4 Tests to Screen For Heart Blockages

Disclaimer: Not Medical Advice. Opinions are my own.

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One of the most asked questions is, "Doc, how can I check to see if I have any blockages in my arteries?"

In today's newsletter, we will discuss four screening tests you need to know to determine your risk for heart disease.

Remember that these are all screening tests, so their accuracy is limited, but they're a great place to start.

I highly recommend you look into these tests if:

1. You have a family history of heart disease

2. You are a smoker

3. You have diabetes

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Non-Invasive Screening Tests

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Echocardiogram

This test uses ultrasound waves to create detailed images of the heart. It helps to assess the heart’s structure and function. It can identify issues such as heart valve problems, heart defects, and areas of the heart muscle that aren’t contracting well due to poor blood flow or previous injury.

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Procedure:

• Preparation: Generally, no special preparation is needed. You might be asked to remove clothing from the waist and wear a hospital gown.

• Positioning: You lie on an examination table, often on your left side, to allow better access to your heart.

• Application of Gel: A technician applies a special gel to your chest to help the ultrasound transducer make secure contact and produce clear images.

• Transducer Use: The technician moves a transducer device over your chest. The transducer emits high-frequency sound waves that bounce off the structures of your heart and are translated into images on a monitor.

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Interpretation:

• Heart Chambers: Assesses the size and function of the chambers, detecting issues like enlargement or reduced pumping ability.

• Heart Valves: Evaluate the structure and function of the valves, identifying conditions like stenosis (narrowing) or regurgitation (leakage).

• Heart Muscle: Detects areas of poor blood flow or damage from previous heart attacks.

• Ejection Fraction (EF): This measures how much blood the left ventricle pumps out with each contraction. A normal EF ranges from 55% to 70%. Lower values can indicate heart failure or other heart problems.

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Cardiac Stress Test

This test measures how well your heart functions under physical stress. It helps to detect problems with blood flow within the heart, assess the severity of coronary artery disease, and determine the effectiveness of cardiac treatments.

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Procedure:

• Preparation: Wear comfortable clothing and shoes suitable for exercise. You may be asked to avoid eating, drinking, or smoking for a few hours before the test.

• Monitoring: Electrodes are attached to your chest, arms, and legs to monitor your heart’s electrical activity. A blood pressure cuff is placed on your arm to monitor your blood pressure.

• Baseline Measurements: Before beginning the exercise, resting heart rate, blood pressure, and EKG are recorded.

• Exercise: You start exercising on a treadmill or stationary bike. The exercise intensity gradually increases as you increase the treadmill’s speed and incline or the bike's resistance.

• Monitoring During Exercise: Your heart rate, blood pressure, and EKG are continuously monitored. You will be asked to report any symptoms, such as chest pain, dizziness, or shortness of breath.

• Post-Exercise Monitoring: After reaching the target heart rate or experiencing symptoms, you will gradually stop exercising, and your heart rate, blood pressure, and EKG will be monitored as you cool down.

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Interpretation:

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• Heart Rate and Rhythm: This test assesses whether the heart rate increases appropriately and identifies irregular heartbeats (arrhythmias).

• Blood Pressure Response: Evaluate how the blood pressure changes with exercise.

• EKG Changes: Looks for specific changes in the EKG that indicate reduced blood flow to parts of the heart muscle, suggesting coronary artery disease.

• Symptoms: Any reported symptoms, such as chest pain or dizziness, during the test are noted and correlated with the EKG and blood pressure changes.

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Calcium CT Score

This specialized CT scan measures the amount of calcium in the walls of the coronary arteries. Calcium deposits can indicate the presence of atherosclerosis, which can lead to blocked arteries. The test is non-invasive and helps to predict the risk of coronary artery disease (CAD).

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Procedure:

- You lie on a table that slides into a CT scanner.

- Electrodes are attached to your chest to record your heart activity during the scan.

- The scanner takes detailed images of your heart, which are then analyzed for calcium deposits.

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Interpretation:

- A higher calcium score indicates a higher likelihood of significant coronary artery disease and an increased risk of heart attack.

- A score of 0 means no calcium is detected, indicating a low risk of coronary artery disease.

- Scores of 1-100 suggest mild atherosclerosis.

- Scores above 100 indicate moderate to high risk of significant atherosclerosis and potential blockages.

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Invasive Screening Test

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Cardiac Catheterization and Angiogram

This diagnostic procedure visualizes the coronary arteries and heart chambers and assesses heart function. It helps identify blockages, measure pressures within the heart, and evaluate the functioning of the heart valves.
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Procedure:

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• Preparation: You may need to fast for several hours before the test. An intravenous (IV) line is inserted into your arm to administer medications.

• Local Anesthesia: The area where the catheter will be inserted (usually the groin or wrist) is numbed with a local anesthetic.

• Catheter Insertion: A thin, flexible tube called a catheter is inserted into an artery and threaded through the blood vessels to the heart using X-ray guidance.

• Contrast Dye Injection: The catheter injects a special dye (contrast medium) into the coronary arteries, making them visible on X-ray images.

• X-ray Imaging: X-ray images (angiograms) are taken to visualize the blood flow through the coronary arteries and identify any blockages or abnormalities.

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Types of Catheterization:
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• Coronary Angiography: Focuses on the coronary arteries to identify blockages or narrowing that can cause chest pain or heart attacks.

• Left Heart Catheterization: Measures pressures in the left side of the heart and evaluates the function of the left ventricle and aortic valve.

• Right Heart Catheterization: Measures pressures in the right side of the heart and evaluates the function of the right ventricle, pulmonary arteries, and tricuspid valve.

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Interpretation:

• Blockages and Narrowing: Identifies the location and severity of any blockages or narrowing in the coronary arteries.

• Heart Chamber and Valve Function: Assesses the functioning of the heart chambers and valves, measuring pressure and flow.

• Ejection Fraction (EF): Determines the ejection fraction, which is the percentage of blood the left ventricle pumps out with each contraction.

• Anatomical Abnormalities: Detects congenital heart defects or other structural abnormalities.

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Post-Procedure:

• Recovery: You may need to lie flat for several hours after the procedure to prevent bleeding from the catheter insertion site.

• Observation: You will be monitored for complications, such as bleeding, infection, or allergic reactions to the contrast dye.

• Results Discussion: Your doctor will discuss the findings and potential treatment options, such as medication, lifestyle changes, or procedures like angioplasty or surgery.

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All the best,

Jeremy London, MD