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Testing for Heart Disease
February 2000

Q. I am a 50 year old male and I notice I have been experiencing chest discomfort along with shortness of breath when I exert myself. My dad had a heart attack and I am worried that I may have heart disease. What is the best test to check for this?

A. Good question! First I would want to know if you have other risk factors for heart disease such as smoking, high blood pressure, diabetes, high cholesterol, obesity or lack of exercise.

However, in your case, regardless, you need to be evaluated. A physical exam and resting EKG is important to start with. After that, a type of stress test would be important. A treadmill stress test is still probably one of the most useful tests to help determine if there is coronary artery disease (narrowing of the heart arteries that can cause angina (chest pain) and heart attacks). Adding a substance called cardiolyte that is injected in a vein and normally gets concentrated in the heart with exercise (as seen via imaging camera) will increase the accuracy of the treadmill stress test. If this is normal, it makes it much less likely that you have coronary disease. If it is abnormal, then you likely should have a cardiac catheterization where a catheter is threaded up a groin artery up into the heart arteries and dye is injected and x-rays are taken. This is probably the most accurate way to see if there are any narrowing of any coronary arteries. If so, often, at the same time, a catheter with a balloon on it can be put in the narrowed artery and open it up (Angioplasty). Often, stents (a firm tubular piece) can be placed there to keep the artery open longer term. Of course in more severe cases, open heart surgery to bypass the blocked arteries may be needed.

There are other types of stress tests such as a stress echocardiogram which is also a very good way to test for heart disease. Of course you should discuss this with your doctor to see which test is most appropriate for you.

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