Cardiac Tests

An electrocardiogram, or ECG test, is used to monitor your heart. Each beat of your heart is triggered by an electrical impulse normally generated from special cells in the upper right chamber of your heart. An electrocardiogram — also called an ECG or EKG — records these electrical signals as they travel through your heart. Your doctor can use an ECG test to look for patterns among these heartbeats and rhythms to diagnose various heart conditions.

An electrocardiogram is a noninvasive, painless test. The results of your ECG test will likely be reported the same day it’s performed, and your doctor will discuss them with you at your next appointment.

Why is an ECG test performed?

An electrocardiogram is a painless, noninvasive way to diagnose many common types of heart problems. Your doctor may use an ECG test to detect:

• Irregularities in your heart rhythm (arrhythmias)
• Heart defects
• Problems with your heart’s valves
• Blocked or narrowed arteries in your heart (coronary artery disease)
• A heart attack, in emergency situations
• A previous heart attack
• Risks

An electrocardiogram is a safe procedure. There may be minor discomfort, similar to removing a bandage, when the electrodes taped to your chest to measure your heart’s electrical signals are removed. Rarely, a reaction to the electrodes may cause redness or swelling of the skin.

A stress test, in which an ECG is performed while you exercise or after you take medication that mimics effects of exercise, may cause irregular heartbeats or, rarely, a heart attack. These side effects are caused by the exercise or medication, not the ECG itself.

There isn’t any risk of electrocution during an electrocardiogram. The electrodes placed on your body only record the electrical activity of your heart. They don’t emit electricity.

How you prepare

No special preparations are necessary. However, avoid drinking cold water or exercising immediately before an electrocardiogram. Cold water can produce potentially misleading changes in one of the electrical patterns recorded during the test. Physical activity, such as climbing stairs, may increase your heart rate.

What you can expect

An electrocardiogram can be done in the doctor’s office or hospital, and is often performed by a technician. After changing into a hospital gown, you’ll lie on an examining table or bed. Electrodes — often 12 to 15 — will be attached to your arms, legs and chest. The electrodes are sticky patches applied with a gel to help detect and conduct the electrical currents of your heart. If you have hair on the parts of your body where the electrodes will be placed, the technician may need to shave the hair so that the electrodes stick properly.

You can breathe normally during the electrocardiogram. Make sure you’re warm and ready to lie still, however. Moving, talking or shivering may distort the test results. A standard ECG takes just a few minutes.

If you have a heartbeat irregularity that tends to come and go, it may not be captured during the few minutes a standard ECG is recording. To work around this problem, your doctor may recommend another type of ECG:

Holter monitoring. Also known as an ambulatory ECG monitor, a Holter monitor records your heart rhythms for an entire 24-hour period. Wires from electrodes on your chest go to a battery-operated recording device carried in your pocket or worn on a belt or shoulder strap. While you’re wearing the monitor, you’ll keep a diary of your activities and symptoms. Your doctor will compare the diary with the electrical recordings to try to figure out the cause of your symptoms.

Event recorder. If your symptoms don’t occur often, your doctor may suggest wearing an event recorder. This device is similar to a Holter monitor, but it allows you to record your heart rhythm just when the symptoms are happening. You can send the ECG readings to your doctor through your phone line.

Stress test. If your heart problems occur most often during exercise, your doctor may ask you to walk on a treadmill or ride a stationary bike during an ECG. This is called a stress test. If you have a medical condition that makes it difficult for you to walk, medication may be injected to mimic the effect of exercise on the heart.

After the procedure

Usually, your doctor will be able to tell you the results of your ECG the same day it’s performed. If your electrocardiogram is normal, you may not need any other tests. If the results show there’s a problem with your heart, you may need a repeat ECG or other diagnostic tests, such as an echocardiogram. Treatment depends on what’s causing your signs and symptoms.

Results

Your doctor will look for a consistent, even heart rhythm and a heart rate between 50 and 100 beats a minute. Having a faster, slower or irregular heartbeat provides clues about your heart health, including:

Heart rate. Normally, heart rate can be measured by checking your pulse. But an ECG may be helpful if your pulse is difficult to feel or too fast or too irregular to count accurately.

Heart rhythm. An ECG can help your doctor identify an unusually fast heartbeat (tachycardia), unusually slow heartbeat (bradycardia) or other heart rhythm irregularities (arrhythmias). These conditions may occur when any part of the heart’s electrical system malfunctions. In other cases, medications, such as beta blockers, psychotropic drugs or amphetamines, can trigger arrhythmias.

Heart attack. An ECG can often show evidence of a previous heart attack or one that’s in progress. The patterns on the ECG may indicate which part of your heart has been damaged, as well as the extent of the damage.

Inadequate blood and oxygen supply to the heart. An ECG done while you’re having symptoms can help your doctor determine whether chest pain is caused by reduced blood flow to the heart muscle, such as with the chest pain of unstable angina.

Structural abnormalities. An ECG can provide clues about enlargement of the chambers or walls of the heart, heart defects and other heart problems.

Stress tests before surgery and why you need them

If you’re having surgery, you may wonder if you need a heart stress test beforehand. It may seem like a good way to ensure a safe surgery. But you probably do not need the test if you are healthy, active, and feeling well, or if you’re having minor surgery. Here’s why:

The tests aren’t useful before minor surgery:

There are different types of tests, but they are all meant to find out the same thing: how your heart performs when it is working hard or under stress. In an exercise stress test, you walk or jog on a treadmill with electrodes attached to your chest. Images of your heart are taken while you exercise. An imaging stress test uses heart ultrasound (also called stress echocardiography) to take pictures of your heart. This is done first while you are at rest. Next, more pictures are taken while your heart is working hard or being stressed. A nuclear cardiology test uses a small amount of a radioactive substance to take pictures of your heart while it is being stressed.

Heart stress tests can show if you have significant heart disease. Serious heart disease could put you at risk of having a heart attack or another serious complication during surgery. The test results may lead to special care before, during, or after surgery. The test results may also prompt your care providers to delay the surgery or change to a less invasive kind.

But the risk of heart complications from a breast biopsy, eye or skin surgery, a hernia operation, or other “same-day” surgeries is very low. The risk is so low for minor surgeries that even most people with heart disease do well. If you feel well and are physically active, your chance of having significant heart disease is low. So you usually don’t need a stress test, even for major surgeries.

Heart stress tests can pose risks:

The tests are usually very safe and some can be done with little or no radiation. But if your risk of having a heart problem is low, they are more likely to result in false alarms. These can cause anxiety or an unnecessary delay of surgery, or lead to more tests.

For example, if your stress test results are not normal, you might have a follow-up coronary angiography (cardiac catheterization). During this test, a catheter is inserted into the heart through an artery, dye is injected, and X-rays are taken. The risks are low, and complications are rare. But the test can lead to bleeding or a heart attack, and sometimes death. Also, exposure to radiation adds up over your lifetime, so it’s best to avoid X-rays when you can.

Heart stress tests can cost a lot:

An exercise stress test costs more than $200, and an imaging stress test costs as much as $2,000, but in Canada all costs of tests covered by OHIO. If abnormal results lead to coronary angiography, that can add thousands more to the cost.

When are stress tests needed before surgery?

Usually, stress testing should be done only when the results would change the plan for your surgery.

You might need a stress test before surgery if you have a serious heart condition. This includes uncontrolled heart failure or severe valve disease, chest pain or trouble breathing, or you get tired or winded more easily than you did before.

You might also need a stress test before surgery if you have the following risks:

• You are having intermediate-risk surgery, such as knee or hip replacement, or high-risk surgery, such as bypass surgery for a blocked artery in your leg.
• And you have diabetes, kidney disease, or a history of coronary artery disease, heart failure or stroke.
• And you have a hard time walking a short distance or climbing stairs.

Inflammation Associated With Cardiac Syndrome X

In most cases, people experience chest pain as a result of plaque buildup in the arteries. Over time, plaque can stick to artery walls, which reduces blood flow to the heart and increases risk for heart attack. Fortunately, there are many ways to treat this condition, which can minimize symptoms and lower cardiovascular risk. However, not all cases are so clear cut.

Some patients have a mysterious condition called cardiac syndrome X, where they have perfectly healthy arteries yet experience unexplained chest pain. To this date, we lack a full understanding of cardiac syndrome X and are unclear on the causes, possible complications, and ways to treat this condition. However, a recent study published in the Journal of the American College of Cardiology identified an important link between cardiac syndrome X and inflammation in the arteries.

Inflammation or swelling in the arteries is closely associated with heart disease risk, and is measured using C-reactive proteins—important markers of inflammation found in the blood. In this study, researchers enrolled 21 patients with cardiac syndrome X and measured their levels of inflammation using a test for C-reactive protein. They also used a positron emission tomography (PET) scan to test blood flow and see how healthy patients’ arteries were. After analysis, researchers found that patients with cardiac syndrome X and inflammation had less-healthy blood flow compared to those without inflammation. And less than normal blood flow can be a sign of small vessel disease, also referred to as coronary microvascular disease, which can increase risk for a heart attack.

So what does this study tell us about the mysterious cardiac syndrome X? This was the first study to show a direct relationship between inflammation, reduced blood flow and cardiac syndrome X in patients without the usual risk factors for heart disease. Patients in this study were otherwise healthy individuals, and experienced unexplained chest pain with no sign of heart disease. Although we don’t know exactly what causes cardiac syndrome X, it’s possible that inflammation may play an important role in this condition. And the closer we get to understanding the cause of cardiac syndrome X, the more we can do to help treat and relieve symptoms, and improve outcomes in patients with this condition.

Many Benefits of Preventive Cardiology

What is preventive cardiology?

Preventive cardiology is all about identifying patients who are at high risk for a cardiac event like a heart attack and then working collaboratively with them to prevent said event or onset of heart disease. With this in mind, we look at specific risk factors and try to recommend strategies for health and lifestyle changes to minimize future risk. Our approach to preventive cardiology includes:

Primary prevention: for those who are more prone to cardiovascular events

Secondary prevention: more of an ongoing maintenance check for those with known heart problems in order to prevent additional events

Comprehensive cardiac evaluation, testing and risk stratification, including individualized programs tailored toward patients’ needs.

Preventive cardiology is also a complete team approach. Clinicians, physical therapists, trainers nutritionists and therapists all work together to educate patients about lifestyle changes that dramatically impact cardiac risk reduction. The cardiologist play a key role in managing the patients medically. We always let patients know they can benefit from nutrition and exercise, stress management and integrative medicine classes that focus on their unique needs. When necessary, medicine can also be part of the treatment plan.

At Stamford Health, we offer all of the above. However, cardiologists work closely with your primary care physicians, as well as staff and providers in cardiac rehabilitation and the Center for Integrative Medicine and Wellness so that you can have a holistic approach to your care.

What is most gratifying for me as a physician is having a patient realize for themselves the dramatic impact lifestyle changes have on their life. They can come off their medication, have greater mobility and feel more in control of their health. That makes me feel as though I’ve really made a difference.

Heart attack symptoms in men

Heart attack symptoms in men: Watch out for these signs of heart attack in men
Myocardial infarction or heart attack is among the leading causes of death today. It is a serious health risk and several people suffer from a heart attack every year. Heart attack or myocardial infarction causes permanent damage to the muscle of the heart. It is caused by decreased blood flow to the heart, depriving the muscles of the heart of oxygen. The death is caused when the patient cannot reach the hospital in time after an attack. If the patient reaches the hospital in time, there is a 90 percent chance of survival of the patient with the modern treatment options available today. Decreased oxygen level affects the heart function. A heart attack is usually confused with cardiac arrest. In cardiac arrest, the heart stops working and death is imminent. If the heart attack is severe, it can result in cardiac arrest. Here are the signs and symptoms of heart attack in men. 

1. Chest pain
Chest pain is the main symptom of a heart attack. Sometimes, you may not experience chest pain at all. You may feel fullness, pain, slight pressure and squeezing in the center of your chest. The pain lasts over a minute then subside and then return. The pain can even spread to your back, shoulder, and arms. You will also experience pain in your neck, jaw and upper torso.

2. Chest discomfort
During a heart attack, you will experience discomfort in the center of your chest. The discomfort usually lasts for a couple of minutes, then subside and then return.

3. Shortness of breath
You will experience trouble is breathing during or before the heart attack. You will find it difficult to breath and this can happen with or without the chest pain or discomfort.

4. Nausea
This symptom is less common but is possible during a heart attack. The feeling of sickness or nausea along with burping or belching has been reported by many patients.

5. Toothache and headache
The pain that starts in the center of the chest spread down the arms and to the back. But, headaches and toothaches have been reported by many patients during a heart attack. Sometimes, the patient also feels dizziness and fainting.

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