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Women’s Heart Exam |
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An Affiliate of Skagit Valley Medical Center |
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Frequently Asked Questions"How often should people with heart disease have a stress test?"
“How important is it to take Coumadin if you have atrial fibrillation?”
However, in those patients who have other forms of heart disease, together with atrial fibrillation, such as heart failure, reduced function of the pumping chambers, disorders of the heart valves, history of prior stroke, or many patients with high blood pressure, more intensive anticoagulation with warfarin (Coumadin) is necessary to reduce the risk of stroke, and in these patients is much more effective than aspirin alone. Multiple scientific studies have shown that the small risk of bleeding with the use of warfarin is far outweighed by the reduction in stroke risk in these patients. In addition, as patients pass the age of 70-75, the risk of stroke increases sufficiently that the benefits of warfarin outweigh the risks of bleeding even in those without other forms of heart disease accompanying their atrial fibrillation (“lone atrial fibrillation”). Though it is well established that warfarin anticoagulation significantly reduces the stroke risk in many patients with intermittent or permanent atrial fibrillation, the expected benefits in reducing stroke risk in any individual patient on warfarin must be balanced against the risks of bleeding. “What is the difference between an echocardiogram and a cardiac nuclear study”
The echocardiogram is a fascinating and informative study that uses a transducer, or probe, applied to the chest wall, to bounce sound waves off the heart. The images that are then created allow you to see the heart muscle and heart valves moving in real time, as well as analyze the directions, velocities, and pressures of blood as it flows through the heart. There is no risk or discomfort with the test, and patients lay on a bed in a darkened room while the technician moves the probe over the chest wall. A cardiac nuclear study looks at the heart in a different way. In a typical study, the patient is given an injection of a low-energy radioisotope that circulates through the heart and binds to the heart muscle. The patient then lies under a scanning camera, which is sensitive to the emitted energy, and allows reconstruction of images of the heart. This provides information about the blood flow through different areas of the heart and the strength of the heart muscle. This evaluation is usually combined with either a treadmill exercise test or "chemical" stress test to look at how the heart and blood flow respond to activity.
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Copyright 2006-2007 Pacific Northwest Cardiology, Inc., P.S. |
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People with chest discomfort or exertion-related symptoms should have a stress test. There is controversy and wide divergence of practices on whether and how often people with heart disease should have routine testing. It is fairly common that patients who have had intervention such as bypass surgery, angioplasty or stent insertion have a stress test a few months after their procedures and sometimes they are advised to have a yearly stress test thereafter. That is not always necessary. For women, and for men with abnormal EKGs, stress testing should be accompanied by imaging of the heart with ultrasound (echocardiography) or nuclear imaging using a radioactive tracer. These imaging procedures improve the accuracy of a stress test for some people. 
Atrial fibrillation is the most common rhythm disorder encountered in adults. Though it is a relatively benign rhythm if the rate is controlled, it carries with it a 2-4 fold increase in risk for stroke due to clots forming in the inactive (fibrillating) receiving chambers (atria) of the heart. In patients who have no other form of heart disease other than this common rhythm disorder, the risk of stroke is minimal and aspirin is sufficient to reduce the risk further.
"When trying to understand symptoms or diagnose problems related to the heart, it is useful to have information about how the heart looks and works. Cardiologists can gather a lot of data from the initial patient history, physical examination, and basic studies such as an electrocardiogram or chest Xray. Frequently, to evaluate the cause and severity of problems such as chest pains, shortness or breath, heart murmurs, or irregularities of the heart rhythm it is necessary to perform additional tests that let you look "inside" and analyze the structure and function of the heart. 
These complex, yet simple, examinations provide essential information about the anatomy and function of the heart and assist in the accurate diagnosis and management of a variety of patient concerns." |
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