These routine tests let your doctor take a closer look at your heart.
What is it? An electrocardiogram (EKG or ECG) is a simple, noninvasive, completely painless test that takes just minutes and is done right in your doctor's office as part of the annual exam. You lie down on an examining table and a technician applies a gel and small patches to your chest, arms, and legs. The heart's electrical activity is recorded as a series of waves (tracings) on a strip of paper. It is important to note that a resting EKG does not reflect the electrical activity of your heart under stress. EKGs can be abnormal for many reasons. An abnormal EKG does not necessarily indicate life-threatening heart disease. Further tests will be done to clarify whether the abnormality represents a real problem.
Follow-up. It is useful to have an EKG yearly, so if new symptoms develop, a new EKG can be performed and compared to a recent one. If you have heart attack symptoms such as chest pain at rest while the new EKG is being taken, the new test may show problems not detected earlier, and this helps your doctor make a diagnosis more quickly. If you've never had a baseline EKG and suddenly develop chest pain, a doctor may mistake a perfectly normal variation in your heart for signs of an imminent problem and treat you more aggressively than necessary.
What is it? An echocardiogram, or ultrasound of the heart, is a noninvasive test that takes about 30 minutes and uses ultrasound technology to provide a picture of the structures of the heart. A water-soluble gel is applied to the skin on your chest, then the ultrasound technician places a device called a transducer on the chest wall to bounce sound waves off the walls and valves of your heart. The sound waves return to the transducer as echoes, which are then converted into sharp moving images of your beating heart and its valves as they open and close. The echocardiogram shows the size of each of the four heart chambers and also the function of your heart's major pumping chamber, the left ventricle. Patients with damage from a heart attack or who have high blood pressure or valve problems will have abnormalities that are readily apparent on the echocardiogram. By adding Doppler ultrasound to the equipment, we get a good picture of the blood actually f lowing through the heart. This allows us to assess the presence and extent of valve leaks and valve narrowing, but we cannot reliably visualize blood flowing through the coronary arteries.
For cardiac prevention, I obtain an echocardiogram in patients with high blood pressure to evaluate the thickness of the left ventricle. If blood pressure is elevated day in and day out, the heart has to push harder to eject the blood. When it does this, the heart muscle gets thicker, just as your biceps do when you are regularly lifting weights.
Walking on the streets of South Beach, it's easy to see who is spending the most time in the gym pumping iron because their muscles are bulging out of their tailored clothes. Similarly, I can tell whose heart has been pumping the hardest on a regular basis by the thickness of the left ventricle. In the famous Framingham Heart Study, the thickness of the heart was a better predictor of heart attack and stroke than blood pressure measurements obtained in the doctor's office. With effective treatment of blood pressure, the walls of the heart can actually get thinner. By evaluating the thickness of the heart muscle, as well as the thickness of the inner lining of the carotid artery by doing a carotid ultrasound, I can better distinguish who has white-coat hypertension (blood pressure that seems to be elevated only in the doctor's office) from those with truly sustained high blood pressure, which is a threat to their organs.
Follow-up. For patients with high blood pressure and thick heart walls, I repeat the test if there is a significant change in their risk factor profile or in symptoms related to the heart.