Diagnosis of Heart Disease

Diagnosis of heart disease is based on a series of tests; however, the doctor first assesses how well your heart is functioning by standard and simple procedures, such as listening to your heart, taking your heart rate and your blood pressure.

Heart rate, rhythm and regularity are assessed by checking pulse. The heart rate is the amount of times the heart beats in one minute. The heart sounds, made by the closing and opening of the valves, are listened with a stethoscope, and thus, the heart’s rate and rhythm can be evaluated. Blood pressure, the pressure exerted in the arteries by the blood as it is pumped by the heart, is recorded as two measurements: the systolic

blood pressure - the pressure in the arteries during the period of the heart's contraction (the upper number), and the diastolic blood pressure - pressure in the arteries when the heart is relaxed, between heartbeats (the lower number). The normal blood pressure for a healthy adult during relaxation is less than or equal to 120 over 80. Blood pressure may increase with age, heart condition, emotions, activity and medications. A physical examination may also give the doctor clues about how well a heart functions.

The heart’s functioning can also be assessed with the help of blood tests. These usually checks cholesterol and other markers that may indicate heart disease. The C - reactive protein (CRP) testing, for instance, indicates the state of inflammation of the arteries as a result of atherosclerosis. The C-reactive protein (CRP) is produced in the body during a general process of inflammation, thus, its presence indicates an increased state of inflammation in the body. A reading of less than 1.0 mg/L means a low risk of cardiovascular disease, one of 1.0-2.9 mg/L indicates an intermediate risk, and if your level of CRP is higher than 3.0 mg/L, it indicates a high risk of heart disease.

Electrocardiograms and specialized EKGs) are tests that record the electrical activity of the heart through 10 small electrode patches attached to the skin on the chest, arms and legs. They are used to assess your heart rhythm, diagnose poor blood flow to the heart muscle (ischemia), a heart attack, or certain abnormalities of your heart, such as an enlarged heart

Chest X-Rays (chest films) use a very small amount of radiation to produce an image of the heart, lungs and chest bones on film. They are used to look at the structures of the chest, to evaluate placement of devices (pacemakers, defibrillators), or to diagnose lung and cardiac diseases. Pregnant women should tell the technician about the pregnancy.

Stress Tests are used to determine the amount of stress heart can manage before developing either an abnormal rhythm or evidence of ischemia (not enough blood flow to the heart muscle). The exercise stress test, (exercise electrocardiogram, stress ECG) is the most common stress and it is used to see how the heart responds to exertion. It usually involves walking on a treadmill or pedaling a stationary bike at increasing levels of difficulty, while your electrocardiogram, heart rate and blood pressure are monitored.

The Head-Up Tilt Table Test is a way to find out the cause of fainting spells. It involves lying quietly on a bed, being tilted at different angles (30 to 60˚), while blood pressure, electrical impulses in the heart and oxygen levels are monitored.

Echocardiograms are graphic outlines of the heart's movement. High-frequency sound waves (ultrasound), provide pictures of the heart's valves and chambers, which allows the evaluation of the pumping action of the heart. This test helps the doctor assess the overall function of your heart and/or determine the presence of many types of heart disease.

Cardiac Catheterization (coronary angiogram) is an invasive imaging procedure during which a catheter (a long, narrow tube), is inserted into a blood vessel in the arm or leg, and guided to the heart with the aid of a special X-ray machine. Contrast dye is injected through the catheter, which allows for X-ray movies of the valves, coronary arteries and heart chambers to be created.

Electrophysiology Testing records the electrical activity and the electrical pathways of the heart. It is used to determine the cause of heart rhythm disturbances and to determine which medication works best.

Electron Beam (Ultrafast) CT (EBCT, or calcium-score screening heart scan) is a test used to detect calcium deposits in the plaque of coronary arteries. Calcium in the coronary arteries is an indicator coronary atherosclerosis and thus, of a greater risk of narrowing. The risk for future coronary artery disease can be evaluated. However, there are some forms of coronary disease that escape detection during this CT scan.

Myocardial Biopsy (cardiac biopsy) is an invasive procedure that involves using a small catheter with a grasping device on the end (bioptome) to obtain a small piece of heart muscle tissue that is sent to a laboratory for analysis. It is usually used to evaluate the presence of rejection after heart transplant, to diagnose myocarditis (inflammation of the heart muscle) or certain other cardiac disorders such as cardiomyopathy.

MRI uses large magnets and radio-frequency waves to produce pictures of the body's internal structures. It creates moving images of the heart throughout its pumping cycle.

The function of the structures of the chest and the presence of some diseases can be evaluated.

Pericardiocentesis (pericardial tap) is an invasive procedure that involves using a needle and catheter to remove fluid from the pericardium. The fluid may then be sent to a laboratory for tests to look for signs of infection or cancer.
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