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To put it simply, there are two categories of heart health tests: functional and anatomic. But when it comes to all the contributing factors that can affect your life and treatment, there’s nothing simple about it.
“The information is very complicated,” Dr. Yale Wang, a researcher with Minneapolis Heart Institute Foundation and an interventional cardiologist at Abbott Northwestern Hospital, says. “Most of these tests are not black and white—they’re many shades of gray.”
And even when you look beyond the complexity, the concept of heart disease can provoke confusion and anxiety, he says. Often, “heart disease” acts as a catch-all phrase for all sorts of conditions that affect the heart’s structure and function, and can lead to life-threatening complications such as heart attacks, strokes, and sudden cardiac arrest.
Whether your family history poses concerns, your body is exhibiting new symptoms, or you’re just plain curious, there are multiple heart-health tests available to inform you of your current and future risk. To make your options a little more digestible (and a lot less daunting), ask your doctor about these five common tests.
Courtesy Dr. C and Mayo Clinic
Work Out Your Issues: Exercise Stress Test
This functional test illustrates how your heart handles exertion and, in turn, reveals blood flow problems. Dr. Panithaya Chareonthaitawee (affectionately called Dr. C), the director of the Nuclear Cardiology Laboratory at the world-renowned Mayo Clinic’s Rochester campus, says she’ll exercise a patient whenever possible to get more data for assessment.
How it works: Patients walk on a treadmill or ride a stationary bike for up to 15 minutes. At each three-minute interval, the test becomes more rigorous. The rationale is that the harder you work, the harder your heart has to work.
Before the test begins, your doctor attaches electrodes to your chest that are hooked up to an electrocardiogram (ECG) machine, which monitors electrical signals inside your heart. They’ll watch the ECG for abnormalities in your heart rate, breathing, and blood flow.
Why it’s useful: Stress tests are ordered to evaluate heart disease symptoms. Because you’re exercising, your heart should show clearer signs of any struggle. “If it’s heart disease, [symptoms] should be worse with exertion and activity,” Dr. C says.
Who it’s for: Though it has benefits for both men and women, this test is most accurate for men who are showing symptoms. If you’re outside this population, you might expect a different testing route. “It’s not very useful in females, actually,” says Dr. Elizabeth Grey, an Abbott Northwestern associate clinical cardiologist and researcher at the Minneapolis Heart Institute Foundation. “It’s the accuracy of a coin flip. You need to add imaging for women.”
Visualize a Solution: Imaging Tests
When an exercise stress test doesn’t show the full picture, or your ECG results have abnormalities, your doctor might order a functional imaging test—which includes stress nuclear tests and stress echocardiograms—to further assess your symptoms. These tests create images of your heart using ultrasound techniques, radioactive tracers, and specialized cameras.
Courtesy Dr. Grey
Stress Echocardiogram
How it works: This test uses soundwaves to produce pictures of your heart. It starts with ultrasound images and is quickly followed by an exercise stress test. “After you finish at peak heart rate, we get more images of the walls of the heart to see if one becomes weak,” Dr. Grey says. “If that happens, it implies the artery supplying that muscle is blocked.”
Who it’s for: In women, Dr. Grey says this is the test she’ll usually start with.
Stress Nuclear
How it works: Stress nuclear tests require a small amount of a radioactive tracer, which acts as a marker for blood flow through the arteries. The tracer (sometimes confused for a dye, Dr. C says) is administered through an IV, and images are taken before and after an exercise stress test with a specialized camera.
Who it’s for: Patients whose symptoms were not pinpointed during an exercise stress test alone, or if there are specific changes on your initial ECG, Dr. Grey says.
Why they’re useful: In both tests, doctors can actually see your heart beating and blood pumping at rest and during exercise, which can be useful in diagnosing heart disease or prescribing treatment.
If these tests uncover a lack of blood flow, your doctor might consider a CCTA test, also known as coronary computed tomography (CT) angiography, which looks directly at the vessels supplying your heart.
Matters of the Heart and Arteries: CCTA Test
The CCTA test is an anatomic study that relies on CT scanning to produce powerful images of your heart and its vessels. This test is unique from the other three for providing information on what’s actually inside the arteries. Though there are different types of angiograms, this one is non-invasive, uses contrast dye, and involves radiation.
How it works: A technician injects contrast dye via IV to make the arteries of your heart visible, Dr. Wang says. They position electrodes on your chest and administer a CT scan. Then, 2D and 3D images are produced of the arteries.
Why it’s useful: Dr. Wang says the test analyzes blood flow patterns and finds narrowed arteries in the heart, allowing doctors to visualize the artery and see where blockages might be. This test also provides a good look at the calcium in your arteries—a predictor of plaque.
Who it’s for: “It’s dependent on age, because as you get older, you tend to have more coronary calcification,” Dr. Wang says. Regardless of age, he says this test is ordered only for patients who have already demonstrated symptoms of heart disease.
Courtesy Dr. Wang
Just Checking: Coronary Artery Calcium (CAC) Scoring
For someone who hasn’t shown heart disease symptoms yet, Dr. Wang says they should consider a coronary calcium scoring test. He describes the test as a “consumer product” because you can order the study without a doctor’s referral. Not all health plans cover it, though, so prepare for an out-of-pocket expense of approximately $100, he says.
How it works: With dye, an ECG, and a CT scan, the specialized test detects calcium in your arteries. It measures the amount of calcium and calculates a score (ranging from 0-500). The lower your score, the lower your risk of developing heart disease.
Why it’s useful: High calcium scoring, which is ideal for individual risk identification, often correlates with future risk of heart attacks and strokes. By uncovering the amount in the arteries around your heart, Dr. Grey says doctors can be more or less progressive with prevention.
Who it’s for: Detectable calcium is more likely when individuals reach a certain age, explaining why the American College of Cardiology recommends CAC scoring only for men over 40 and women over 50. For individuals in this age demographic who have no symptoms and want to quantify their risk, Dr. Wang says it’s one of the best.
But for younger, asymptomatic patients out of this range, Dr. Grey says she’ll often suggest more common measures, like evaluating blood pressure and assessing cholesterol. She also emphasizes the importance of modifying risk factors, like smoking, obesity, and inactivity.
These tests have one over-arching purpose: “The real reason for these tests is really to decide how we should treat you,” Dr. Wang says.
Prevention 101: Kick Up the Cardio
When it comes to heart health, there are certain risk factors you simply can’t change—like age, sex, race, ethnicity, and family history. But with those come a number of preventative measures you can take to decrease your risk of future complications.
“The best treatment for all of this is exercise,” Dr. Grey says.
While Dr. Wang recommends 150 minutes of exercise on a weekly basis, Dr. Grey kicks it up a notch and goes as far as to suggest 225 minutes. On top of managing your weight and body mass index (BMI), she recommends at least 10,000 steps per day.
Other tips to keep your heart in tip-top shape:
- Eat a heart-healthy diet. Mayo Clinic suggests controlling your portion sizes and choosing more fruits, vegetables, and whole grains.
- Reduce your stress levels. C and Dr. Grey agree that stress reduction plays a larger role in heart health than you’d think.
- Manage your sodium intake, cholesterol, and blood pressure. The American Heart Association recommends less than 2,300 mg/day of sodium for healthy adults, and Dr. Grey stresses the importance of looking at your high-density lipoprotein (HDL) levels. In men and women, 60 mg/dL or above is desirable for optimal heart health, according to Mayo Clinic.
3 Sure-Sign Symptoms
Dr. C says she’s seen it all. There are plenty “textbook” signs of heart disease, she says, but there are even more atypical symptoms you’d never think twice about—like armpit or shoulder blade discomfort, and even teeth pain.
Specifically, she says women tend to display more unusual symptoms and sometimes present no symptoms at all. But everyone—men and women of all ages—should be aware of the sure-sign symptoms that something may be wrong.
- Chest discomfort. Patients often describe the feeling not as pain but as pressure. Imagine an elephant sitting on your chest.
- Shortness of breath. This symptom often presents itself during exercise only, and, according to Mayo Clinic, can be an indicator of heart failure.
- Diaphoresis. Also known as sweating, this symptom should be taken seriously—especially if it’s for no apparent reason.
Cardiologist-Approved Eats
It’s one thing for a doctor to recommend diet adjustments for heart health, and another altogether for them to develop foods for that exact purpose. Edina-based cardiologist Dr. Elizabeth Klodas’ line of Step One Foods smoothie mix, breakfast bars, pancake mix, and more use whole fiber, Omega-3 fatty acids, plant sterols, and antioxidants to help dieters lower their cholesterol and fight heart disease.
A study—partly funded by Step One and including independent scientists from Mayo Clinic—showed that diet alterations incorporating Step One products lowered cholesterol in participants after four weeks, without statins (medications formulated to lower cholesterol). steponefoods.com –Katie Ballalatak
The Minnesota-based cardiology experts in this article stress the importance of consulting your doctor with questions or concerns regarding your heart health. Though all of these tests are widely accessible at most hospitals throughout the Twin Cities and at Mayo Clinic in Rochester, they may not be as readily available at rural hospitals in Greater Minnesota.
