On Tuesday evening, March 8, the Navigating the Medical System Lecture Series featured an important virtual lecture hosted by Congregation Etz Chaim on cardiac testing. Dr. Mel Breite, Founder and Director of the Navigating the Medical System Lecture Series, welcomed everyone. He shared that this is a two-part lecture. The second one will be given on Tuesday evening, April 5, and that lecture will focus on women’s cardiac disease.
Next, Dr. Alexander Volodarskiy, Director of Echocardiography and Cardiac Computed Tomography at NewYork-Presbyterian Queens, began his extremely informative and detailed lecture. He listed the various types of cardiac tests and explained that tests vary with each patient, and which test should be administered should be determined by the internist or cardiologist.
The first heart test is taking blood pressure. This gives the physician a glimpse into someone’s cardiovascular health. The systolic number is the pressure in arteries when the heart beats and that’s the number on top. The diastolic pressure is pressure in the arteries when the heart is relaxing and that’s recorded on the bottom. A normal pressure is 120/80. The stage for hypertension is 140/90. The treatment at this point is exercise and losing weight and possibly medicine. He shared that 80 million Americans have hypertension. Forty percent of patients with high blood pressure also have high cholesterol. These two factors put them at risk for heart attack or stroke.
He then explained the two types of cholesterol. LDL is bad cholesterol. It should ideally be under 100. HDL is good cholesterol and greater than 60 is considered high. Currently, the only medicines available for cholesterol are ones that decrease bad cholesterol. There are no medicines to increase good cholesterol. You should know your cholesterol numbers and speak to your physician about your risk profile.
Dr. Volodarskiy then taught about the different types of tests. ECG, also known as EKG, is a non-invasive low-risk test. It uses electrical vectors to measure cardiac electrical activity. It provides information about prior or acute cardiac disease, hypertension, or congenital cardiac defects. There is higher voltage with higher blood pressure. If an ECG is abnormal, it doesn’t always indicate an imminent heart attack. A lot of times, findings are nonspecific, and so it doesn’t always mean there is something wrong with the heart. An ECG cannot see valves or muscles.
If a patient has an abnormal ECG, the next step is to do an echocardiogram. This is an ultrasound of the heart. It is non-invasive, safe, and low risk to the patient. There is no radiation with this test; rather, it uses sound waves to generate many cardiac images. It provides information regarding cardiac function, valve disease, and congenital cardiac disease. It allows the doctor to see muscle function of the heart. With an echocardiogram, the doctor can actually see valves functioning and if they are not opening well or if there is a leak.
Another test that can be administered is a stress test. Not everyone needs this test. It is driven by symptoms. A common reason for this test is someone feeling pressure on her chest or feeling tired when walking. It is usually done with a treadmill. This test provides useful information about functional capacity.
Still another test is a nuclear stress test, which shows how blood flows to the heart. This test uses radiation.
There is also a cardiac CT, which is fairly new and it’s a low-risk, painless test. It uses x-rays to take detailed pictures of the heart. It shows small slices of the heart, which are reconstructed into three-dimensional images. This allows the physician to actually see into the arteries. This is a powerful test. If a person keeps having chest pain, this allows the doctor to see if there are deposits of cholesterol in the heart. The doctor can see how muscles are squeezing and moving. This test takes around five-to-ten minutes.
Another test is the calcium score test, which is a CT-scan with no injection of dye. This test looks for calcium deposits, and it’s used as a screening test for patients who have a family history of heart disease, and they are asymptomatic but their scores are borderline. If the arteries are clear, then there is no need to begin medication. A full cardiac CT is for problematic situations.
An angiography procedure involves putting in an IV into the artery and then taking a tube and snaking it up the artery all the way to the heart. A dye is injected and then the doctor looks at x-rays to see how the dye flows down the artery. During this procedure, the doctor can insert a stent to open a blockage.
If a stress test and CT-scan are abnormal, then the patient needs to discuss with his doctor about whether or not he needs the above-mentioned procedure of cardiac catheterization. In severe coronary artery disease, bypass surgery may be necessary. Vascular disease can also be accessed.
In a cardiac MRI, there is no radiation. This is the most accurate assessment of the heart function. This evaluates morphology and characterizes masses. It shows if anything is abnormal with the texture of the muscle. This test takes around 30-40 minutes.
Most primary care physicians do the ECG, and most cardiologists do the echocardiogram. Cardiac CT is only available in a few hospitals. NewYork-Presbyterian Queens is one of those.
Factors that are considered for cardiac tests include family history, symptoms, risk factors, your ability to exercise, and your preference for invasive or conservative tests. An empowered patient understands his or her condition and the tests available. When you see your doctor, always bring past results of cardiac tests, a list of medicines you take, recent lab and test results, and a list of questions.
Everyone thanked Dr. Breite and Dr. Volodarskiy whole-“heartedly.”
By Susie Garber