Slidell Memorial Hospital Cardiology Services Heart Health Series: Part 2

Part 2

Detecting Heart Disease: Which Test You Choose Matters

It probably comes as no surprise that early detection of heart disease is crucial to successful treatment. What may surprise you, however, is the sheer number of tests your cardiologist has to choose from.

For many years, testing options were limited. Not so anymore. Cardiologists now have advanced imaging and blood tests that provide a much more accurate assessment of heart attack risk.

Choosing the right test is important, especially for women, since phases of the menstrual cycle and use of birth control pills have been shown to throw off results, indicating that estrogen's effects on heart cells might be a factor.

Having more options has improved early detection dramatically, but it has also made choosing the right test seem more daunting for patients. It can feel overwhelming at times, and that can be enough in itself to dissuade some patients from getting tested.

Fear is Your Enemy

Fear is as much a killer as heart disease itself, especially if it prevents you from getting tested in the first place. Whether it’s fear of the test procedure itself, or fear of negative results, it’s dangerous. Damage from heart disease is cumulative, and if you are developing or already have heart disease, waiting to find out not only delays treatment, it makes it less likely that treatment will be as effective long-term at preventing death from heart attack or heart failure.

That said, it is normal to have some trepidation, especially of the unknown. All the more reason we want you to have as much information as possible on the various tests we offer at Slidell Memorial Hospital Cardiology Services. We hope a better understanding of these tests not only helps you select the ones best suited to your needs, but also helps you face them without fear.

Heart Disease Detection Test Options

The following is a list of seven tests available now to detect heart disease in patients at risk. Familiarizing yourself with these tests will help you better prepare to discuss your options with your cardiologist.

Cardiac Calcium Scoring

Best for: Patients 50 or older with risk factors, or younger with a family history and several risk factors. Since the test involves x-rays, women shouldn't have it if there's any chance they might be pregnant.

How it works: A CT scanner checks for atherosclerotic plaque (made up of calcium, cholesterol, and scar tissue) in your heart's arteries. After electrodes are attached to your chest and to an EKG machine that monitors your heartbeat, you lie on an exam table that slides into a short, doughnut-shaped tunnel and hold your breath for 10 to 20 seconds.

You'll get an Agatston score (named for the doctor who developed the test) that indicates the total amount of hard and soft plaque in your heart's arteries. A score of zero means you have no calcium deposits and a low risk of heart attack in the next 5 years. A score of 400 or more puts you at high risk of a heart attack within 10 years; a score of 1,000+ means you have up to a 25% chance of having a heart attack within a year without medical treatment.

If your score is 200 or higher, your doctor may advise lifestyle changes, a statin to lower cholesterol, or a diabetes drug to lower blood sugar—all of which will also reduce plaque.

Carotid Intimal Medial Thickness Test

Best for: Patients 40 or older, or patients under 40 with a close relative (parents or siblings) who’ve had heart attack or a stroke before age 55. This test does not involve x-rays, so it’s a good test for pregnant women as well.

How It Works:This test takes a picture of the left and right carotid arteries, which supply blood to your head and brain. After putting a gel on your neck, a technician uses anultrasound transducer over your carotids to measure the thickness of the arteries' lining. Studies show a link between abnormal thickness of the carotid lining and coronary artery disease. The test takes about 15 minutes.

You'll get two numbers: the thickness of your carotid lining (normal is less than 1.06 mm) and your "arterial age," an estimate of how that thickness compares to that of healthy women your age. If your arteries are more than 8 years "older" than you are, your doctor can tailor treatment to reduce your risk.

High-Sensitivity C-Reactive Protein Test

Best for:Patients 40 and older.

How it works: This is a blood test that measures CRP, a protein in your blood that's a strong indicator of inflammation throughout your body. The test takes about 5 minutes.

Cholesterol plaque injures blood vessels, triggering inflammation and raising CRP levels in your blood. That's dangerous because women with high levels of CRP may be up to 4 times more likely to suffer a heart attack or stroke. A high CRP is most dangerous if you also have another risk factor: a waist circumference of more than 35 inches, indicating the presence of belly fat.

If your score is under 1.0 mg per liter, your risk of developing heart disease is low. A score between 1.0 and 3.0 mg/l equals average risk. Above 3.0 mg/l, you're at high risk. It's possible to have high CRP without heart disease, though, because infections and injuries can also trigger a spike in levels.

High CRP is not a warning sign though unless you’ve had three positive results on three separate occasions, and there’s no other reason for inflammation. If you get three high scores, you need cardiac calcium scoring and the CIMT test to check your blood vessels.

Advanced Lipid Profile and Lipoprotein(a) Test

Best for: Patients with a family history of heart disease.

How it works: Unlike the traditional cholesterol blood test, which measures total cholesterol, HDL, LDL, and triglycerides, the advanced test also looks at particle size. This is important because some particles are big and fluffy, so they tend to bounce off artery walls as they travel through the body. Others are small and dense, meaning they can penetrate the artery lining and form clumps of plaque. The Lp(a) blood test analyzes a specific type of cholesterol that can triple heart risk.

Sizing particles provides a clearer picture of heart risk than the conventional test: Having a lot of large particles cuts risk, while small ones raise it. The more Lp(a) you have, the worse it is too—it makes LDL particles extra sticky, so they cling to the lining of blood vessels, causing plaque and clots. The test takes about 5 minutes.

Levels above 30 mg/dl put you at increased risk, and your doctor may prescribe medication or Niacin supplements.

A1C Blood Glucose Test

Best for: Patients 45 or older, or earlier if for patients who are overweight and have one or more diabetes risk factors, such as family history, high triglycerides, or low HDL.

How It Works:A blood test indicates your average level of blood sugar over the prior 3 months. Unlike other glucose tests that require fasting or drinking a sugary beverage, this test requires neither. The test takes about 5 minutes

This test is the easiest way to predict future diabetes risk, and diabetes is one of the major risk factors for heart disease.

An A1C level between 4.5 and 6% is normal, between 6 and 6.4 indicates prediabetes, and 6.5 or higher on two separate tests means you have diabetes.

Genetic Tests

Best for: Patients 40 and older

How They Work:A blood sample is tested at a lab for mutations of the KIF6 and APOE genes. The test takes about 5 minutes.

A common variation in the KIF6 gene and two mutations in the APOE gene raise your heart disease risk.

A recent study found that people with a certain variant of KIF6 had a better response to statin treatment, with a 41% drop in heart attack risk, while people without this mutation didn't respond as well, with a 6% drop.

Stress Echocardiography

Best for: Patients who already have signs of heart disease, regardless of age.

How It Works:This test is an improvement over the standard stress test because it adds an ultrasound both before and after exercise to evaluate blood flow to your heart's pumping chambers and check for blockages in the arteries that supply the heart.The test takes about 45 minutes.

Adding echocardiography to the standard stress test raises accuracy by as much as 85% for women.

If the test detects reduced blood flow, one or more of your coronary arteries may be blocked.

Why Choose Slidell Memorial Hospital Cardiology Services

Now that you know more about the different tests available and why they are so important, we want you to know that Slidell Memorial Hospital Cardiology Services is here to help you choose the right detection options for your unique healthcare needs.

Slidell Memorial is the most experienced hospital in cardiac services on the Northshore, consistently being first to offer new, innovative services in cardiac care. Our physicians are clinicians are here to offer you the latest state-of-the art detection and diagnostic tests, and if necessary, treatment and rehabilitation care options.

For example, in 2004, SMH became thefirst facility in East St. Tammany Parish to offer multi-slice CT scanning, which provides highly detailed images of the circulatory system and internal organs.

The 16-slice scanner and its new64-slicecounterpart give SMH physicians and patients access to potentially life-saving technologies such as CT angiography, CT fluoroscopy and calcium scoring, all non-invasive procedures that can detect problems early, when they are most treatable.

The 64-slice scanner is fast enough to create a clear, stop-action image of a beating heart while requiring nothing more invasive than an IV injection in the patient's arm.

Remember, forewarned is for-armed, and we at SMH Cardiology Services are here to help you fight, and win any battle with heart disease.

As a 229-bed acute care hospital located in the heart of Slidell, LA, Slidell Memorial Hospital provides access to cardiology services, as well as the latest treatments, technology and expert physicians.