Most Americans assume their heart is in pretty good shape until something happens to tell them otherwise–severe pain in the chest, inability to exercise without shortness of breath...or a heart attack.
Heart disease is the number one killer of both men and women in this country, often striking without prior warning. Based on studies of the blood vessels of young persons who died of other causes, doctors know that heart disease often develops at a young age, silently laying the groundwork for a disabling or fatal heart attack several decades later.
The ideal, of course, is to know what’s happening inside the heart and blood vessels so that problems can be headed off early. And there are numerous tests–some simple and others technologically sophisticated–that can do just that.
One of the easiest and most effective is one that your doctor or nurse probably performs every time you visit. A reading of your blood pressure tells a lot about how your heart is doing.
High blood pressure is anything greater than 120/80. It can be a sign of early developing heart disease. And, if left uncontrolled, it causes irreversible damage to both the heart and blood vessels. Fortunately, blood pressure is easily controlled with diet, exercise and medications. Unfortunately, it rarely causes symptoms, so it is easy to ignore.
High cholesterol may be an even more important risk factor for heart disease. Cholesterol testing is recommended at least once every five years for adults age 20 and over and more frequently after age 50. A complete lipid profile–measuring LDL, HDL and triglycerides–can be accomplished with a simple finger stick blood test at the pharmacy or at the lab. The test requires several hours of fasting ahead of time. When cholesterol is mildly elevated, a change in diet and exercise may be recommended. When it’s significantly elevated, or if other risk factors exist, a doctor may prescribe cholesterol-lowering medications.
Doctors now know that damage to arteries (atherosclerosis) involves tissue inflammation that damages blood vessels and leads to the accumulation of fatty blockages. One indication of inflammation is a high level of C-reactive protein (CRP), which can also be measured through a blood test at the lab.
When high CRP is found, however, there is no certain way to lower it. Recent research indicates that this marker may not reveal much beyond what is known about high cholesterol, hypertension or excess weight. These risk factors are usually found in conjunction with high levels of CRP.
TESTING THE ARTERIES
It is now possible, through CT and ultrasound technology, to get actual images of the arteries. This can determine how much narrowing has taken place or how much calcium is present in coronary arteries–a more direct indication of disease.
When there is a strong suspicion of coronary heart disease, there are tests a physician can use to focus more directly on the heart itself, its rhythms, and its pumping action.
Uncontrolled blood pressure can strain the left side of the heart, leading to a thickening of the walls and a weakening of its pumping action. This is known as left ventricular hypertrophy (LVH), and it’s a sign of possible heart failure.
One of the most common tests to evaluate the functioning of the heart is a resting electrocardiogram (EKG). It involves placing electrodes on the skin of chest, arms, and legs. The EKG can monitor and record heart rhythm.
Heart Tests
If abnormalities are found, a left ventricular ultrasound can measure the diameter, mass and wall thickness of the ventricle. Sometimes an electrocardiogram performed on a treadmill or a stationary bicycle can be performed to figure out why symptoms occur. This is known as an exercise stress test.
The exercise stress test can determine if there are blockages that are keeping the heart from getting sufficient blood flow during physical activity. Another approach uses a Holter monitor, a small portable recording device worn on the belt and hooked up to electrodes that record the heart’s electrical activity over a 24-hour period with normal daily activity. A person who has had unexplained palpitations or fainting might wear a Holter monitor to help diagnose the problem and monitor the effectiveness of medications.
A nuclear medicine stress test uses a mildly radioactive substance, injected into the body to track blood flow and pinpoint areas of the heart getting insufficient blood flow. It’s more accurate than the standard exercise stress test.
The gold standard for assessing blockages in coronary arteries is angiography. It’s usually performed after a resting or exercise EKG has already indicated insufficient blood flow to the heart. Through angiography, a doctor can identify which arteries are affected and determine whether balloon angioplasty or surgery is required for treatment. A catheter is inserted into an artery in the groin or arm and guided to the heart through images projected on a video monitor. Contrast material injected through the catheter makes it possible to view abnormalities on x-ray film.
There are many other tests, each with its own specific role in diagnosis and treatment. With technological advances, new tests are constantly being introduced. As valuable as these tests are, the major tools in defeating this major killer remain the same: a health-conscious public who understands the value of diet, exercise and control of blood pressure and cholesterol.
Michelle Herbert Thomas, PharmD, CDE
Clinical Director
