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Diagnosing Heart Disease

Q: What is the best test to diagnose heart disease?
A: There is not one single test that is best for everyone. A history and physical exam by your physician are the first step. If your cardiologist or internist suspects heart disease, he or she may want you to have an echocardiogram (ultrasound of the heart) and/or a stress test.

An echocardiogram looks at the heart muscle pump function of the heart, the heart valves and their function, as well as the pressures inside the heart. A stress test is a noninvasive test to look for blockages in the coronary arteries or arteries that supply blood to the heart.

A stress test can be done with exercise (most commonly on a treadmill) or with medication (requires imaging, either echo or nuclear stress testing). If the stress test is positive or the doctor's suspicion for heart disease is very high, a cardiac catheterization may be performed. Additionally, a coronary CTA (computed tomography angiogram) may also be ordered to visualize the coronary arteries.

Your doctor will determine which is the best test for you.

Answered by Noelle Mann, MD. Dr. Mann is a cardiologist and assistant professor of medicine. She is co-director of the Women's Heart Program.

Q: What is a stress test and is it safe?
A: A stress test is a noninvasive test to diagnose blockages in the coronary arteries or arteries that supply blood to the heart. It is a very safe test. The incidence of having a heart attack or dying from is stress test is very low; that is, 1 in 10,000.

Stress testing can be done with exercise (usually on a treadmill), or with medication if you are unable to exercise, with what's called a "chemical stress test."

With exercise, EKG leads are placed on you, and you walk on a treadmill. The treadmill starts on an incline, and every 3 minutes the treadmill becomes faster and steeper. The EKG is monitored and analyzed continuously, and your blood pressure is taken every minute.

If the doctor ordered the test with imaging, either echo or nuclear stress testing, pictures of your heart will be taken once exercise is completed. If the test is a chemical stress test, in addition to EKG monitoring, either echo images or nuclear images will be taken once the medication has been given.

After the images and EKG are analyzed, the doctor interpreting the test will determine if the results are normal or abnormal. If they are normal, there is a very high probability you do not have obstructive blockages in your coronary arteries and in fact your risk of having a heart attack in one year is less than 0.05%.

If the test results are abnormal, then your doctor may want to perform a more invasive test such as a cardiac catheterization to determine the exact location and severity of the blockages in your coronary arteries.

Click here for more information about the electrocardiogram (ECG or EKG) stress test.

Answered by Noelle Mann, MD. Dr. Mann is a cardiologist and assistant professor of medicine. She is co-director of the Women's Heart Program.

Q: What is an echocardiogram?
A: An echocardiogram is an ultrasound of the heart. It can tell us many things about your heart. It will determine the size of the chambers of the heart. It can determine the function of the two pumping chambers of the heart -- the left and right ventricles. It allows the doctor to determine the relaxation properties of the main pumping chamber (the left ventricle).

An echocardiogram also allows the doctor to assess the function of the valves of the heart -- which are the "doors" between the chambers of the heart. We can calculate the pressures inside the heart to determine if they are normal or elevated. Additionally, it allows us to look at the sac that surrounds the heart, called the pericardium. Click here for more information about echocardiography.

Answered by Noelle Mann, MD. Dr. Mann is a cardiologist and assistant professor of medicine. She is co-director of the Women's Heart Program.

Q: How is valvular heart disease best diagnosed?
A: Echocardiography, which is an ultrasound exam of the heart, is often used when evaluating a patient with suspected or known valvular disease. It provides important information about the structure and function of the valves and of the heart muscle. Just like other ultrasound techniques, echocardiography is very safe. It is non-invasive, does not involve radiation, and is relatively fast to perform. Click here for more information about echocardiography.

Answered by Smadar Kort, MD, a cardiologist, is professor of medicine and director of the Valve Center. She also is director of cardiovascular imaging and director of the echocardiography laboratory.

Q: What other diagnostic tests may I need?
A: In addition to regular echocardiography, 3-dimensional echocardiogram may be used in order to provide more detailed anatomic picture of the heart. Some valvular pathology is better assessed using an echocardiogram probe mounted on a tube that is inserted into the stomach, in a test referred to as transesophageal echocardiography (TEE).

At Stony Brook University Medical Center, we have the ability to perform 3-dimensional TEE that provides more accurate and detailed information, and is available to be used whenever your doctors think it is indicated.

Sometimes a stress echocardiogram will be performed so your doctors can evaluate your functional capacity, assess your heart function during stress or evaluate for development of exertional symptoms. Other diagnostic tests may be necessary and could all be performed in our institution, including CT, MRI, or cardiac catheterization.

You can always be assured that our doctors will evaluate all the tests you already have had done, and will perform only those tests essential to fully understand your problem and guide treatment.

Answered by Smadar Kort, MD, a cardiologist, is professor of medicine and director of the Valve Center. She also is director of cardiovascular imaging and director of the echocardiography laboratory.

Q: How often do I need to have theses tests done?
A: Sometimes, depending on what our doctors find, they may recommend that you come back at a later point and repeat the echocardiogram and possibly also the stress test. This decision is based on the degree of your valvular disease, on your symptoms as well as other parameters such as the affect of the valvular disease on the heart muscle and pressures in the lungs. All these parameters would also be taken into consideration when deciding how often you come back for follow up and for repeat testing. The follow-up plan will be discussed with you during your visit to our Valve Center, as well as situations in which you should return for evaluation sooner.

Answered by Smadar Kort, MD, a cardiologist, is professor of medicine and director of the Valve Center. She also is director of cardiovascular imaging and director of the echocardiography laboratory.

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