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Heart disease isn’t just one condition — it comes in several different forms. It is also the leading cause of death worldwide, which makes early diagnosis very important. Detecting heart disease early allows treatment to begin sooner, improving the chances of staying healthy. In this article, we will explain the tests doctors use to diagnose heart disease.
Heart disease can usually be diagnosed quickly once testing begins. Early on, heart disease symptoms can be mild and easily confused with other conditions or with signs of aging. Many people don’t realize they have heart disease until they have a heart attack.
According to Harvard Health Publishing, in the U.S., the average age at first heart attack is about 65 for men and 72 for women. Between 4 percent and 10 percent of heart attacks strike people — mostly men — younger than 45.
Many people are diagnosed with hypertension (high blood pressure) by their primary care physician or family doctor. Others may be diagnosed by an emergency department physician after a heart attack, angina (chest pain), or an episode of syncope (fainting). Some people are referred to a cardiologist (heart doctor) or cardiac surgeon for diagnosis and treatment.
Heart disease is diagnosed based on symptoms you share with your doctor and signs your doctor finds during an exam. Doctors also use many tests to diagnose or confirm the presence of heart disease. Some tests may be repeated several times to get an accurate idea of how and why the heart isn’t functioning correctly.
An electrocardiogram (ECG, also sometimes abbreviated as EKG) is an important test for diagnosing heart disease. ECGs are painless, quick, and inexpensive to perform. An ECG monitors the heartbeat using patches that attach to the skin. A standard ECG records 12 leads attached to 10 electrodes. The machine senses electrical impulses in the heart and records the pattern of heartbeats. The results of an ECG test can indicate many different types of heart disease, including arrhythmia (abnormal heart rhythm), and whether a person has had a recent heart attack.
An ECG may be performed during a stress test, during which you exercise to raise your heart rate. A Holter monitor is a portable ECG device that you wear for an extended period, usually between 24 and 48 hours. An event monitor uses ECG technology but records only when triggered, capturing a few minutes at a time. Event monitors can be worn for up to 30 days.
Imaging tests help doctors visualize and diagnose problems with the structure of the heart, such as heart valve disease. Imaging tests are painless and noninvasive. Imaging tests used to diagnose heart disease include CT scans, MRIs, and echocardiograms (or echos), which use ultrasound.
Cardiac catheterization is an invasive procedure. You may be sedated before cardiac catheterization, but you’ll still be awake. The doctor uses a needle to make a small opening in a blood vessel in your arm or groin. They then introduce a thin tube into the blood vessel and guide it into the heart. Once the catheter reaches the heart, the doctor injects contrast material (a colorless liquid) that can be seen on X-rays (this imaging procedure is referred to as coronary angiography).
The doctor may also use ultrasound technology to image the coronary arteries from the inside in a procedure known as intravascular ultrasound. These imaging techniques provide a detailed picture that shows how the heart is functioning and the exact location of any narrowed arteries or blockages.
Cardiac catheterization is also used to perform treatments such as angioplasty and stent placement.
Stress tests evaluate how well your heart functions when it’s working hard, like when you’re exercising. During an exercise stress test, an ECG is performed while you exercise on a treadmill or bicycle. If you can’t engage in physical activity, your doctor may give you medication to simulate how hard your heart works during exercise.
For a nuclear stress test, you get an injection of a radioactive substance that a detector then tracks as it passes through your heart and vessels during exercise. This allows your doctor to see blockages and heart damage.
Like an ECG, an electrophysiology (EP) study tracks your heart’s electrical activity. Your healthcare provider might use this test if they suspect you have an arrhythmia.
To pick up your heart’s electrical signals, your doctor places sensors inside your heart. These sensors can record information more accurately than ECG electrodes on your chest. Your doctor can use equipment and medications to speed up or slow down your heart rate in a controlled environment while evaluating how your heart responds. This test will show what type of arrhythmia you have, so your doctor can choose the best treatment.
Blood samples tested in the lab can reveal many important clues about heart disease. These blood tests can help determine your risk of developing heart disease or the impact of any current heart disease. Blood tests for heart disease often include:
Doctors might use other blood tests to understand how various body systems that might impact your heart health are working, such as thyroid-stimulating hormone (TSH) tests or sodium and potassium tests.
Your doctor will tell you if there’s anything you need to do to prepare for a blood test ahead of time. For some tests, you may need to fast (avoid eating) for 12 hours before providing the blood sample.
According to Harvard Health Publishing, heart disease may be misdiagnosed or take longer to diagnose in women. Most research on heart disease comes from studies on middle-aged men, so doctors are more familiar with the signs and symptoms of heart disease common in men.
According to Cleveland Clinic, women are more likely to develop small vessel disease — blockages in small blood vessels — as opposed to blockages in the larger coronary arteries typically seen in men (which can be easily viewed on angiograms).
The reason some women may have a higher likelihood of heart attacks without typical pain or findings on angiograms is unclear, but the decline in estrogen after menopause appears to increase women’s heart disease risk, according to Baylor College of Medicine.
Heart attacks may also be harder to diagnose in women. Some studies indicate that women and people with type 2 diabetes are more likely to experience a “silent” heart attack with no obvious symptoms. According to Brigham and Women’s Hospital, there are also different symptoms for men and women: some women experience the same crushing chest pain and tightness that men tend to have during heart attacks, but others have different heart attack symptoms, such as intense fatigue, upset stomach, nausea, and back pain.
According to Brigham and Women’s Hospital, cardiologists who have experience treating women are more likely to recognize the different patterns of signs and symptoms that heart disease can present in women.
On MyHeartDiseaseTeam, people share their experiences with heart disease, get advice, and find support from others who understand.
Which tests helped diagnose your heart disease? Let others know in the comments below.
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After years of heart failure and a small heart attack, I became increasingly short of breath, my internist referred me to a cardiologist in Ottawa where they did a TEE and found my heart enlarged, 4… read more
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