Diagnostic heart tests

When you're facing a potential heart or vascular condition, you want answers as quickly as possible. At HonorHealth, we've streamlined the way you're diagnosed through revolutionary research, the latest technology and compassionate care.

Revolutionary Technology

HonorHealth's specially trained cardiologists and radiologists work together to provide a full evaluation of your individual risks and symptoms. Using the latest in imaging techniques, they'll partner with you to diagnose and help you make important decisions about your care and treatment.

HonorHealth uses the latest technologies to diagnose heart attack, cardiac arrest, heart failure, cardiac arrhythmia, heart valve disease and peripheral artery disease, including:

• Real-time catheter tracking: John C. Lincoln Medical Center is the first in Arizona, and only one of eight hospitals in the U.S., to reduce radiation using precise, real-time catheter tracking for patients undergoing pacemaker or defibrillator implantations.
• An implantable pulmonary artery monitoring device that is indicated for patients diagnosed with NYHA Class III Congestive Heart Failure.
• A coronary imaging system, a diagnostic tool that detects lipid core-containing plaque, a deadly type of fat in the bloodstream. This plaque is believed to be the culprit in most sudden cardiac deaths, strokes and non-fatal heart attacks. This system can find this dangerous plaque, which more mainstream tests like treadmill exams and coronary angiograms miss, and help get you started on your way to a healthier heart. HonorHealth had the first team that offered this technology in Arizona.
• Cardiac computed tomographic angiography (CCTA): This type of imaging uses a computed tomography (CT) scanner to look at the heart's structures and blood vessels. These vessels are more difficult to view because they're small and move quite fast with the heartbeat.
• Nuclear perfusion imaging: This nuclear technique is used for cardiac imaging with single photon emission computed tomography (SPECT) and positron emission tomography (PET). Radioactive agents called radioisotopes are injected into the bloodstream to assess blood flow to the heart. These tests are performed at rest to assess the adequacy of blood flow to the heart in a non-exertional state, and also during stress through exercise or medications.
• Myocardial perfusion imaging: This nuclear medicine procedure illustrates the function of the heart muscle to evaluate coronary artery disease (CAD), hypertrophic cardiomyopathy and abnormalities in heart wall motion. This scan is done in conjunction with a cardiac stress test.
• PET Imaging: Positron emission tomographic scanning, or PET scanning, is a nuclear imaging test that measures important body functions including blood flow, oxygen use and sugar (glucose) metabolism to help doctors evaluate how well organs and tissues are functioning. If you have had heart attacks due to blocked coronary arteries, a PET scan can assess the extent of heart muscle damage and help determine if interventions to improve blood flow to the area of the damaged heart muscle will allow some recovery of function.
• Holter and event monitoring: Holter and event monitors are ongoing, portable electrocardiogram (ECG) tests that track when a heart is beating too quickly, too slowly or in an irregular manner. A Holter monitor is typically worn in a pouch around the waist for a day or two, to continuously record heart activity. If you experience an irregular heart rhythm, you can press a button to record symptoms, which later are analyzed by an arrhythmia specialist. An event monitor is worn for weeks or months. The device records heart activity only when you experience symptoms and activate it.

Diagnostic Heart Tests

Blood Tests:

Blood tests play an important role in confirming — or ruling out — heart conditions such as coronary artery disease and heart failure. Blood tests can measure these and other biomarkers:

• B-type natriuretic peptides (BNP) produced by the heart to help the body eliminate fluids from the body. High levels of BNP can signal damage to the heart muscle and heart failure.
• Blood urea nitrogen (BUN) tests for elevated levels of urea nitrogen, a sign of kidney failure. BUN is often tested when heart failure is suspected.
• C-reactive protein produced by the liver in response to injury (inflammatory disease). High levels of C-reactive protein can signal atherosclerosis (narrowing of the arteries).
• Enzymes: When damaged, a heart may release enzymes. Elevated enzyme levels indicate whether a heart attack has occurred, and can predict heart disease risk.
• Fibrinogen, a protein that helps the blood clot. High levels of fibrinogen can indicate risk of a blood clot, resulting in heart attack or stroke.
• Glucose (blood sugar): High glucose levels can indicate diabetes, a major risk factor for coronary artery disease.
• Homocysteine, a protein that builds and maintains tissue. Too much homocysteine can increase risk of stroke and coronary artery disease.
• Lipids: A lipid panel or profile offers a reading on fats (lipids) in the bloodstream. Elevated lipid levels can help predict risk for heart attack and heart disease.

Other Diagnostic Tests:

• CT scans: Computed tomography (CT) scans use advanced X-ray technology to produce high-resolution, three-dimensional images of the heart and surrounding arteries. The test can be used to locate arteries narrowed or blocked by plaque, investigate congenital heart disease and evaluate the heart prior to surgery.
• Cardiac catheterization: A thin, flexible tube (catheter) is guided through a major artery to the heart to measure blood pressure, blood oxygen levels and the heart's overall pumping strength. A contrast dye may be injected into the blood to reveal if arteries near the heart are blocked or narrowed by plaque. If so, these obstructions can be removed immediately.
• Cardiac CT scan angiography (CCTA): CCTA is a noninvasive test that allows physicians to see important blood vessels feeding the heart muscle. Contrast dye injected during the scan shows blood flow in the coronary arteries. Software manipulates the data into three-dimensional images to reveal any coronary artery atherosclerosis, helping your doctor determine your risk for a heart attack.
• Echocardiography: An echocardiogram is a painless, noninvasive ultrasound of the heart. The test enables doctors to assess the size, structure and function of the heart as it pumps blood. The test helps detect abnormal communications between the heart's left and right sides, the leaking of blood through the valves and calculation of cardiac output.
• Ejection fraction testing (EF): Typically performed with an echocardiogram, an EF test measures how much blood remains in the heart's pumping chambers (ventricles) after each heartbeat.
• Electrocardiogram (ECG) and heart rhythm monitoring: An ECG measures the heart's electrical activity through electrodes taped to your chest, arms and legs. An ECG can help assess heart rhythm, check blood flow to the heart, diagnose heart attack and investigate heart muscle irregularities.
• Electrophysiology (EP) study: An EP study investigates the electrical patterns of the heart and can be helpful in determining the cause of an abnormal rhythm (arrhythmia) of the heart. In a typical procedure, a catheter is guided along a blood vessel to the heart. At the end of the catheter, tiny electrodes gather data on the heart's electrical signals. These electrodes also transmit electrical impulses to the heart muscle to either trigger or turn off an abnormal heart rhythm, or pinpoint the source of incorrect electrical signals. An EP study can be followed by radiofrequency ablation that delivers high-energy electrical signals to inactivate abnormal heart tissue causing arrhythmias.
• Exercise stress test: This provides readings of heart activity during and after exercise. A doctor can see how well the heart performs under stress and identify problems that may not be apparent when the heart is at rest.
• Cardiac magnetic resonance imaging (MRI): A cardiac MRI is a noninvasive, painless test to:
  • Evaluate the function of cardiac valves.
  • Assess for diseases causing the heart muscle to thicken or stiffen, or the heart chambers to dilate.
  • Assess for abnormal vascular connections that characterize congenital heart diseases.
  • Find the presence of obstructive coronary artery disease.
• Tilt-table testing: This measures how well the body's nervous system regulates blood pressure and heart rate. You're secured to a table in a horizontal position. The table is then tilted, with your head up, at 60 degrees for five minutes. Abnormal blood pressure may signal the need for a pacemaker.
• Transesophageal echocardiogram (TEE): A standard echocardiogram (ECG) uses ultrasound waves to produce images of the heart. The ultrasound device is guided down the esophagus, producing even more detailed, close-up images of the heart's valves and chambers without obstruction from the ribs and lungs. TEE can help find blood clots in the heart's filling chambers (atria), which result from atrial fibrillation.
• Ultrasound and vascular ultrasound: Ultrasound uses high-frequency sound waves to create graphic images of the heart and blood vessels. Ultrasound can produce moving images of the pumping heart, as well as the direction and prevalence of blood flow throughout the body's arteries. Ultrasound is a leading test for peripheral vascular disease, a condition in which plaque deposits develop in the arteries of the neck, arms and legs.
  • Vascular ultrasound — also called a duplex study — examines blood circulation in the arms and legs. The test can calculate the speed of blood as moves through blood vessels. In a heart mapping procedure, it can highlight one or more blood vessels that require a bypass graft.
  • X-rays: One of the first diagnostic imaging techniques to be invented, X-ray can still play an important role in detecting heart conditions. Chest X-rays can help diagnose congestive heart failure, show heart infections and enlargement, and even sometimes calcified heart valves or coronary arteries.