What’s the leading cause of death in Western countries? It’s still cardiovascular disease, a health problem that’s more common in men, but women catch up to men after menopause and have a similar rate of cardiovascular disease. According to the American Heart Association, the increased risk shows up about 10 years after menopause.
You might think that if your heart isn’t healthy, you’d have the classic symptoms of cardiovascular disease, like shortness of breath with exertion and chest pain. However, many people have no symptoms before they have their first heart attack, making cardiovascular disease a health problem that can be silent for long periods of time.
Ideally, you want to know you have coronary artery disease, the most common form of heart disease, before your first heart attack. If you discover it early, there are treatments that can reduce your risk of dying of a heart attack.
It’s important to know your risk factors. If you have a close family member who had cardiovascular disease before the age of 50 or multiple family members who had it, you’re at higher risk yourself and need closer monitoring. The first level of screening is to monitor your blood pressure, fasting blood sugar level, and lipids.
If your doctor deems you’re at high risk of developing cardiovascular disease, they may recommend certain other tests. Let’s look at some of the tests doctors use to screen for and diagnose cardiovascular disease.
You might have had this common test one or more times during your life. An electrocardiogram, or EKG, is a tracing of the heart’s waves. An EKG can detect an abnormal heart rhythm and signs of a previous heart attack. This simple office procedure that only takes a few minutes can sometimes show signs that the heart isn’t getting enough oxygen due to coronary artery disease, but it isn’t a very sensitive test. In other words, you can have coronary artery disease and have a normal EKG. That’s because your heart may get adequate blood flow when you’re resting and not exercising, and the EKG tracing will look normal. But if you launch into a workout where oxygen requirements increase, your heart doesn’t get adequate blood flow. Since you’re not exercising when you get a resting EKG a normal tracing doesn’t rule out coronary artery disease.
Exercise Stress Test
Better than a resting EKG is an exercise stress test. For an exercise stress test, the technicians apply electrodes to your chest, legs, and arms to monitor your heart. You then walk on a treadmill as the technician gradually increases the incline to make it more challenging. The technicians monitor your heart rhythm and electrical activity through your heart using an EKG tracing.
How well your heart performs and whether it gets good blood flow during exercise is more accurate for detecting coronary artery disease than an EKG at rest. However, some people aren’t capable of walking on a treadmill and need an alternative way to evaluate blood flow to the heart.
Nuclear cardiac stress test
A nuclear cardiac stress test is useful for people who have trouble walking or running on a treadmill. Rather than exercising a technician injects a medication that causes your arteries to dilate, mimicking the effects of exercise. They also inject a radioactive tracer into your bloodstream to light up your blood vessels. The technician then takes photos of your heart. Thanks to the radioactive tracer, the photos show how much blood reaches your heart. If it’s low, you might have plaque build-up in your coronary arteries.
This test will also show whether you already have damage to your heart muscle and how efficiently your heart pumps. The nuclear stress test is more sensitive than an exercise stress test since the technicians can see the blood flowing to your heart rather than depending only on an EKG tracing. The downside is you’re exposed to small amount of radiation and it’s possible, although uncommon, to have a reaction to the tracer.
The information you get from an EKG is limited for the reasons mentioned, while an echocardiogram can tell you more about the heart’s structure and function. An echocardiogram uses sound waves directed at the inner structures of the heart, such as heart valves, to show how they’re moving and how well the heart is pumping. It’s not very useful for detecting coronary artery disease, but it can identify heart muscle weakness or damage due to a previous heart attack or insufficient blood flow. The best thing about an echocardiogram is that it’s non-invasive and still offers useful information about heart health.
This is the definitive test for diagnosing coronary artery disease, but because it carries some risk, most cardiologists recommend a nuclear stress test first. For coronary angiography, also known as cardiac catheterization, the cardiologist threads a catheter into a blood vessel and allows the catheter to travel to your coronary arteries. When they inject contrast material through the catheter, your heart and coronary arteries show up when they take X-rays. By looking at the images, they can tell how much blood is flowing through the coronary arteries to the heart and identify any blockages. The test lasts from 30 minutes to an hour and supplies more definitive information about heart health.
Coronary Calcium Scan
This is a relatively new screening test for coronary artery disease. It uses CT scanning to check for calcium deposits inside the coronary arteries that deliver blood to the heart. Build up of calcium within the coronary arteries can indicate coronary artery disease and a higher risk of a heart attack.
Coronary calcium scanning is only used as a screening test for disease in people who don’t have symptoms. If you have symptoms, health care professionals recommend a nuclear cardiac stress test or angiography to make a definitive diagnosis. It’s also not clear how useful coronary calcium scanning is for predicting future risk of coronary artery disease. Most experts believe it’s most useful for people at intermediate risk of coronary artery disease.
The Bottom Line
Only a physician can determine which test is right for you. Of course, it’s best to do what you can to lower your risk of coronary artery disease by leading a heart-healthy lifestyle that includes regular exercise, an anti-inflammatory diet, adequate sleep, and stress management.
- org. “Nuclear stress test”
- org. “Heart scan (coronary calcium scan)”
- com. “What Is a Coronary Calcium Scan?”
- com. “Echocardiogram”
- J Tehran Heart Cent. 2013 Jan; 8(1): 1–13. Published online 2013 Jan 8.
- org. “Menopause and Heart Disease”
- org. “Nuclear Stress Test”
- Biochem Res Int. 2017; 2017: 3824903.Published online 2017 May 2. doi: 10.1155/2017/3824903.