Heart Disease (cont.)
How is heart disease diagnosed?
The diagnosis of heart disease begins with obtaining a history that the potential
for coronary artery disease exists. Risk factors need to be assessed, and then
testing may be required to confirm the presence of heart disease.
Heart disease tests
Not every patient with chest pain needs heart catheterization (the most
invasive test). Instead, the healthcare provider will try to choose the testing
modality that will best provide the diagnosis, and if coronary artery disease is
present, decide what impairment, if any, is present.
Electrocardiogram (ECG or EKG)
The heart is an electrical pump, and the electrical impulses it generates can
be detected on the surface of the skin. Normal muscle conducts electricity in a
reproducible fashion. Muscle that has decreased blood supply conducts electricity
poorly. Muscle that has lost its blood supply and has been replaced with scar
tissue cannot conduct electricity. The electrocardiogram (EKG)
is a noninvasive test used to reflect underlying heart conditions by measuring
the electrical activity of the heart.
Some people have "abnormal" EKGs at baseline but this may be normal for them.
It is important that an electrocardiogram be compared to previous tracings. If a
patient has a baseline abnormal EKG, they should carry a copy with them for
reference if they ever need another EKG.
Stress testing
If the baseline EKG is relatively normal, then monitoring the EKG tracing
while the patient exercises may uncover electrical changes that may indicate the
presence of coronary artery disease. There are a variety of testing protocols
used to determine whether the exercise intensity is high enough to prove that
the heart is normal.
Some patients are unable to exercise on a treadmill test, but they can still
undergo cardiac stress testing by using intravenous medication that causes the
heart to work harder.
Stress testing is done under the supervision of medical personnel because of
the potential of provoking angina, shortness of breath,
abnormal heart rhythms,
and heart attack.
Next: Echocardiography »
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