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FDA
FDA Consumer
magazine
November-December 2003 Issue
By Rita Redberg, M.D.
Heart disease may be diagnosed late because people don't recognize their symptoms. This is most notable in women, who tend to be diagnosed later in the course of heart disease than men. Compounding this challenge of timely diagnosis is the fact that some tests, such as the treadmill test, are not as accurate in middle-aged women as in men.
Heart disease symptoms may not always be evident, but usually there are symptoms that can alert you to a potential problem. A classic symptom is chest pressure or left arm discomfort, which occurs during stress (physical or emotional), and goes away with rest, or with nitroglycerin, a medication that dilates blood vessels. Much less commonly, women may also experience unusual fatigue, shortness of breath, dizziness, nausea or even abnormal heart beats (palpitations). These are a few symptoms that may suggest that you have a heart problem. The diagnosis of heart disease begins with discussing your symptoms with your health care provider.
Diagnosis also depends upon knowing and understanding the factors that increase the risk of developing heart disease. After reviewing your risk factors and medical history, your health care provider will perform a physical examination. The doctor will pay special attention to the examination of the lungs, the heart and all of the blood vessels, and may then suggest that special heart tests be performed.
An electrocardiogram (EKG) is a simple test that is performed by placing special patches (electrodes) on your chest. The test records the electrical activity of your heart and gives information about the heart rhythm and the sizes of the different heart chambers, and can oftentimes identify a heart attack.
Various stress tests are used to diagnose different types of heart problems. The most common reason to have a stress test is to evaluate for possible blockages in the arteries that supply blood to the heart. Your doctor may suggest a stress test if your symptoms suggest that blockages may be present.
The most common type of stress test is an exercise test, which involves walking on a treadmill that increases in speed and grade every three minutes. The test will be stopped when you become fatigued or short of breath or experience symptoms of chest pressure, or when your provider thinks it is necessary to stop. Your heart rhythm and blood pressure are monitored continuously.
A stress test sometimes can be combined with other techniques to take images of your heart before and after exercise. An exercise (treadmill or bicycle) echocardiogram, also known as echo, is one such test in which an ultrasound picture of the heart is taken before and after exercise to see if the heart responds appropriately to exercise.
A nuclear thallium or sestamibi test is another type of imaging stress test. For this test, an IV is placed in your arm. A small amount of a radioactive material is injected into your bloodstream before and after exercise. Pictures of the blood supply of the heart are then made.
For those unable to exercise, a medicine (either dobutamine or dipyridamole/adenosine) is given through an IV to gradually increase the work of the heart, as if it were exercising. Pictures of the heart are then taken, either with the echo or with the nuclear test, to determine how well the heart's overall pumping action is increasing and whether there are any problems with blood supply to one of the walls.
An angiogram is a test that provides a look at the blood vessels around the heart. This test can also give information about the heart muscle and the heart valves. This test requires that a special catheter be threaded into your body through a blood vessel in your groin or arm. This catheter then reaches the arteries around the heart. The catheter allows dye to flow into the blood vessels while pictures are taken with an X-ray machine. The pictures will show if there are any blockages in the arteries and how severe these blockages are. If blockages are found, your doctor will discuss the treatment options with you.
Your doctor will discuss the best test for you based on your symptoms, risk factors and physical exam. It's important that you go to a health professional regularly for checkups and for the evaluation of any new or changing symptoms.
Remember that you are the most important determinant of your risk of heart disease, so eat lots of fruits and vegetables, exercise regularly, and quit smoking!
Rita Redberg, M.D., is professor of medicine and director of women's cardiovascular services at the University of California, San Francisco.