Chest pains, also called angina, are scary, but are often triggered by non-cardiac causes such as underlying stress or anxiety. However, they can also be a symptom of life-threatening coronary artery disease, narrowing or blockages of the blood vessels that supply oxygen-rich blood to your heart.
That’s why the first step your cardiologist might take to diagnose your angina is a cardiac stress test. This non-invasive examination evaluates your heart’s electrical system and how well it works when physically taxed by exercise or medications.
The most common kind of stress test involves walking on a treadmill while your heart’s activity is monitored by an electrocardiogram (ECG or EKG). Your cardiologist will first study your heart while it is resting to obtain a baseline measurement. Then, every three minutes or so, the speed of the treadmill will be increased.
When stressed during exercise, a heart beats faster and blood supply to the organ increases. Blood supply to specific parts of the heart muscle may lag due to a blockage in one of the arteries, which could lead to symptoms of chest pain or shortness of breath and/or EKG changes.
A cumulative score called the Duke treadmill score, can be calculated from the time on the treadmill, EKG changes and symptoms of chest pain. This score will give your cardiologist the information he or she needs to determine whether or not you have a heart problem.
Other forms of stress testing involve imaging. These include:
- a stress echocardiogram, a non-invasive test that uses sound waves to visualize your heart’s structure and function before and after a stress test;
- a nuclear stress test, which uses a radioisotope tracer (usually thallium) to image a specific area of the heart muscle.
Patients who are unable to exercise on a treadmill due to other medical conditions—such a respiratory illness, hip/knee problem, or back pain—may undergo a pharmacological stress test.
This kind of test, explains Holy Name interventional cardiologist Tariqshah Syed, MD, requires the patient to lie down while the physician evokes the same kinds of responses from the heart with medication, as with treadmill exercise. “The patient is continuously monitored by a cardiologist and a nurse during all types of stress tests,” assures Dr. Syed.
Dr. Syed notes that when the blood supply to the heart increases during exercise or because of medications, it should increase to every part of the heart. “If not, then we suspect a blockage,” he says, “and portions of heart muscle might be in jeopardy.”
If these blockages are in small arteries or are not severe, medication and lifestyle changes, such as amping up exercise or quitting smoking, might be prescribed. If a large portion of the heart muscle is not receiving adequate blood, an angiogram using cardiac catheterization would be the next step, says Dr. Syed.
During an angiogram, a cardiologist threads thin catheters through the wrist or groin up to the heart to assess blood flow to the organ. If there is a blockage, an interventional procedure, such as angioplasty and stenting, may be used to open the blockage and keep it from recurring.
Depending on the patient’s diagnosis and prognosis, Dr. Syed says a cardiologist may recommend a follow-up exercise stress test and outpatient cardiac rehabilitation.
For a referral to a Holy Name Medical Center cardiologist please call 1-877-HOLY-NAME (1-877-465-9626).