Heart Disease (cont.)
Echocardiography
Used with or without exercise, echocardiography can assess how the heart
works. Using sound waves to generate an image, a cardiologist can evaluate many
aspects of the heart. Echocardiograms can examine the structure of the heart
including the thickness of the heart muscle, the septum (the tissues that
separate the four heart chambers from each other) and the pericardial sac (the
outside lining of the heart).
The test can indirectly assess blood flow to parts of the heart muscle. If
there is decreased blood flow, then segments of the heart wall may not beat as
strongly as adjacent heart muscle. These wall motion abnormalities signal the
potential for coronary artery disease.
The echocardiogram can also assess the efficiency of the heart by measuring
ejection fraction. Normally when the heart beats, it pushes more than 60% of the
blood in the ventricle out to the body. Many diseases of the heart, including
coronary artery disease, can decrease this percentage (the ejection fraction).
Perfusion studies
Radioactive chemicals like thallium or technetium can be injected into a vein
and their uptake measured in heart muscle cells. Abnormally decreased uptake can
signify decreased blood flow to parts of the heart because of coronary artery
narrowing. This test may be used when the patient's baseline EKG is not normal
and is less reliable when used to monitor a stress test.
Computerized tomography
The latest generation of CT scanners can take detailed images of blood
vessels and may be used as an adjunct to determine whether coronary artery
disease is present. In some institutions, the heart CT is used as a negative
predictor. That means that the test is done to prove that the coronary arteries
are normal rather than to prove that the disease is present.
Next: Heart catheterization or coronary angiography »
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