Dr Arvind Kohli
India is now dubbed as the diabetes capital of the world. It may soon become the capital of cardiac diseases as well, despite most sophisticated techniques available for treatment. Faulty lifestyle is the biggest culprit. Unhealthy diet, that is-rich in sodium, calories and fats, produces harmtut chemicals that block arteries and cause heart attacks. Stress, fit-of anger and erratic working hours add to the problem. As more youngsters are adopting such a lifestyle, they are falling a victim to these diseases. Out of 100 cases, at least 20 cases are of youngsters between 30-40 years.
Diagnosis & Tests
In order to check the increasing spectrum of cardiac ailments, it is very important to make the people aware about the various investigations and diagnostic test available to identify the cardiac ailment and then objectively treat it. Following are the armamentarium of diagnostic tests-available.
The ECG is the most common test for heart conditions. It is a simple, painless test that takes about 10 minutes.
Every time the heart beats, natural electrical currents can be picked up by electrodes placed on the chest, arms and legs. An electrocardiogram machine records your heart’s rhythm onto paper. The recording will show whether the heart muscle is damaged or is short of oxygen.
Exercise ECG (treadmill test or stress test
Some heart problems only appear when your heart needs to work harder. Your may need an exercise ECG (a continuous ECG) to show how your heart is coping when you are exercising, instead of resting. While you walk on a treadmill, which will slowly get faster and tilt uphill, your heart rhythm and blood pressure will be reported. The test takes about 10 minutes.
Holter monitoring (24 hours ECG)
The Holter monitor is used to identify any heart rthythm problems. The Holter monitor is a small, portable, battery powered ECG machine worn when at home over a 24 to 48-hour period. It will record your heart rate and rhythm over this time and you will be asked to keep a diary of what you do and any symptoms that you experience while you are wearing the Holter monitor. At the end of the time period, the monitor needs to be returned to the hospital or clinic so that the recorded information can be studied.
This test uses ultrasound (sound waves) to study the structure of your heart and how the neart and valves are working. A probe is passed over your chest and heart which sends out and records these sound waves, showing a moving image of your heart on a computer and shows efficiency of heart functions.
Echocardiogram stress test
A stress echo test is performed to see how your heart works while your exercise. An echocardiogram is taken while you rest, you then exercise, and then another echo is done while your heart is beating fast. Alternatively, if you are unable to exercise, you are given medication via an intravenous (IV) needle in you arm which makes your heart react as if your body was exercising.
‘‘Thallium scan’’ or “nuclear scintigraphy”, this stress test is similar to an echo stress test, but it focuses in more on the coronary arteries and their ability to deliver blood to the heart under stress. A Thallium stress test may be indicated if the echo stress test was inconclusive,or it may be done instead, if there is a likelihood of coronary artery disease. Thallium scans ar also done after a bypass or angioplasty to evaluate the success of the procedure. Sometimes technetium is used instead of thallium as the radiopharmaceutical agent.
Transoesphageal echocardiogram (TOE)
A TOE is a special type of echocardiogram. Pictures of your heart are taken by inserting a probe into your throat (oesphagus). These pictures are clearer because the oesophagus is close to your heart and there is no chest wall in the way.
A local anaesthetic solution is sprayed onto the back of the throat to numb the area. Although yu will be awake during the procedure, you will be given some medication to make you feel relaxed and drowsy.
Your nurse will advise when you can eat and drink again; this is usually about two hours after the test. Occasionally people have a sore throat for 25 hours following the procedure.
Electrophysiological studies (EPS)
Electrophysiology studies is the investigation of choice if you have an abnormal heart rythm or palpitations. Similar to an angiography, fine tubes called electrode catheters are introduced through a vein and/or artery, usually in the groin, They are then gently moved into position in the heart, where they stimulate the heart and record the heart’s electrical activity.
Blood tests for cardiac troponin measurements can help either confirm or exclude a heart attack in a person who may be having or recently had a cardiac event. They can also help decide what treatments a person with unstable angina may need.
Troponin T and Troponin I are proteins that are part of the heart or cardiac muscle. When heart muscle injury occurs, these proteins are released. This makes them a valuable test to detect mild heart attacks. They can be detected in blood as early as three hours after a heart attack associated chest pain starts. The levels peak at 10 to 24 hours and can still be detected up to five to 10 days later.
Angiography (cardiac catheterization)
Coronary angiography is an x-ray procedure used to examine the arteries of the heart. An introducing sheath is inserted into an artery, usually in your groin or arm.
A catheter is threaded through this to the part of the aorta near the heart, where the coronary arteries start. A special dye is injected through the catheter, into your bloodstream.
X-rays of the heart and coronary arteries are then taken. The dye highlights the coronary arteries and the narrowings in them. Your cardiologist with then review the x-rays and discuss the results with you. Coronary Angiography presently is gold standard test for diagnosis of Coronary artery disease.
Take Home Message
It is important to emphasizes early detection of heart disease through screening, medical evaluation and noninvasive diagnostic testing because knowing it earlier will make it easier to cure and faster. Early detection and testing are especially important if someone is experiencing symptoms indicative of a heart condition, including chest, neck, jaw or arm discomfort, especially with activity, frequent indigestion or abdominal discomfort shortness of breath; easy fatigability decreased effort tolerance; palpitations; and lightheadedness or fainting….With such basic and advanced investigations now available the objective management of cardiac ailments is revolutionzed.
Dr Arvind Kohli