“Another non-invasive test is an echocardiogram, which uses sound waves for testing. Among other things, this test lets us see how large the heart is, and how it is functioning,” says Arai.
“There is also a test in which a nuclear dye is injected into your system. By tracking the dye’s path we can see blockages,” says Suneja. These and other tests are done in a specialist’s office, outpatient clinic, or hospital.
About Angiograms
Perhaps the most common invasive procedure is an angiogram, which combines two diagnostic procedures. It starts with a cardiac catheterization, a procedure in which a catheter (a long, thin tube) is threaded from an artery in the leg up into your heart. Then a dye is injected into your heart and/or arteries. The angiogram then takes pictures and shows blockages.
“An advantage of an angiogram is that if the patient needs further work inside the heart, you are already inside and can proceed. You don’t need to put them through two separate procedures,” says Suneja.
Breakthroughs to Think About
“Angiograms have limitations. They only show narrowing in the coronary arteries, but blockages aren’t the source of heart attack. It’s plaque. There are a lot of plaques that don’t significantly narrow the artery, but can cause a heart attack,” says Steven Nissen, M.D., chair of cardiovascular medicine at the Cleveland Clinic.
That is one reason experts keep looking for new heart diagnostic techniques. “For 70 years we have had this sort of holy grail search to look at coronary arteries. Now with CT scans we can do it,” says Arai. “The new CT angiogram takes about 15 minutes and is relatively accurate. It can be a good test for someone considered only at a moderate risk for heart disease,” says Suneja.
Cardiac MRI is another area being explored. “The new ones are great for looking at how well your heart is beating, finding damaged areas, and tracking blood supply. It is also good at giving us images of a woman’s smaller heart, where it is easier to miss things,” says Arai.
Both tests can give surgeons a lot of information before an operation. However, neither is widely available (they tend to be found at major medical centers) and aren’t always covered by insurance.
Look Locally First
“For better recognized problems like chest pain or congestive heart failure, I send someone to the local cardiologist or local medical center with heart experts. Heart conditions need to be taken care of quickly and most people need a doctor or facility they can get to easily,” says Arai.
“If it is a more specialized problem, I direct them to a major medical center that is known for high quality cardiac care. At such facilities you can be more assured the professionals are skilled at performing and reading the diagnostic tests you need,” he adds.