Health Resources

What is the best test to diagnose heart disease?
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.

What is a stress test and is it safe?
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 a 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.

What is an echocardiogram?
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.

How is valvular heart disease best diagnosed?
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.

What other diagnostic tests may I need?
In addition to regular echocardiography, 3-dimensional echocardiogram may be used in order to provide a 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.

How often do I need to have these tests done?
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 effect 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.

What are blockages in arteries?
Blockages in arteries are buildup of cholesterol, scar, and muscle tissue with calcium within the wall of the artery that can block the flow of blood to the vital organ, such as the heart. They build up from damage to the inner lining of the artery, and can abruptly change in severity to cause symptoms. An angiogram is useful to determine if the blockage is causing symptoms, such as chest pain (angina), or is impairing blood flow which can be seen during a stress test.

Are any non-surgical treatments available for valve problems?
Currently, clinical trials (research studies using patients) are underway for the replacement of aortic valves without using open heart surgery. These valves are not available in the United States for standard treatment outside of trial settings, but are likely to be available in the near future. Treatments for mitral valve leakages have also been developed for patients considered too high a risk for surgery.

My doctor says I have heart failure. Do I need one of those new artificial heart devices?
Heart failure is classified from Class 1 (mild symptoms controlled with medication) to Class 4 (severe symptoms despite maximal medical treatment). Heart transplantation is the gold standard treatment for Class 4 heart failure, but is limited because of a shortage of donors and concomitant patient features such as significant kidney disease or history of cancer. The left ventricular assist device (LVAD) was developed initially as a "bridge" to help patients accepted for transplant survive until they received a new heart.

In February 2010 the FDA approved the LVAD called HeartMate 2 as "destination therapy," so that appropriate patients with Class 3 or 4 heart failure, who are ineligible for a transplant, might be supported indefinitely by the device. It is piggy-backed onto the left ventricle, the main pumping chamber of the heart. The blood pump sits in a pocket under the heart and pumps blood up to the aorta, the main artery exiting the heart. All is contained within the body except for the driveline, an electrical cord, which is connected to a power source. This may be a plug-in power-based unit, when the patient is stationary, as when in bed at night, or a battery pack which allows freedom of movement.

Studies show a significant improvement in quality of life with the HeartMate 2 compared to conventional medical treatment.