DESCRIPTIONS OF FREQUENTLY ADMINISTERED TESTS
Going to a cardiologist appointment can be terrifying–trust me, I know! It certainly helps to know what you’re in for, so read about your upcoming test here!
Blood Work: Cardiologists are not vampires; they don’t take too much of your blood. For a complete cardiac work-up, your cardiologist shouldn’t take more than five vials; my doctor, who might just be an amazing and incredible superhuman, did it in four. It is likely that your doctor will run a Complete Metabolic Panel (CMP) plus magnesium to check your electrolytes and blood sugar, as electrolyte abnormalities can cause cardiac arrhythmias and high blood sugar can be indicative of and/or prefigure heart disease. A lipid panel/lipid profile is run to check your cholesterol; triglycerides, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) are tested and your total cholesterol is calculated; high levels of triglycerides occur when someone eats more calories than they burn and a high number here alerts you to a higher risk of heart disease as do high levels of LDL (aka ‘bad cholesterol’), especially lipoprotein a; if your total cholesterol is found to be above 200mg/dL, be worried! If the lipid panel results show an increased risk of heart disease, your doctor will check your C-reactive protein (CRP), if they have not already, to see if there is inflammation in your arteries. They will also check your troponin levels (either troponin I or troponin T) to assess damage to the heart muscle; this protein is released by the myocardium when it has suffered some injury, and elevated troponin significantly signals such an event. Other proteins tested for are fibrinogen, a protein that helps blood clot, and brain natriuretic peptide (BNP), a protein that is used in blood vessel relaxation and fluid elimination; elevated levels can respectively disclose a proclivity to stroke and heart attack inducing blood clots and evidence strain on the heart; BNP levels are checked frequently to see the effectiveness of treatment.
Cardiac Catheterization: Cardiac catheterization is a procedure in which a catheter is inserted through an artery in your groin, neck, or arm and threaded through your blood vessels to your heart. A local or general anesthetic will be administered, and electrodes will be placed on your chest to monitor your heart for the duration of the catheterization. The catheterization’s cause dictates the details of the procedure. Many catheterizations are diagnostic, such as a heart biopsy, a coronary angiogram, and a right heart catheterization. In a heart biopsy, a small sample of tissue will be painlessly snipped from your heart. A coronary angiogram is used to see if the arteries are narrowed or blocked; during your coronary angiogram, dye is inserted into your blood vessels and x-ray images are taken in rapid succession. A right heart catheterization checks the pressure in your right heart chambers and measures the blood flow there. Other cardiac catheterizations are interventional. Balloon angioplasties are done to open narrowed arteries; two catheters are inserted, one which goes to the artery and a smaller one, the balloon catheter, that goes through it to the artery often to place a stent, which will ensure the permanent opening of the artery. A balloon valvuloplasty is a similar procedure done to open narrowed heart valves; here a catheter is threaded across the valve and a balloon (yes, an actual balloon!) is blown up to open the valve. This method is mimicked in another catheterization procedure, a valvular replacement, where an artificial valve is implanted instead of a balloon inserted. Heart holes are also closed via catheterizations with the insertion of a plug or clip.
Chest X-Ray: A chest x-ray is, as the name makes very self-evident, an x-ray of your chest. It takes a couple minutes at most. You will stand with your left-side to the x-ray machine and then with your chest directly against it, and a beam of x-rays will pass through the chest to capture an image of the heart, lungs, blood vessels, and bones. Once the x-ray is developed, your cardiologist will be able to see the location of your heart, its size and shape, and whether there is fluid surrounding it.
Echocardiogram: An echocardiogram (echo for short) is an ultrasound of your heart. It is a diagnostic test that shows the size/shape of your heart, its pumping capacity, and the direction of blood flow. The most common type of echocardiogram is a transthorastic echocardiogram, a ten minute procedure where a technician puts electrodes on your chest and images your heart with a gelled probe; this test is non-invasive, painless, and has no side effects. Stress echocardiograms are also done, sometimes as part of a larger cardiac stress test; in this test, two echocardiograms are done, one before and one after the patient is subjected to stress via either exercise or medication. On a rare occasion, your cardiologist may order a transesophogeal echocardiogram in which the probe is inserted through the esophagus after a sedative and local anesthetic are administered.
Electrocardiogram: Abbreviated as either EKG or ECG (yes, they are the same thing!), an electrocardiogram measures the electrical activity of your heart. Electrodes (about ten) are placed on your chest area for no more than thirty seconds, and the heart muscle’s de- and repolarizations are transcribed either electronically or on paper. Many abnormalities are immediately diagnosable with an EKG, including sinoatrial tachy- and bradycardia, atrial fibrillation, acute pericarditis, and ventricular hypertrophy. Learn how to read an EKG here.
Holter Monitor: A holter monitor is like a walking EKG. A technician will stick electrodes on your chest; these electrodes are connected to a tiny pager-sized device that you clip to the waistband of your pants. As long as you wear the monitor (typically 24-48 hours), your heart’s electrical activity will be recorded and sent back to your doctor for analysis. You will be given a log to note feelings of chest pain, palpitations, and/or faintness; in addition to documenting these sensations, you should push the call button on your device to draw your doctor’s attention to this specific temporal point. As holter monitors are not waterproof, you should not shower, swim, or otherwise get wet while wearing one. If your holter monitor gets disconnected, alert your doctor immediately.
Stress Test: As there are several variations on the cardiac stress test, it would be helpful to first address the constants. An electrocardiogram (ECG/EKG) will always be done, and your blood pressure will always be monitored at regular intervals; a doctor and/or lab technician will always be present and will frequently interrogate you as to how you’re feeling (even if you can’t breathe to utter the words!). The purpose of this test is to see how your heart responds to stress, so naturally, stress will always be placed on your heart; the way this is done is the differentiating factor for the tests in question. Stress tests can be broken down into two primary categories–exercise and pharmacological. During an exercise stress test, you will walk on a treadmill or pedal on a stationary bicycle; the rate of exercise and/or degree of difficulty will gradually increase over the course of the seven to twelve minutes. When someone is, for whatever reason, unable to do an exercise stress test, similar strain is put on the heart with a drug like dobutamine or adenosine. Often an echocardiogram will be taken before and after the exertion, but this is not always the case; if your doctor does have you do this, beware, you will have a lot of goo on your chest!