To get to the “why” of your symptoms, your cardiologist may order one or several different heart tests. These noninvasive tests help your provider evaluate your condition and develop a treatment plan that works best for you.
Electrocardiogram (EKG or ECG)
To measure the electrical activity of your heartbeat, your provider may order an electrocardiogram. During this test, your cardiologist will consider the time between heartbeats (the interval) as well as the amount of electrical activity that passes through your heart. The procedure doesn’t take long, and it is conducted by applying sticky patches on your skin connected to the EKG machine via thin wires.
To create an image of your heart, an echocardiogram uses sound waves to see how blood moves through your heart and valves. This can be used in conjunction with exercise, called a stress echocardiogram, and monitors your heart at rest and during physical activity.
Also known as a stress echo, a stress echocardiogram monitors how well your blood vessels and heart are working. For the test, you’ll be monitored beginning at rest with up to 10 small, sticky patch-like electrodes on your chest. These connect to an electrocardiograph (ECG) to measure your heart’s electrical activity. And you’ll also receive a resting echocardiogram, or ultrasound. Then, your provider will have you use a treadmill or stationary bike to raise your heart rate. You’re measured again, and then monitored during your cool down as your heart rate slows, too.
Transesophageal Echocardiogram (TEE)
Similar to other echocardiograms, the transesophageal echocardiogram (TEE) uses an ultrasound to create a visual picture of your heart. However, this test is conducted by inserting a special probe into your esophagus (while you are sedated), to take a clearer picture of your heart. Your cardiologist may order a TEE for you if the standard echocardiogram didn’t provide a clear picture or in conjunction with heart surgery.
Cardiac CT Angiography
To get a better look at the arteries that feed into your heart, your cardiologist can use a cardiac CT angiography (CCTA). This imaging test is a noninvasive way to look for hard and soft plaques that may be narrowing your arteries. The CT scan is a powerful x-ray used in combination with dye inserted into your veins via IV to create detailed images of your heart. You’ll also have electrodes attached to your chest to monitor your heart rate.
Coronary Calcium Scoring
Used as a screening tool for people to identify their risk of heart disease, the coronary calcium scoring exam doesn’t use medication or injections. Instead, you answer a short questionnaire and then receive an EKG test. The coronary calcium scoring test takes into account risk factors (like age, family history, lipid profile, cholesterol, etc.) as well as the total load of hardened (calcified) plaque in your arteries.
To get a better understanding of how your heart functions over an extended period of time, your provider may recommend an event monitor. The monitor is used as an outpatient option to record and study your heart rhythm for any issues that aren’t captured by a standard EKG.
Another type of outpatient monitor — the Holter monitor — is a small, battery-powered, wearable device that monitors your heartbeat for much longer than an EKG. This is helpful if your symptoms are irregular or don’t happen frequently. When you wear the Holter monitor, you’ll also be asked to keep a record of your activities and any symptoms that you experience. This information will help your provider diagnose or identify other heart tests for you.
Treadmill Stress Test
Also known as a stress electrocardiogram (EKG), a treadmill stress test looks at how your heart functions at rest and when active. Your heart rate and blood pressure will be tracked by the EKG machine through sticky patches applied to your skin. Once your heart’s been recorded at rest, you will begin walking on a treadmill. You’ll start off slow and then increase in speed gradually. Your provider or technician will ask if you’re feeling lightheaded or any discomfort, and then will again monitor your cool down.
Nuclear Stress Test
To get a clearer understanding of how your heart functions under different levels of activity, your provider may recommend a nuclear stress test. During this procedure, dye is injected into your veins via IV. Then the first round of monitoring will begin at your resting heart rate. A special camera (known as a gamma camera) takes pictures of your heart and blood flow, and electrodes placed on your chest will monitor your EKG. You will then be asked to walk on a treadmill and the pace will increase until you’ve reached your target heart rate. Another round of dye will be injected, and then the camera will again take pictures of your heart and blood flow. The “resting” and “active” images will be compared to identify any issues.