How is cardiovascular disease detected?
Often, heart disease is detected well before an emergency event occurs. Your primary care physician can do a preliminary assessment of your risk for heart disease. If you are at risk and/or are experiencing symptoms, further diagnostic testing may be advised.
If the diagnostic tests show that you are at high risk for cardiovascular disease, your physician may order screening and standard diagnostic tests for heart disease. These include:
Standard diagnostic testing
- Electrocardiogram (EKG): Electrodes are placed on the patient's chest, arms, and legs are monitored to determine normal or abnormal heart rate and response.
- Stress testing with EKG: The well-known treadmill exercise test that helps determine the heart's reaction to an increased demand for oxygen.
- Screening tests for heart disease and risk factors, which are various noninvasive tests or blood tests to detect cardiovascular disease.
- Blood pressure
- Coronary risk profiles/cholesterol: Measures levels of total cholesterol, HDL (good) cholesterol, LDL (bad) cholesterol and triglycerides
- HeartScoring: Detects the presence of calcium buildup (or hardening of the arteries, plaque or artherosclerosis) inside the major arteries of the heart
If the results from screenings and standard diagnostic tests are positive for risk factors for cardiovascular disease, then more advanced testing may be necessary. Such tests include:
Advanced diagnostic testing:
- Echocardiography: Uses ultrasound technology to determine normal or abnormal blood flow through heart chambers and valves. A transducer placed on the chest over the heart transmits high-frequency sound waves. The echoes of the waves are transmitted into electrical impulses that are displayed and recorded on an echocardiogram machine.
- Stress echocardiogram: Looks for evidence of previous heart muscle damage and finds any areas of the heart that have a decreased blood supply. EKG wires are attached to the patient's chest, and ultrasounds of the heart are taken before the patient exercises. The patient is then monitored while exercising on a treadmill. Immediately after the patient stops exercising, more ultrasounds are taken of the heart while it is beating rapidly.
- Stress testing with imaging: Imaging, or nuclear scanning, of the heart shows how well blood flows to the heart muscle. It's usually done in conjunction with an exercise stress test on a treadmill, but can also be performed using medicines such as adenosine, dipyridamole, and dobutamine that effectively simulate the effects of exercise on the heart. Cardiac Nuclear Stress Imaging helps determine whether coronary artery stenoses (blockages) are so severe as to limit blood flow to heart muscle when it needs it most... during physical activity.
- Holter monitoring: A continuous EKG recording of heart rhythm during normal activity, usually for 24 hours. Electrodes are placed on the chest and connected to a battery-operated recording monitor that can be placed in a pocket or a pouch around the neck. The patient usually keeps a written record of the day's activities so that any abnormalities can be linked to specific activities. Sometimes this test is done to determine how a patient is responding to cardiac medication.
- Angiogram: Done in the Cath Lab, this special X-ray test is done to find the spot where a coronary artery is clogged. It can reveal how clogged the artery is and determine if the patient needs treatment such as angioplasty or coronary artery bypass surgery, or medical therapy. The cardiologist inserts a thin tube or catheter into an artery through your arm or groin and extends it to your heart. Special fluid or "contrast" is inserted through the catheter so the arteries show up well on the X-ray. By studying the X-ray, the cardiologist can see any problems with your coronary arteries.