Most people know the term Cardiac Catheterization and might know that this assessment procedure involves injecting dye into the coronary arteries and the pumping chamber of the heart in order to visualize blockages and the performance of the heart muscle. Yet, the Cardiac Cath is only one of many tests cardiologists use to pinpoint heart problems before deciding whether to try medication or move on to a surgical procedure.
“The heart presents a complex combination of muscles, valves and an electrical system,” says McLeod Cardiologist Fred Krainin, MD. “We use a wide range of assessments and testing to find the injury or flaw that causes a patient problems.”
First used in 1903, the ECG or EKG records your heart pattern from wires attached with sticky pads to your legs, arms and chest. These tests can be performed in a physician’s office.
TREAD MILL STRESS TEST
One EKG variation, records your heart while you walk and jog on a treadmill. The cardiologist testing you can speed up and raise the incline of the treadmill to see how your heart handles the increased stress.
Using a type of ultrasound, a microphone-type (transducer) attachment sits on your chest and sends sound waves to the heart. As the waves bounce back, they create an image of the heart that can be recorded on video.
In an effort to get a closer look at the heart, a cardiologist will guide a probe down your throat (esophagus) until it sits directly behind the heart. The reflected sound waves generate more detailed images than an echocardiogram taken from outside the chest.
This test enables the cardiologist to see how well the heart is pumping, if abnormal tissue exists around the heart valves, if the heart valves are leaking or if blood clots exist in your heart.
TILT TABLE TEST
The name of this assessment pretty well describes it. After predetermined exercise, the patient is securely fastened to a testing table. The patient is connected to an ECG and a cuff to measure blood pressure. The table tilts so the head is about 30 degrees above your feet. After five minutes, the table moves to a 60-degree tilt, where you stay for about 45 minutes. If you feel dizzy or faint-headed, it means your brain is not getting sufficient blood and may indicate a problem with your heart muscle or clogged arteries.
LOOP or EVENT MONITOR
Occasionally, your cardiologist wants to see how your heart works in a normal setting outside the medical office or find out what your heart is doing when you feel ill. An event recorder – about the size of a pager can be hand-held or worn on your wrist. Sensors are placed on your chest, and the connection to the recorder is wireless. When you feel dizzy or your heart beats too slow or fast, you start the device to record your heart during this episode.
A loop monitor will record several minutes at a time, then start over. Pushing a button during or after an event saves the recording. For longer periods of monitoring, there is an implantable version. Patients wear these recorders from a week to a month.
Sensors are attached to your chest with wires running to a device on your belt or in your pocket. You’ll wear it for 24 to 48 hours. Your heart rhythm gets transmitted and recorded for later evaluation by your cardiologist.
If your symptoms don’t occur often, you may wear a Holter monitor without wires from the chest to the device for weeks until you have an episode that can be recorded.
Monitors are especially useful in identifying heart rhythms, such as arrhythmias or atrial fibrillation.
MYOCARDIAL PERFUSION SCAN
If your cardiologist wants to get a better idea of your heart’s pumping action or the blood flow through to your heart muscle, they can recommend a Myocardial Perfusion Scan (MPS). A very small amount of a radioactive tracer substance is injected. An imaging device positioned close to your chest sees the blood flow, which is highlighted by the tracer substance. You may exercise before the tracer injection. After the first phase of the test and a rest, a second test will occur.
Through the test, your cardiologist views the overall function of the heart muscle, can determine the extent of narrowing of the arteries, determine if coronary artery disease is present or assess damage following a heart attack.
CT CORONARY ANGIOGRAM (CTCA)
A relatively new way to look at coronary arteries involves injecting a tracer substance in your arteries, then taking a series of pictures. Less invasive than a cardiac catheterization, the CTCA has the ability to spot many of the same problems.
ACTION YOU CAN TAKE
Cardiologists have more and better ways to assess your heart and arteries while diagnosing the problem and determining the best treatment. The tests listed here are just that – tests. During a cardiac cath, a cardiologist can often correct problems, such as a blocked artery, as soon as the blockage is located.
You and your cardiologist need to work together to determine what is the best assessment or procedure for you, especially if your problem is acute and serious.
Sources include: McLeod Health, National Institutes of Health, Heart Rhythm Society, British Heart Foundation, Heart & Stroke Foundation, American Heart Association