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How doctors test for and diagnose heart disease

Heart disease is the #1 cause of death in both men and women in the United States. According to the Centers for Disease Control and Prevention, every 36 seconds, an American dies from cardiovascular disease. But there’s good news—lifestyle modifications, like diet and exercise, can make a world of a difference in reducing your risk for heart disease and improving your overall health.

Equally as important in lowering your risk of death from heart disease: detecting it early, when it’s easier to treat. Your doctor will start by taking your personal and family medical history (especially important if heart disease runs in your family), recording current and past symptoms, and doing laboratory tests and an electrocardiogram.

Based on the results of the assessment and tests, your doctor may order further tests. Let’s talk about four of the most common diagnostic tests for heart disease.

The EKG, or electrocardiogram

EKGs are a simple, in-office test that looks at the electrical activity of the heart. Commonly seen on TV medical shows, the EKG involves attaching connectors to your chest, wrists and ankles. Those connectors are wired to a machine that prints out a scroll of paper detailing your heart’s electrical activity. While lacking in terms of specific cardiac detail, the EKG is a useful starting point for studying your heart rhythm and heart rate.

The heart monitor

Where the EKG shows us a brief snapshot of your heart’s health, a wearable heart monitor provides your care team with a much more complete picture. Utilizing wires attached to the chest which lead to a small recorder box clipped your belt, a heart monitor will be for worn 24 hours stretches, capturing data on some 100,000 beats per day.

This data will detail the pace of your heart—under what circumstances it’s faster or slower, the presence of skips or pauses, even extra heartbeats of different varieties.

Sometimes, a heart monitor is worn for up to a month at a time. This expands the timeframe to collect and analyze data, so we can actually see a heart rhythm problem as it’s occurring. If those events are frequent, they’re generally easy to find.

For electrical activity that’s more infrequent, we now have battery-powered monitors that are implanted just below the skin in the chest wall. No larger than a Q-tip, these monitors can last for years, pinpointing over time the precise origins and nature of your heart’s electrical events.

Stress testing

It may be called a stress test, but it’s nothing for you to stress about! If your doctor recommends a stress test, it will likely involve exercising on a treadmill.

By increasing blood circulation and heart stress, the treadmill is a wonderful diagnostic tool for inducing symptoms that allow us to analyze your heart health. Coupled with an EKG machine and a blood pressure cuff, a treadmill stress test will analyze how exertion impacts chest pain. Perhaps your arteries are clogged, or the blood circulation to your heart is poor—the treadmill stress test allows us to reproduce and isolate the nature of your pain.

When more data is needed, we often perform heart imaging in conjunction with the treadmill stress test. That’s performed in one of two ways: through ultrasound pictures of the heart or through nuclear imaging, in which an IV-injected radiotracer offers even more precise pictures of the heart.

If you’re not capable of walking on a treadmill, chemical stress tests can provide similar snapshots of your heart’s electrical activity.

Echocardiograms

Just as an ultrasound captures pictures of a fetus, the echocardiogram uses ultrasound technology to take pictures of the heart. By applying the probe to your chest, we can see how big the heart is, how small, how thick or thin. We can see how well the valves open and close, whether they leak or if they’re restricted in their motion.

As a cardiologist, my primary job is to keep you healthy and out of the hospital. And that’s the beauty of diagnostic testing: it steers you toward the right medications and lifestyle changes, and empowers you to make informed decisions about your health—all with the goal of keeping you out of the hospital. That’s something I strive to do every day.

You shouldn’t wait until you develop heart problems to see a cardiologist. No matter your age, seeing a preventive cardiologist is an excellent way to be proactive about your health and take the necessary steps today to avoid future heart problems.

If you’re already at high risk of heart disease or looking for ways to prevent progression of the condition, a cardiologist can help.

Take this short quiz to learn more about your risk for heart disease, or find a cardiologist near you.

About the author

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Dr. Scott Ewing, DO, is an interventional cardiologist on the medical staff at Baylor Scott & White Heart and Vascular Hospital – Fort Worth.

How doctors test for and diagnose heart disease