Tests for hidden heart disease
As men age, heart disease becomes a greater concern. Indeed, heart problems can develop seven to 10 years earlier in men than in women. Half of men who die suddenly from heart disease had no warning signs. Men worry, understandably, that they harbor a “heart attack waiting to happen” and wonder if high-tech tests can offer important information—or at least reassurance.
However, experts say that checking an otherwise healthy man for hidden heart disease is usually fruitless. “It is just throwing money and time down the drain, and it doesn’t achieve its intended purpose,” says Dr. Sekar Kathiresan, director of preventive cardiology at Harvard-affiliated Massachusetts General Hospital.
Indeed, an advisory report released in March 2015 by the American College of Physicians urged doctors not to use electrocardiograms (ECGs) and exercise stress tests to check men with no symptoms of heart disease. Other major medical organizations have taken similar positions.
Here is what you need to know to have an informed discussion with your doctor and make a smart cardiac screening decision.
What’s the right heart test for you?
There’s a good chance your first test will be noninvasive. This means it may be possible to obtain information without inserting needles or tubes into your body. “We usually start with the least complex and least expensive test, and go from there,” says Dr. Marcelo Di Carli, director of the cardiovascular imaging program at Brigham and Women’s.
A treadmill stress test is often the first test performed. You’ll walk at a brisk pace on a treadmill that’s slowly inclined to offer more resistance. This gets your heart pumping harder and faster. As you walk, an electrocardiograph measures your heart rate and the electrical activity in your heart, and your blood pressure is recorded periodically. A person who cannot walk on a treadmill will be given a drug to mimic the effects of exercise.
For this test, the patient is made to work hard e.g. run on a treadmill or exercise while the leads of EKG/ECG are placed over their body. Those who cannot exercise are given pills to raise their heart rate. The test detects the effects of the exercise on the heart.
In patients with atheroisclerosis and coronary heart diseases the arteries that are narrowed by plaques cannot supply adequate blood to the heart muscles while it is beating faster. This may lead to shortness of breath and chest pain. The EKG/ECG pattern, arrhythmias etc. also show the possibility of a coronary artery disease.
Blood pressure is an important measurement that can be taken by your doctor, nurse or healthcare assistant. It’s recorded as two readings:
systolic pressure (higher reading) – this records the pressure within the blood vessels as the heart contracts and forces blood out into the arteries
diastolic pressure (lower reading) – this records the pressure when the heart fills up with blood again
Your blood pressure fluctuates throughout the day, depending on what you’re doing. The “white coat effect” is when your blood pressure rises at the thought of having your blood pressure taken. To prevent this when you get your BP taken, try to relax. You might be asked to sit quietly for at least five minutes beforehand. Tell the person taking your blood pressure about any prescribed medicines you’re taking.
Sometimes your doctor may want you to monitor your blood pressure at home over a period of time. This can be either by 24-hour ambulatory monitoring or by home monitoring.
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