Heart tests that might save your life.

Heart tests will be done to determine if you’re having a heart event, especially, when you tell your doctor “I have chest pain”. For me it is not clear cut whether you are having a cardiac event or is something else going on? In your chest you have skin, muscles in between the ribs, ribs, lungs, esophagus, and heart plus associated blood vessels. That is a lot of stuff jam packed in there. So just because you have chest pain, it doesn’t mean your having a heart attack. However there is nothing wrong with going with the worst case scenario for peace of mind.

If a 48 year old man walks into my emergency department and says "I have chest pain that feels like an elephant sitting on my chest and goes up into my neck down my left arm"; whom is sweating, pale and smells of tobacco smoke and overweight. I am going to rush him into the department as fast as I can because he most likely is having a heart attack. This scenario has happened a handful of times given the number of patients we see. These are text book signs and symptoms of a heart attack. If everyone who is having a heart attack presented this way, it would make my job easier. The problem is that there are little nuances and subtleties to chest pain that it is not always clear cut. So we have cardiac tests that help rule out or rule in heart problems.

ECG/EKG are heart tests that will show us what the wiring of the heart is doing and whether or not a heart attack is happening right when the ECG/EKG is being done called an acute myocardial infarction. This shows us maybe 20% of the time any damage that is being done. It is an essential first step since everyone experiences pain differently the same holds true for any cardiac event.

Cardiac blood markers are heart tests drawn to determine if the heart has been damaged in the last 6 to 8 hours for troponin, 2 hours for CK-MB. Troponin is an enzyme the heart releases when damage has occurred in the past 6 to 8 hours. It rises for any cardiac injury and can be high after certain surgeries. Doctors will most likely repeat the test to time the result to 6 or 8 hours after the start of chest pain. Word of warning though some diabetics can have no chest pain and still have a heart attack called a silent MI. CK-MB is another cardiac marker call creatine kinase it is also released when heart muscle is damaged but it is not generally as sensitive of a test. These tests are generally the emergent ones your family doctor can order other test to rule in risks factors; such as Cholesterol/lipids screen.

The doctor may order heart tests as an outpatient screening such as a cardiac exercise stress test or persantine stress test. The doctor will hook up blood pressure monitoring equipment and an ECG/EKG machine while making you exercise on a treadmill of increasing difficulty. The doctor may or may not send you for a 2D echo which is an ultrasound of your functioning heart and can measure your heart’s output and look at the physical wall of the heart to determine if any cardiomyopathies or valve problems are evident.

Heart tests are not perfect and if they all come back negative and you have significant risk factors then consider it a warning sign or wake up call. If you do continue down the path with chest pain you will be burned at some point and you may not get a second chance.

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