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Tests

Learn more about medical tests: how they work, what the results mean, and how heart conditions are diagnosed.

  • I am 35 and female. I am having episodes of tachycardia, up to 170 beats per minute at rest, and premature ventricular contractions (PVCs) for 3 months. I had a 24-hour Holter monitor that confirmed this. Electrocardiogram (EKG) showed ST segment depression, which I understand can be false with females. Nuclear stress test showed good perfusion and ejection fraction (EF) of 67%. I will now be going for an echocardiogram. My question is: What will an echo show that the other tests haven't shown?
  • In a patient with tachycardia, it is important to assess the left ventricular (LV) function and to rule out structural heart disease. Also the right ventricular (RV) function needs to be assessed. In addition, assessment of the heart valves is essential and can be done by echocardiogram.

    Best regards,

    Mouaz H. Al-Mallah, MD, FACC

  • I am 76 years of age. My echocardiography report shows that I have mild diastolic dysfunction. My EF is 69%. How dangerous is it? What are the risks involved?

  • The finding of mild diastolic dysfunction on an echocardiogram is not concerning. Echocardiograms, or ultrasounds of the heart, assess the left ventricular function, valvular function, and some intracardiac pressures. An ejection fraction of 69% is normal (normal is anything above 50-55%), meaning that your heart is pumping strongly. Mild diastolic dysfunction means that the heart muscle is slower to relax as it fills with blood before pumping it to the body. It is actually a common finding with age, and is considered a normal finding in patients over age 65 as there is mild increase in the stiffness of the heart muscle with age. However, this does mean that the stiffness will increase with time or cause symptoms. There is no danger or risk involved in mild diastolic dysfunction on your echocardiogram. This finding does not merit further testing or any changes to your medications. 

    Best regards,

    Michelle M. Kittleson, MD, PhD
    Director, Heart Failure Research
    Director, Post-Graduate Education in Heart Failure and Transplantation
    Cedars-Sinai Heart Institute

  • If a patient has had two negative cardiac enzyme tests and a negative electrocardiogram (EKG), what are the chances that a second EKG would be positive?

  • I assume this question addresses patients with chest pain in the emergency room. If such a patient had two negative cardiac enzyme tests and a negative EKG, the chances that a second EKG would be positive depend on many things. This is related to the patient's pre-test probability of having acute coronary syndrome or heart disease as well as how typical are his or her symptoms. Although the second EKG is unlikely to be positive if the patient has negative enzymes, a negative first EKG and no recurrence of symptoms, the chances of it being abnormal is not 0%. If the first EKG was done when the patient had no symptoms and he/she experienced recurrence of symptoms in the emergency room and an EKG is done while he or she is having chest pain, then the EKG is likely to be positive.

    Regards,

    Mouaz H. Al-Mallah, MD, MSc, FACC, FAHA, FESC

  • I am the first in my family to have had a heart attack. Since my heart attack, I have tried to learn what I could have done to have prevented it. I took the stairs, ate salads, slept, worked. When I went down there was one short warning, and that was it. This article suggests that if the patient has a family history of heart attack then an echocardiogram could be considered, but how is a person supposed to know when veins are becoming blocked? I think a test should be given, like taking your weight or height, to see how blocked a person’s veins are.
  • It’s quite common and understandable after a heart attack to wonder whether a test could have prevented it by identifying blockages in the blood vessels of the heart. However, there isn’t any test that can reliably do this just yet, for several reasons.

    The majority of heart attacks, especially in previously healthy individuals without symptoms, occur at locations where the blockage (caused by cholesterol plaques) is only mild. Unfortunately, many of the tests we have are good at identifying severe build-up of the plaques, but do not pick up mild blockages that don’t limit blood flow. The article you are referring to discusses the role of echocardiograms (an ultrasound of the heart). This test generally does not provide any information on whether there are blockages or not. One day medical science may advance to the point that we have tests to accurately predict which plaques are the most likely to lead to heart attacks. In the meantime, however, we also have to be careful about inappropriate testing, and avoid situations where the test performed doesn’t give a lot of information and can even lead to harm.

    I also want to make a final point: Although we can’t predict heart attacks perfectly, we do know that a healthy lifestyle is beneficial for reducing the risk of heart attacks as well as preventing its complications. So the things you have done, such as exercising regularly and eating healthy, are all very important and helped you get better, and I definitely encourage you to keep them up!

    Best regards,

    Siqin Ye, MD, MS

  • What is an echocardiogram?
  • An echocardiogram (also called an echo) is a type of ultrasound test that uses high-pitched sound waves that are sent through a device called a transducer. The device picks up echoes of the sound waves as they bounce off the different parts of your heart. These echoes are turned into moving pictures of your heart that can be seen on a video screen and help the doctor learn more about your heart.
  • What is a nuclear stress test?
  • Nuclear stress tests utilize imaging of the heart during physical activity and at rest to see how the heart performs in different states. Results from this imaging can help diagnose heart disease, evaluate the severity of heart conditions, and help guide treatment plans. Although nuclear stress tests are generally safe, patients undergoing these tests are exposed to radiation, which can slightly increase cancer risk.
  • What do results of a nuclear stress test show?
  • Nuclear stress tests help diagnose heart disease and provide important information that can help guide treatment plans for patients. Since imaging is taken during exercise and at rest, the test will show whether a patient has normal blood flow during exercise, at rest, or both. It can also show if there is scar tissue in the heart, like from a heart attack.
  • How is PAD diagnosed?
  • Doctors often diagnose PAD by using the ankle-brachial index (ABI) to assess blood flow to the legs. The ABI is a simple test that can be done in your doctor’s office. During the test, you lie flat while your doctor measures the blood pressure in both arms using a standard blood pressure cuff and a small hand-held Doppler ultrasound probe. The ultrasound probe detects the first sound of blood flow as the cuff is deflated; that’s the upper number in your blood pressure. Your doctor then measures the blood pressure in both ankles by placing an inflatable blood pressure cuff between the ankle and calf and again using the Doppler ultrasound probe to listen for blood flow.

    The next step is to calculate the ratio of the highest ankle pressure to the highest arm pressure on the same side of the body. This is the ankle-brachial index. If the blood pressure in the ankle is a lot lower than in the arm, it is a sign that a blockage is interfering with blood flow to the lower leg.

  • What if I have tried to learn more about my health but still have trouble understanding?
  • Patients who have trouble understanding their health conditions should ask for help from their health care team, whether it's a doctor, nurse or counselor. Health care providers can help point patients to a variety of resources that can cater to individual needs.
  • What is a biomarker?

  • Biomarkers found in the blood or tissue may be used to indicate a normal or abnormal process, a condition or disease, or how the body is reacting to treatment.
  • What is a high-sensitivity C-reactive protein (hsCRP)?
  • C-reactive protein is a type of protein that the liver makes in response to inflammation in the body. Because inflammation is linked with heart disease, doctors often use a simple blood test called a high-sensitivity C-reactive protein test to better assess an individual’s heart health.
  • What is percutaneous coronary intervention (PCI)?

  • Percutaneous coronary intervention (often referred to as balloon angioplasty or simply angioplasty) is often recommended for patients diagnosed with diseased arteries of the heart (coronary arteries) or for patients suffering a heart attack. Percutaneous coronary intervention includes a variety of procedures developed to compress fat and cholesterol build-up in the arteries, known as plaque deposits, to help increase the size of narrowed or blocked arteries and improve blood and oxygen flow to the heart.
  • What factors impact lipoprotein-a levels?

  • Research has shown that lipoprotein-a is genetic, and some are predisposed to have very high levels while others have very little. Although no medications have been proven to lower lipoprotein-a, lifestyle changes and medications, such as statins, can still help lower cardiovascular risk in high risk patients.
  • Who should use ambulatory blood pressure monitoring?

  • Currently, most patients using ambulatory blood pressure monitoring are those susceptible to the “white coat effect,” resistant hypertension that does not respond well to traditional therapy, and those with episodic hypertension. However, use of ambulatory monitoring may become more widespread if found useful in proper blood pressure control.
  • Why does door-to-balloon time vary among patients?

  • Door-to-balloon time can vary for many reasons, such as availability of operating rooms and/or staff. Based on the size of a hospital, number of staff and influx of patients, the promptness of care can differ as a result of the hospital’s ability to meet the demand of patients.
  • Why is the radiation dose higher in complex procedures and in people with artery disease?

  • It’s really a matter of the time the x-ray machine is used for creating pictures inside the arteries. Challenging procedures take longer to perform, which increases the total amount of x-rays passing through the body, and the total radiation dose. It’s the same situation with artery disease. If a person has had coronary bypass surgery in the past, angioplasty is more complicated and time-consuming. If the leg arteries are full of cholesterol deposits, it takes more time to thread a tube from a groin artery and into the heart. Both significantly increase the radiation dose.
  • Why is the radiation dose higher in people who are obese?

  • A stronger x-ray beam is needed to penetrate through a large body while still creating high-quality pictures of the coronary arteries. In addition the angles that are used for directing the x-ray beam into the body may be different in obese people. This can cause the x-rays to travel a longer path inside the body. Both of these factors increase the radiation dose.
  • Why should blood pressure be measured on at least three separate occasions to diagnose hypertension in older individuals?
  • There are many factors that can impact blood pressure measurements in older individuals. For example, white-coat hypertension is common among older individuals, where blood pressure temporarily increases in patients due to the stress of being seen by a healthcare provider. At least one type of home blood pressure monitoring is recommended to rule out this phenomenon. Other factors that can affect blood pressure in older individuals include taking measurements while patient is standing vs. sitting, as well as the time allowed for the patient to rest before taking blood pressure.
  • Will policy changes come about soon in the healthcare industry to improve patient-provider communication?
  • The idea of shifting healthcare policies from “fee-for-service” to “pay-for-performance” has been in the works for years. This means that healthcare organizations would provide incentives for physicians to spend more time with patients, providing higher quality care to the individual, rather than just seeing the highest number of patients possible. The implementation of these changes will take time, but as more and more patients, providers, and leaders recognize the importance of communication and high-quality care for patients, the likelihood of policy changes increases as well.
  • Why is communication not an important skill taught to physicians?

  • With so much for students to learn during medical school, patient-provider communication is addressed, but can be overshadowed by the wealth of information that students must learn throughout their education. Later, when students move onto residency programs, few programs have structured programming in communication, and supervisors do not have the time to observe residents’ patient interactions for evaluation and feedback. During this cycle, patient-provider communication often takes a backseat to the many other responsibilities that physicians hold.
  • Why is FDG-PET good at finding inflammation?

  • The “G” in FDG stands for glucose, which is a type of sugar. Inflamed tissues burn through a lot of energy. They take up the glucose to use as fuel. Normal tissues don’t burn through as much energy, so they take up less glucose.

    When doctors are looking for inflamed or cancerous tissue, they use FDG that has been labeled with a small amount of radioactivity. The FDG is injected into a vein and is taken up by inflamed tissues as it circulates through the body. The PET camera can see how much glucose the inflamed tissue is using by measuring the radioactive particles the FDG releases.

  • What is the difference between unstable angina, ST Segment Elevation Myocardial Infarction (STEMI) and Non-ST Segment Elevation Myocardial Infarction (NSTEMI)?
  • STEMI and NSTEMI are two classifications for a heart attack. Although both result from the interruption of blood supply to a part of the heart, STEMI results in ST-elevation (elevation of a cardiac enzyme) while NSTEMI does not. Unstable angina, on the other hand, is a condition characterized by chest pain or discomfort that is unexpected and usually occurs at rest. Unstable angina is often accompanied by shortness of breath, indigestion and/or dizziness. Unlike STEMI and NSTEMI, which cause muscle damage in the heart, unstable angina is not associated with muscle damage. However, unstable angina is very dangerous, may progress to a heart attack, and needs emergency treatment.

    Unstable angina and NSTEMI often appear identical at first presentation. The difference can be ascertained only after an ECG and blood tests to look for markers that indicate heart muscle damage.

    Call 9-1-1 immediately if you have the following symptoms:

    • Chest pain, pressure, tightness, or heaviness.  This discomfort may radiate to the neck, jaw, shoulders, back, or one or both arms.
    • Weakness, dizziness, lightheadedness, loss of consciousness.
    • Indigestion or “heartburn”; nausea and/or vomiting associated with chest discomfort
    • Shortness of breath that does not go away
  • What should I do if I have red, inflamed gums?

  • Even if you’re not worried about heart disease—but especially if you are—you should see your dentist or periodontal specialist. It’s important to follow their recommendations for treating your gum disease. Good care of your teeth and gums requires some effort every day, but it will keep you healthier. Remember, it’s not just your smile that’s at stake—it could be your heart.
  • What types of medical tests emit radiation?

  • There are a number of medical tests that emit radiation, including X-rays, CT scans and cardiac imaging. However, each test can emit different doses of radiation.
  • How can doctors assess the hostility of a patient?

  • Doctors often use an Expanded Structural Interview (ESI) to assess whether a patient is considered “hostile” or not. The ESI is a 12-minute interview designed to assess how individuals respond to stressful situations. During the ESI, the interviewer rates the degree to which the participant expresses hostility, either through hostile statements, vocal hostility or a combination of both.

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