by Dr. Don Rose,Writer, Life Alert
I now present the second part of my “Heart to Heart Talk” article, in the same question-and-answer format as Part One. Part Two focuses on various kinds of heart tests.
What is the purpose of a heart test?
Heart tests are typically done for one of two purposes: Screening or Diagnosis. Screening tests are done before any problems have surfaced, to determine if you are at risk for a problem or if a problem is beginning to develop. A diagnostic test typically comes after a problem is observed (by you or your doctor) and the doctor needs to determine the cause.
Which heart tests are best for me?
The answer “will depend on your age, symptoms, family history and other personal factors” with “no single test to diagnose heart disease.” Keep in mind that “the testing one person undergoes may be significantly different from what is best for someone else.” 
Which heart screening tests should most people have? What are some examples?
Screening tests help determine your “personal risk factors” for heart disease. As you embark on changes to your lifestyle, these tests can help you monitor your progress or tell you if you need to do more to reduce your heart disease risk. Below are the screening tests that most adults should get :
Blood pressure – should be checked each year; some drugstores now have blood pressure machines to check your BP ratio, but it’s best to have it done at your doctor’s office, not just to ensure accuracy but to get an immediate interpretation of the results. If your numbers are high (140/90 or above), it’s probably best to start monitoring it on a more regular basis. Another good idea would be to take action to reduce your BP ratio. How? Try eating less and exercising more (the one-two punch to lower body fat), as well as adopting a diet with more heart-healthy ingredients and less sodium. Many low-sodium products are on store shelves now, and some products - even some restaurant menus - use a red heart label for foods that benefit the heart. In some cases, you may want to ask your doctor about hypertension medication. The goal: reduce blood pressure to 120/80 or less.
Fasting lipid profile – should occur after turning 20; this test measures total cholesterol, LDL (bad cholesterol), HDL (good cholesterol) and triglycerides (a type of fat in the blood that can provide a useful measure of heart health). Repeat this test every five years if results are normal (i.e., under 200 mg/dl total cholesterol; under 100 LDL; and over 50 HDL for women, 40 for men). Redo test with more frequency if results aren’t normal (plus increase exercise, and do a diet lower in fat and higher in heart-healthy ingredients).
Fasting blood glucose – checks blood sugar levels (normal is under 100 mg/dl during a fast or first thing in the morning, while over 126 is diabetic level); lean, fit people without diabetes running in their family can wait till age 40 or higher for this test, while folks who are heavier or have diabetes in their family should be tested as early as their twenties. A high number means you should embark on a plan to lose weight, exercise more, and eat more “fruits, vegetables, fiber, whole grains and low-fat … products.” 
When would I need more specialized screening tests?
Such tests may be called for by a physician if, for example, heart disease runs in your family. They delve more deeply into “lesser-known blood factors that have been implicated in heart disease” such as:
C-reactive protein (CRP) – a “marker of inflammation.”
Lp(a) – a “harmful type of cholesterol that’s similar in chemical structure to LDL.”
Homocysteine – an amino acid.
Elevated levels of one or more of these three factors “can help physicians decide how aggressively to treat a person for other borderline-high risk factors.” 
What are some examples of heart diagnostic tests?
Electrocardiogram (EKG or ECG) – gives medical professionals a “graphic picture of the electrical impulses in the heart” in order to detect anomalies or defects, such as “abnormal heart rhythms, decreased blood flow to the heart or heart attack.”
Echocardiogram – uses sound instead of electricity to create graphic images of your ticker in order to see “how the heart muscle and valves are functioning.” This test may be called for “if a baseline EKG is abnormal or a heart murmur or hypertension is present.”
Stress test – comes in three varieties:
- Exercise stress test – you walk or pedal (treadmill or bike) while one of the “E” cardiogram tests above is run and “evaluates the heart’s response.”
- Nuclear stress test – both the name and description sound a bit scary: “a radioactive isotope travels into the heart and, with a scanning camera, provides a picture of how blood flows through the heart during exercise.”
- Chemical stress test – sounds even scarier: “uses synthetic medications that mimic the effects of exercise.”
CT scan angiogram – may be needed if the stress test “indicates reduced blood flow to the heart”; employs X-rays to produce “a cross-section view of the insides of the body.” Such scanned images “may be recommended if your doctor suspects unstable angina (chest discomfort) or if you’ve had an abnormal EKG or stress test or are having heart attack symptoms.” The angiogram “can also help pinpoint the location and amount of obstruction in a blood vessel.” The best part is that info-gathering via this “computerized tomography” process can be done in an “outpatient setting.”
Coronary angiography – an “invasive test, done in a hospital” during which “a catheter (tube) is inserted into an artery in the groin, and dye is injected into the coronary arteries to highlight blockages in the heart’s blood vessels.”
Ankle-brachial index (ABI) test – compares leg blood pressure ratio to arm blood pressure ratio, and can serve as a screening “for peripheral artery disease (PAD), a condition caused by plaque buildup in arteries outside the heart.”
Coronary artery calcium scoring – “uses a CT scan to find and quantify calcium deposits in the heart’s arteries” which can be “a sign of accumulated plaque, which raises heart attack risk.” Finding such deposits may spur your physician to be more aggressive with medication “to try to lower cholesterol or other risk factors.”
Today, greater knowledge exists about heart disease, its symptoms and how to detect them than ever before. However, it is also true that an increasingly younger group of people suffer heart attacks each year, due in part to a rise in obesity, poor dietary habits, lack of exercise and increased stress.
The first line of defense when it comes to your health is prevention. Live a healthier lifestyle (less stress, more exercise, better diet), and not only will heart emergencies become less likely but other health risks will also decrease.
After prevention, the best defense against health emergencies is medical emergency response protection by Life Alert. If an emergency strikes, one press of Life Alert’s ultra-light medical alert pendant signals the Life Alert Dispatch Center, which can then send immediate help, 24/7, 365 days a year. When it comes to staying protected in the event of heart attacks or other emergencies, Life Alert’s unique service is extremely helpful and often essential, especially for older Americans and folks living alone. Life Alert’s medical alert pendant is small in size, but its benefits are huge. It can literally save your life.
 “Heart Smarts” by Stacey Colino. CVS Healthy Living (A Medizine Publication), Spring 2009.
 “Heart Health”. Rite Aid Pharmacy guide.
 “Get the best vitamins for your heart.” Prevention, March 2007.
The information provided above is, to the best of our knowledge, reliable and accurate. However, while Life Alert always strives to provide true, precise and consistent information, we cannot guarantee 100 percent accuracy. Readers are encouraged to research any statements made and use any resource links provided to gather more information before drawing conclusions and making decisions.
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