Ask Dr. Pat · Health

Testing for a Healthy Heart

Patricia Yarberry Allen, M.D. is a Gynecologist, Director of the New York Menopause Center, Clinical Assistant Professor of Obstetrics and Gynecology at Weill Cornell Medical College, and Assistant Attending Obstetrician and Gynecologist at New York-Presbyterian Hospital. She is a board certified fellow of the American College of Obstetrics and Gynecology. Dr. Allen is also a member of the Faculty Advisory Board and the Women’s Health Director of The Weill Cornell Community Clinic (WCCC). Dr. Allen was the recipient of the 2014 American Medical Women’s Association Presidential Award.

Dear Dr. Pat

I am 52 years old with a family history of early heart disease.  My father died at the age of 50 of a heart attack while he was jogging.  He didn’t smoke and was careful about his diet.  His father and three brothers also had early heart attacks, but they paid no attention to their diets.  I have always feared that I too would die early from heart disease. My primary care doctor tells me that since I am a thin woman and I exercise that I am not at the same risk for heart disease as the men in my father’s family.  By the way, my father had no sisters, only the three brothers who had early heart attacks.  My cholesterol is elevated but the doctor says that the ratio is normal enough and I don’t need a drug to lower it.  I asked for a referral to a cardiologist and he told me that it wasn’t medically necessary. I need more information about the tests that are available to let me know my risk.  As it is, every time I have heartburn, I think it is a pending heart attack.  Recently, I’ve noticed I have shortness of breath when hiking up inclines. This is new for me.



Dear Wanda,

Of course you are worried. February is National Heart Health Month.  We stress during this month that the number one cause of death for women is heart disease.  Dr. Kirsten O. Healy, a member of our Medical Advisory Board discusses the complete list of diagnostic tests that are available to determine if a patient needs medication or further testing.  You are to be congratulated for treating your family history seriously and for taking good care of your heart health.

Dr. Pat


Dr. Kirsten O. Healy Responds:

Cardiology is an exciting field with an increasing number of diagnostic tests available to further the understanding of heart disease and help stratify patients thought to be at risk for either symptomatic coronary artery disease (CAD) or an underlying arrhythmia. Cardiac testing for underlying CAD encompasses diagnostic coronary angiography (invasive) or a variety of non-invasive tests.

Non-invasive tests include the following:

  • Electrocardiogram (ECG or EKG) is a simple and fast procedure that is used to evaluate the electrical activity of the heart, which is measured in “waves.” Variations in the waves can be diagnostic of a problem with the heart. This is an excellent screening test and should be done at every cardiology visit.
  • Echocardiogram (echo or ultrasound) is a non-invasive test that uses sound waves to evaluate the heart chambers, valves and the strength of the heart muscle. This test is painless and non-invasive and is performed when a transducer is placed on the patient’s chest and emits high frequency sound waves. When the sound waves bounce back to the transducer they are interpreted by a computer and the results are shown on the monitor. The echocardiogram is most commonly performed to evaluate damage to the heart muscle or screen for valvular heart disease.
  • Exercise stress testing (treadmill or exercise ECG) is used to evaluate how the heart functions during physical exertion. It can reveal problems with the heart that can go undetected as exercise makes the heart pump harder and faster than it normally would. During the stress test you will exercise on a treadmill and the blood pressure, heart rate, heart rhythm and ECG tracing will be monitored. At three-minute intervals, the speed and incline will increase. Depending on the patient’s age and fitness level, the test can take from a couple of minutes up to fifteen to twenty minutes. The test is stopped when the patient’s heart is beating at a targeted rate, or when fatigue, chest pain and blood pressure changes necessitate cessation. A basic stress test is most often used as a screening tool to detect underlying coronary artery disease or to determine safe levels of exercise after a heart attack or heart surgery.
  • Stress Echocardiogram is an exercise stress test with an echocardiogram performed before exercise and after exercise. The addition of the echocardiogram to the stress test increases the sensitivity and specificity of the test. It images the heart muscle both at rest and after the maximum heart rate is achieved. With stress the heart muscle should pump harder and more vigorously. If part or all of the muscle does not augment during exercise, it suggests that there may be significant underlying coronary artery disease.
  • Nuclear Stress Test (Nuclear perfusion imaging) is a diagnostic test performed to determine if the heart is receiving adequate blood supply under both stress and rest conditions. The test is done with an injection of a small amount of radioactive material (thallium or sestamibi) into the bloodstream, which will circulate throughout the body and help to evaluate the blood flow or lack of to the heart. The injection is given both at rest and with exercise. Images are taken under a camera prior to exercise and after exercise. The sets of images are interpreted by the cardiologist to look for underlying perfusion deficits that are diagnostic for coronary artery disease. This type of stress test should be used if there is a high suspicion of coronary artery disease or if a patient has known coronary artery disease and needs evaluation for ongoing ischemia. The Nuclear stress test is rarely used in asymptomatic patients who need stress testing for screening underlying coronary artery disease. It is also helpful if the patient is unable to exercise as special medicines are administered in order to stress the heart in the same way that exercise does. These medicines are extremely short acting and have limited side effects, but should be reviewed with your cardiologist prior to being administered.

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  • Sue Scott February 26, 2018 at 2:48 pm

    Thank you for this information. My current doctor is pushing me to take cholesterol meds when in the past the doctors have said my HDL is high enough that I am not in the danger zone. Recently my cholesterol levels have decreased. I understand there is a new test for cholesterol that is more accurate. Was it mentioned here? If not, would you share more information about it? Thank you,