Heart attacks.
A leading cause of death
To treat a heart attack effectively, it is important to diagnose it right and fast2. Your doctor gathers information from your clinical findings and a few investigations to diagnose a heart attack. Sometimes, the diagnosis of a heart attack could be challenging. However, medical science has evolved to provide more and more tools to diagnose heart attacks accurately.
Typical Symptoms
Diagnosis of heart attacks starts from the evaluation of symptoms2. Chest pain or any equivalent symptoms of coronary artery disease like breathlessness, cold sweat, dizziness should prompt towards taking the first step of doing an electrocardiogram or ECG. The index of suspicion is higher incase there is a coexisting hypertension (high blood pressure) or diabetes(raised blood sugar). It is important to note that the patients with diabetes are particularly at risk of suffering from ‘silent heart attack’ where chest pain is not prominent. This happens because of the affection of pain nerves in diabetes.
Electrocardiogram
An electrocardiogram, also known as an ECG or EKG, gives a lot of information about your heart rhythm, structure, and function. An ECG may show whether a heart attack has caused damage to your heart. Your doctor looks for specific changes in an ECG which point towards a heart attack.
Cardiac Enzymes
A lot of times, when an ECG has non-definitive changes, the doctor orders certain blood tests called Cardiac Enzymes. Cardiac Troponin tests and CKMB (Creatinine Kinase -MB) are the commonly advised tests for this purpose. These are the enzymes (proteins) which are present in the heart. In the event of damage to the heart muscle because of reduced blood supply, these are released in the blood. Hence their detection of more than the expected level in the blood points towards a heart attack. Usually, serial measurement of these parameters helps in diagnosis 3.
2D Echocardiography
Sometimes, a 2D Echocardiogram which is an ultrasonographic examination of the heart helps in diagnosis a heart attack when one sees a part of the heart pumping with lesser force because of reduced blood supply to that region4.
Coronary Angiography
An important tool in the diagnosis of heart attacks is the coronary angiogram. A coronary angiogram can show if any blockage and/or narrowing has occurred. A special dye is injected into the coronary arteries so that they can be seen in an x-ray. Information from the angiogram will help your doctor decide how to treat you.
Cardiac Stress test
Sometimes, when the chest pain is chronic and intermittent on exertion, and your doctor wants to confirm if the cause of the chest pain is the reduced blood supply to the heart during exertion, a stress test is a useful diagnostic tool. Usually, during a stress test, a person walks on a treadmill, while acontinuous ECG is being monitored. Certain changes in the ECG at the time of exertion or during recovery after exertion may show a compromised blood supply to the heart because of coronary artery disease.
Myth:
Stress test is used to diagnose a heart attack or predict the possibility of aheart attack in the future.
Fact:
A stress test is used to confirm the diagnosis of coronary artery disease in case of symptoms of shortness of breath or chest pain on exertion. A negative stress test shows that there is no significant blockage in the coronary arteries and does not rule out the possibility of a heart attack in the future.
CT Coronary Angiography
One can visualize the coronary arteries using computerized tomography or CT scan, and can detect blockages in the arteries. While it is not a substitute for an angiography by the cardiologist in a cardiac catheterisation lab, your doctor would best advice on when it can be useful 4.
- https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.118.005195
- https://www.heart.org/en/health-topics/heart-attack/warning-signs-of-a-heart-attack
- https://www.heart.org/en/health-topics/heart-attack/diagnosing-a-heart-attack/invasive-tests-and-procedures
- https://www.heart.org/en/health-topics/heart-attack/diagnosing-a-heart-attack/noninvasive-tests-and-procedures
- https://www.nhs.uk/conditions/coronary-angioplasty/
- https://www.nhs.uk/conditions/coronary-artery-bypass-graft-cabg/
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