February 2008
Common tests for heart pain
Feeling a mild stab of pain in your chest is scary, since it may signal a heart attack.
Trying to decide what to do about it shouldn't be.
Unfortunately, making the right decisions when you’re suffering from chest pains (otherwise known as angina) isn't always easy. Getting the right tests at the right time is essential, but making the right choice isn't straightforward, in part because doctors don't always agree on when each test is justified. Rushing into invasive or unproven tests when simpler or more established ones would suffice exposes you to unnecessary risk and expense; failing to get the more involved tests when they are required may keep you from getting the treatment you need.
Coronary patients—and those who care about them—need to learn about the tests being used; this allows them to ask the right questions and, if necessary, seek a second opinion. Here's a concise guide to that essential information:
Electrocardiogram
In this painless, noninvasive test, electrodes attached to the chest pick up electrical signals from the heart, which are then displayed as a line on a graph.
An ECG reveals how fast your heart is beating, whether it’s beating in a regular pattern, and the size and thickness of the heart walls. It can even indicate whether you have had a heart attack.
Stress test
This noninvasive test assesses heart function and circulation while the muscle is stressed by exercise (walking on a treadmill). The test data are collected via ECG; in addition, the doctor might use sound waves to create a moving image of your heart as you exercise (an echocardiogram).
Echocardiogram
This test uses sound waves to produce an image of your heart. It can reveal how well your heart’s chambers are filling with blood and pumping, if your heart chambers are of normal size, if your heart muscle has any damage, and whether your heart valves are working properly.
Angiography
When the stress test yields worrisome results, follow-up angiography (the diagnostic gold standard) is warranted to pinpoint the arterial blockage. Skipping the stress test and going straight to angiography is justified in people who are extremely likely to have clogged arteries or have one of these conditions that make stress testing too risky:
Electron-beam computed tomography (EBCT)
Some doctors add this newer test, which detects calcium in the artery walls; some even substitute it for the stress test.
The calcium score seems to correlate fairly well with the overall extent of arterial blockage. But our medical consultants say the calcium test should not be used to assess chest pain, since it supplies only general information about the coronary arteries but none about how blood flows through those arteries, or what happens to them during exercise.
In people without symptoms, this test provides little if any information beyond what is known from standard risk factors.
CT angiography
This test uses an ultra-fast X-ray scanner to take up to 64 virtually simultaneous images of the heart, which a computer reassembles to create a three-dimensional image. Our medical consultants say most people are better off with standard angiography, usually preceded by a stress test. While those procedures are longer and less comfortable than CT angiography, they're still the gold standard for determining the extent of coronary disease. And they're needed to rule out severe blockage that might require bypass surgery, even if you've taken the CT test.
Plus, CT angiography is not without risks. The newest CT scanner, for example, exposes you to 80 to 325 times the radiation exposure from a standard X-ray, an amount that could cause death from cancer in up to 1 of every 2,000 people, according to some estimates.
Trying to decide what to do about it shouldn't be.
Unfortunately, making the right decisions when you’re suffering from chest pains (otherwise known as angina) isn't always easy. Getting the right tests at the right time is essential, but making the right choice isn't straightforward, in part because doctors don't always agree on when each test is justified. Rushing into invasive or unproven tests when simpler or more established ones would suffice exposes you to unnecessary risk and expense; failing to get the more involved tests when they are required may keep you from getting the treatment you need.
Coronary patients—and those who care about them—need to learn about the tests being used; this allows them to ask the right questions and, if necessary, seek a second opinion. Here's a concise guide to that essential information:
Electrocardiogram
In this painless, noninvasive test, electrodes attached to the chest pick up electrical signals from the heart, which are then displayed as a line on a graph.
An ECG reveals how fast your heart is beating, whether it’s beating in a regular pattern, and the size and thickness of the heart walls. It can even indicate whether you have had a heart attack.
Stress test
This noninvasive test assesses heart function and circulation while the muscle is stressed by exercise (walking on a treadmill). The test data are collected via ECG; in addition, the doctor might use sound waves to create a moving image of your heart as you exercise (an echocardiogram).
Echocardiogram
This test uses sound waves to produce an image of your heart. It can reveal how well your heart’s chambers are filling with blood and pumping, if your heart chambers are of normal size, if your heart muscle has any damage, and whether your heart valves are working properly.
Angiography
When the stress test yields worrisome results, follow-up angiography (the diagnostic gold standard) is warranted to pinpoint the arterial blockage. Skipping the stress test and going straight to angiography is justified in people who are extremely likely to have clogged arteries or have one of these conditions that make stress testing too risky:
- Unstable angina (heart pain that strikes when you're at rest or gets stronger or more frequent over a short time period).
- Aortic stenosis (narrowing of the heart's main valve).
- Congestive heart failure (inadequate pumping).
Some doctors add this newer test, which detects calcium in the artery walls; some even substitute it for the stress test.
The calcium score seems to correlate fairly well with the overall extent of arterial blockage. But our medical consultants say the calcium test should not be used to assess chest pain, since it supplies only general information about the coronary arteries but none about how blood flows through those arteries, or what happens to them during exercise.
In people without symptoms, this test provides little if any information beyond what is known from standard risk factors.
CT angiography
This test uses an ultra-fast X-ray scanner to take up to 64 virtually simultaneous images of the heart, which a computer reassembles to create a three-dimensional image. Our medical consultants say most people are better off with standard angiography, usually preceded by a stress test. While those procedures are longer and less comfortable than CT angiography, they're still the gold standard for determining the extent of coronary disease. And they're needed to rule out severe blockage that might require bypass surgery, even if you've taken the CT test.
Plus, CT angiography is not without risks. The newest CT scanner, for example, exposes you to 80 to 325 times the radiation exposure from a standard X-ray, an amount that could cause death from cancer in up to 1 of every 2,000 people, according to some estimates.
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