Heart tests – sorting out what is best

Blocked heart arteries are the ultimate cause of heart attacks. These blockages occur slowly over a person’s lifetime and many people do not have any symptoms until the blockage causes 70 percent narrowing or more in a blood vessel.

People at risk for heart attack include those with elevated lipids – cholesterol and triglycerides – patients who smoke, those with diabetes, overweight individuals (especially those with poorly controlled blood pressure), and individuals with certain ethnic backgrounds. A strong family history of heart disease, especially at a young age in a sibling or parent, also increases the risk.

Symptoms occur when there is an increased workload on the heart brought on either by physical or emotional stress or a combination of the two. Because the heart is a muscle, physical activity such as shoveling snow, or running a vacuum cleaner puts more demand on the heart to increase blood flow, which in turn raises the need for oxygen being supplied to the heart. Stress also puts more demand on the heart.

A dull aching sensation or pressure in the center of the chest are common symptoms. Some people have described symptoms as feeling “like an elephant sitting on my chest” or “like my chest was in a vice.” Both women and men may experience a burning sensation or indigestion which is unlike any symptoms that the patient has experienced before. Some women awaken in the middle of the night complaining of a smothering sensation or pain in the jaw, shoulder or arm.

If you think you’re at risk, have your doctor examine you. He or she will review your family history and ultimately assess your risk based on lifestyle and health. Tests that may be performed during your evaluation:

Stress test. This test measures heart activity before and during exercise when the heart rate increases.

Nuclear stress test. An isotope, usually technetium or thallium, is injected into your veins during exercise and washes out after a period of time. The doctor watches an EKG to monitor the electrical changes in the heart during the stress test.

Stress echocardiogram uses ultrasound to observe and compare the heart contraction at rest versus during exercise. The cardiologist then predicts contraction deficits, which correlate with areas of decreased blood flow in the heart muscle.

Coronary CT scan is a newer and very sensitive way to visualize blocked arteries in the heart, but it is sometimes overly sensitive in finding plaque, which is not yet resulting is severe obstruction.

Lifestyle modifications have been shown to improve your risk for developing heart disease. Smoking cessation, exercising at least thirty minutes five times a week, eating a proper diet and losing weight are all important to prevent the problem before and after heart attacks occur.

Dr. James A. Smith, DO, is vascular and internal medicine physician with Kansas Vascular Medicine. He is board certified by the American Board of Vascular Medicine and the American College of Osteopathic Internists. For more information or to schedule an appointment, please call (316) 425-5016 or visit www.kansasvascular.com.


By Dr. James A. Smith, DO

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