Ask Dr. Pat · Health

Testing for a Healthy Heart

  • Cardiac Computed Tomography (Cardiac CT) is a painless, non-invasive test that allows high resolution, three-dimensional visualization of the coronary arteries of the heart. The two main types of Cardiac CT are coronary artery calcium scoring and Cardiac CT angiography (Cardiac CTA). In calcium scoring, pictures of the heart are taken to look for the presence of calcium deposits in the coronary arteries. This calcium is a very specific sign of coronary artery disease and people who have significantly elevated amounts of calcium are at increased risks to have a heart attack or heart complication. In patients who have a strong family history of premature heart disease or in patients with intermediate risk of heart disease, calcium scoring can help better assess their risk of heart disease and can dictate medical therapy, most importantly statin therapy. In coronary angiography, contrast is circulated through the heart and the CT scanner takes high resolution images of the heart and heart arteries. Cardiac CTA is very useful in the evaluation of patients with atypical chest pain to exclude blockages in the coronary arteries. This test is very helpful in patients with equivocal stress tests. Patients who appear to be at high risk for having blockages in the arteries will most likely undergo the invasive cardiac catheterization (see below). However, for patients who are at low to intermediate risk of significant blockages, CTA has the advantage of being faster, less invasive and lower risk than cardiac catheterization. Also, very importantly, Cardiac CTA has the ability to detect the earliest signs of coronary artery disease that cannot be revealed on routine stress tests.
  • Carotid Ultrasound tests for plaque in the carotid arteries, which increases the risk of stroke. It is a safe and simple test to perform and early diagnosis and treatment of this plaque can decrease stroke risk. Also, when there is plaque seen in the carotid arteries it is suggestive of plaque in other arteries and more aggressive treatment of cardiovascular risk factors can be instituted.
  • Arrhythmia Monitoring: Heart arrhythmias occur when the electrical impulses that coordinate the heartbeats are not functioning properly, resulting in the heart beating irregularly, too quickly or too slowly. To diagnose a heart arrhythmia multiple cardiac tests can be performed to monitor arrhythmias. These tests include:
    • Holter Monitor: a small device that keeps track of the heart’s rhythm for 24 hours while daily activities are performed.
    • Event Monitor: a portable device that you attach to your body as you experience symptoms.
    • Zio patch: a small wearable patch that continuously records your heart rhythm for up to 14 days.

 

Often times non-invasive testing to diagnose coronary artery disease may be skipped if the suspicion for underlying coronary artery disease is high and a more invasive cardiac catheterization, which is the “gold standard” of tests, will be performed immediately. During a cardiac catheterization, a long thin catheter is inserted into an artery in the groin and is threaded through the blood vessels to the heart. Once the catheter is in the arteries of the heart, contrast is injected to locate narrowing or blockages in the blood vessels of the heart. If a significant blockage is found, a balloon can be inserted at the site of the blockage to help widen the narrowed artery. This is typically combined with implantation of a small metal coil called a stent in the clogged artery to help prop it open and decrease the chance of narrowing again. In the appropriate clinical setting, this procedure is very important and helpful but because it is an invasive procedure there are some risks. It is important to carefully weigh the risks and benefits of this test with your cardiologist.

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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,

    Reply