Heart tests are the bread and butter of a cardiologist’s job. Although a detailed patient history and clinical examination are essential to try and reach a diagnosis various heart tests are important in trying to confirm the suspected heart condition.
Heart tests are the bread and butter of a cardiologist’s job. Although a detailed patient history and clinical examination are essential to try and reach a diagnosis various heart tests are important in trying to confirm the suspected heart condition.
The most basic of tests that are an essential part of the consultation with a cardiologist is the 12 lead ECG. This is also known as a ‘heart tracing’ or ‘EKG’. The proper name for this is the electrocardiogram. It is a measure of the electrical activity of the heart in real time (i.e. it will tell you about the electrical activity at that particular moment). An ECG is performed by attaching 12 sticky electrodes to the patient’s arms, legs and left chest. The signal from the electrodes is then recorded on a machine and a printout of the ECG made at that time. Some ECG machines provide an interpretation of the ECG (known as a report) but these are often inaccurate. The cardiologist will be able to interpret the ECG and let the patient know about the findings and what they mean. A normal ECG won’t necessarily mean the heart is normal whilst an abnormal ECG might provide some clues as to whether further heart tests are required.
Heart Scans
An echocardiogram, also known as a ‘heart scan’ or ‘heart ultrasound’ is also a very important test in trying to reach a diagnosis. The heart scan allows us to view the heart directly and to observe how well it is working. It tells us how strongly the heart is squeezing blood around the body as well as whether the valves within the heart are working properly. A normal heart scan can give a strong indicator that the patient’s outlook (called prognosis) is good. It may not necessarily be enough to reach a diagnosis but it can provide a great deal of reassurance that the patient’s heart is in good working order. The heart scan or echocardiogram may also be important is diagnosing a number of different heart conditions such as heart failure or narrowed or leaking heart valves. If a patient is complaining of breathlessness an echocardiogram is vital
Portable ECG monitoring (called ambulatory ECG monitoring) is a good heart test to diagnose the cause of palpitations. Palpitations (also known as abnormal heart beat, funny or strange heart beat) are troublesome symptoms that may indicate the patient is suffering from a heart rhythm problem. Depending on how frequently a patient’s palpitations occur ECG monitoring can be done from anywhere between 24-hours to 7 days. The ECG monitor is a small device with wires that can monitor a patient’s ECG. If the patient gets symptoms then they can press a button on the monitor to indicate they have had symptoms and the ECG can then be downloaded to try and match the ECG findings with any symptoms they may have.
If the palpitations are less frequent then a heart test known as a ‘cardiomemo’ can be used. This is a small device that does not have any wires but the patient can carry around for up to 2 weeks. If they have symptoms they can press the device to their chest and record their heart tracing. The important part of portable ECG monitoring is to try and match the patient’s symptoms to the ECG at the time they are experiencing these symptoms.
Exercise ECG testing (also called a treadmill test or exercise stress test) is another important but less frequently utilized heart test. This test involves a patient walking on a treadmill that gradually increases in speed and the slope to make the patient’s heart work harder in stages. All the time the patient’s ECG (heart trace) and blood pressure are monitored to assess for any abnormalities. The exercise ECG used to be an important test to help diagnose coronary artery disease (narrowing of the heart arteries). While it is less commonly used for that purpose it is a useful heart test for a number of other reasons. It is useful to assess a person’s heart rate response to exercise, to see if there are any heart rhythm problems that become apparent upon exercising and whether the patient has any valve conditions that might require attention. It is also a useful test if a patient is already known to have narrowing of the heart arteries to determine if these narrowings are causing a strain on the heart. Finally, exercise ECG testing is used by some insurance companies to assess a person who may be applying for a life insurance policy.
Other more complicated heart tests are coronary angiography, CT coronary angiography and electrophysiology testing. These are more invasive tests and often require more sophisticated equipment. However, the basic heart tests such as an ECG, heart scan (echocardiogram), ECG monitoring and exercise stress testing will often be sufficient to reach a diagnosis in most patients. If these tests are normal they will indicate the person has a good prognosis with respect to their heart.
