Evaluation of Heart Disease

Evaluation of Heart Disease
Heart disease is the most prevalent medical condition in the adult population and is the number one cause of death is developed countries. This is a well-studied problem and medical science has outlined the pathophysiology, risk factors, as well as the signs and symptoms. This knowledge has lead to the development of effective treatment and preventive strategies. Death from coronary artery disease is preventable in most cases.

Chest pain, pressure or discomfort is the most recognizable symptoms however there are other signs suggestive of heart disease. Shortness of breath, nausea, pain in the arm or jaw, and extreme fatigue are also symptoms of coronary artery disease (CAD). Those with diabetes, family history of heart disease, elevated lipids, hypertension and obesity are at greater risk and should not hesitate to seek care if they develop any of the above symptoms.

The initial evaluation should consist of a complete history and physical examination. This allows the doctor to learn more about your medical history and risk factors. This helps then to develop a formal or informal risk assessment. The examination may reveal signs of long standing problems. Blood tests, chest x-ray (CXR) and electrocardiogram (ECG) are further test that may aide in evaluating your symptoms. The blood test searches for causes of the symptoms and evaluates the health of other organ systems. The CXR can look at the heart size and may show evidence of fluid in the lungs. The ECG shows the electrical activity of the heart and can provide evidence of current or previous heart ischemia or infarction.

Once this initial evaluation is done, further test maybe suggested depending on the results of the above tests and the risk assessment. The exercise stress test is the most common next step. The heart is monitored closely while walking or running on a treadmill. Exercise increases the work of the heart and therefore the demand for blood supply is greater. Partially blocked arteries are unable to deliver on this demand, resulting in ischemia in certain parts of the heart. This ischemia then leads to chest pain, also known as angina.

The exercise stress test has its limitations. Other test are indicated if a person is unable to exercise or unable to increase the work of the heart. Medications can be given to stress the heart. Radionuclide myocardial imaging, echocardiography and cardiac computed tomography (CT) either alone or in combination are alternatives for further evaluating the heart.

Coronary angiography, also called, cardiac catherization is indicated in the setting of a positive stress test or any other test that is highly suggestive of coronary artery disease. It is the gold standard by which the coronary arteries are directly evaluated. It involves the passage of a catheter from the femoral artery, through the aorta and into the coronary arteries. A radiolucent dye is injected and video imaging can view the degree of patency of the coronary arteries. This technique also allows for the placement of stents or the injection of thrombolytic medication to break up clots. Ischemic heart disease caused by arterial spasm and micro-vascular disease can’t be detected in this manner and this scenario explains why 41% of women with signs of ischemic heart disease have a normal cardiac catherization.

Heart disease is a serious condition and can lead to sudden death and significant morbidity. Tests are available to detect evidence of early disease providing an opportunity for early treatment, prevention of further damage and to potentially even reverse some damage. Understand your health history so you can know if you are at risk and seek immediate care if you have any symptoms of heart disease. This could be a life saving step.

I hope this article has provided you with information that will help you make wise choices, so you may:

Live healthy, live well and live long!

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