerides- A lipid profile measures levels of lipids which are fats and fatty substances, in the bloodstream.
Urea and Electrolytes (Us and Es) – urea levels help to monitor how the kidneys are working. Electrolytes help to stabilize the heart rhythm.
Glucose – this test measures the level of sugar in the blood.
Liver and thyroid function – These tests measure liver function and the thyroid function.
Troponin blood test – Troponin is a protein which is released into the blood stream when the heart muscle is damaged. In general, the troponin level provides a quick and accurate measure of any heart muscle damage. It’s used to help in the assessment following suspected heart attack. It may be taken on admission to hospital and/or 12 hours from the onset of symptoms.
Natriuretic peptides – an indicator of heart failure.
CRP – C Reactive protein – CRP is a marker for inflammation and atherosclerosis has an inflammatory component. Patients with elevated levels of CRP have an increased risk for heart attack, stroke, sudden death, and vascular disease.