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Making a patient wait for a Cardiac Evaluation is a RISK WE ARE UNWILLING TO TAKE! About every 26 seconds an American will suffer a coronary event and about every minute someone will die from one. 50 percent of men and 64 percent of women who died suddenly of CHD had no previous symptoms of this disease.
Major signs and symptoms of cardiac disease:
- Pressure, fullness, discomfort, or squeezing in the center of the chest.
- Pain that goes to your shoulders, neck, jaw, or arms.
- Discomfort in your chest with lightheadedness, fainting, sweating, nausea, or shortness of breath
What does a cardiac evaluation include?
Typically a cardiac evaluation begins with a cardiologist consult. A cardiologist is a physician trained in Internal Medicine, specializing in the heart and vascular system. A resting 12-lead electrocardiogram is often performed to detect irregular heart rhythms or old injuries to the heart.
The next commonly used test is called an Echocardiogram, and it gives the cardiologist data about different parts of your heart using three different techniques: The M-mode is used to measure the size of the heart chambers and the thickness of the heart walls. The two-dimensional echo shows the heart wall motion. A third technique, the Color flow Doppler echo is used to assess the direction and velocity of the blood flow through the heart chambers and valves.
Of the non-invasive tests, the simplest is a Treadmill Stress Test, where the patient walks on the treadmill, and the cardiologist assesses the EKG before, during, and after the test for specific abnormalities. Unfortunately, this treadmill Stress test is only about 60-70 percent accurate. Also, false abnormalities often occur, especially in female patients.
A big step beyond is a Nuclear Stress Test, of which there are two kinds. In a Treadmill Nuclear Stress test, the patient performs the Treadmill test as above, and then gets a tiny IV injection of an isotope (you could call it “liquid x-ray”) which give pictures of the heart muscle, and how much blood it receives before, and after the exercise. Abnormalities in these pictures give the cardiologist clues about where and how severe a heart blockage could be.
For patients unable to walk on a treadmill, there is a chemical Nuclear Stress test, in which the patient receives a tiny IV dose of a drug that chemically mimics the effects of the physical exercise. This drug lasts in the body for a few seconds, and then “dies”, with no further side effects.
A Nuclear Stress test gives a lot more information than the simple treadmill test, not only about possible heart artery blockages, but also about any previous heart attacks, the current strength of the heart, and any threat of a future heart attack.
A totally normal nuclear stress test has an accuracy of over 95 percent in diagnosing heart artery blockages. Rarely, in about 5-10 percent of patients, the nuclear stress test may be falsely normal, i.e. it may be normal, and the patient may still have significant underlying heart artery blockages. On the other hand, the nuclear stress test may be falsely abnormal in about 10 percent of patients, i.e. it may be abnormal, but the patient would not have significant heart artery blockages.
On a scale of 1 to 10, the EKG has an accuracy of about 1 or 2; the echo has an accuracy of about 4 or 5, the treadmill test about 6 or 7, and the nuclear stress test of over 9.
It is only after doing all three—the EKG, the Echocardiogram, and the Stress Test— that the cardiologist gets a complete picture of the patient’s heart.