Initial Cardiac Screening Tests

Physical Examination

The first interaction between the doctor and patient is the physical examination. After a series of questions about symptoms and lifestyle, the doctor measures blood pressure and heart rate, checks temperature and skin color, and examines neck veins. Breathing is also auscultated, as an irregular heart rhythm may indicate a malfunction of the heart valves. Auscultation of the heart allows for the detection of any potential heart murmurs or arrhythmias before the electrocardiogram. Finally, the cardiologist checks for swelling in the abdomen, ankles, and legs.

Electrocardiogram (ECG)

The ECG measures the heart's electrical activity, measuring the intensity and duration of these signals as they pass through the heart muscle. Generally, an ECG isn't recommended without symptoms, but it is recommended when the patient complains of certain disorders, such as arrhythmias (alterations in heart rhythm), hypertension, chest pain, etc.

The ECG alone doesn't allow for a precise diagnosis, but anomalies in electrical conduction, heart rhythm, or axial deviations (i.e., from the physiological position of the heart relative to the horizontal axis) indicate a potential problem requiring further investigation with more specific tests.

Blood Tests for the Heart

Cardiac biomarkers such as troponin, proteins released when muscle cells are damaged, can be included in blood tests. These heart-specific biomarkers may also be ordered alongside more general blood tests, such as:

• Hemoglobin analysis, a test that evaluates pH and oxygen and carbon dioxide levels;
• Complete metabolic panel (CMP), a group of tests used to evaluate organ function;
• Electrolytes, which measure the body's salt and water balance;
• Stress test;
• A typical diagnostic test offered during sports examinations, the "stress" ECG, as it is commonly called, is performed during moderate physical activity, usually walking on a treadmill or cycling. It's useful because it measures the fatigue the heart muscle shows during physical exertion. Movement requires greater blood flow to the heart compared to rest, hence the importance of monitoring the organ's reaction to stress. If the slightest effort "tires" the heart too much, further diagnostic investigation is necessary. For example, using Holter monitoring;

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Holter Monitoring

Holter monitoring is continuous ECG monitoring that measures the dynamic evolution of the electrocardiogram. It allows monitoring of cardiac efficiency and rhythm regularity over 24 to 48 hours, using a device the patient wears day and night. The Holter records the duration of heart contractions and their frequency at rest and during exertion, i.e., during normal daily activities. It consists of a part fixed to the chest with wires and electrodes that connect to a second, battery-powered unit worn in a pocket or attached to a belt.

Echocardiography

Echocardiography allows for the detection of:

• Damage from a myocardial infarction (when blood supply to the heart stops);
• Heart failure (when the heart is fatigued and cannot pump blood effectively);
• Congenital heart disease (cardiopathy);
• Heart valve problems;
• Cardiomyopathies (thickening or expansion of the heart walls);
• Endocarditis (inflammation of the inner walls of the heart);

This examination is also necessary to monitor cardiac activity in patients who have had a heart attack or undergone heart surgery. A cardiac ultrasound usually takes 20 to 30 minutes.

In cases where echocardiography is uninformative, such as in heavy smokers, a cardiac MRI is performed.

Myocardial Scintigraphy

If there is doubt concerning the myocardium, the doctor recommends myocardial scintigraphy, which examines blood flow in the arteries and myocardial perfusion using a radiopharmaceutical product that binds to the heart muscle, both at rest and under stress. It is performed in cases of ischemic heart disease (myocardial infarction, angina pectoris) and helps the doctor decide whether or not to perform a coronary angiography.

Coronary CT Scan and Coronary Angiography

Coronary CT Scan

A coronary CT scan produces images of anatomical cross-sections using X-rays, useful for identifying the state of the coronary arteries and the presence of lesions. The patient lies on a couch that moves into the tomography apparatus. If a coronary artery lesion is suspected, coronary imaging is performed.

Coronary Angiography

If there is doubt about the coronary arteries, coronary angiography is performed, a radiological examination visualizing the coronary arteries. Coronary angiography involves introducing a contrast agent into the bloodstream to make the coronary arteries visible. This is done using a flexible catheter. The patient undergoes local anesthesia. It determines whether the coronary arteries are unobstructed or blocked by clots, narrowed (stenosis), or cholesterol plaques (atheromas).

Transesophageal Echocardiography

Transesophageal echocardiography is invasive but provides precise information on the heart and its vessels. A thin probe is introduced through the throat into the esophagus, positioning it near the heart. This proximity allows for much more precise images to detect even the smallest anomalies.