An electrocardiogram - abbreviated as EKG or ECG - is a test that measures the electrical activity of the heartbeat. With each beat, an electrical impulse (or "wave") travels through the heart. This wave causes the muscle to squeeze and pump blood from the heart. A normal heartbeat on ECG will show the timing of the top and lower chambers.
Electrical signals in the heart trigger heartbeats. These signals start at the top of the heart in an area called the right atrium. The electrical signals travel from the top of the heart to the bottom. They cause the heart muscle to contract as they travel through the heart. As the heart contracts, it pumps blood out to the rest of the body.
The patient lies on an examination table, and 10 electrodes (or leads) are attached to the patient's arms, legs, and chest. The electrodes detect the electrical impulses generated by the heart, and transmit them to the ECG machine. The ECG machine produces a graph (the ECG tracing) of those cardiac electrical impulses. The electrodes are then removed. The test takes less than 5 minutes to perform.
EKG recordings of this electrical activity can help reveal a number of heart problems, including : -
Heart attack
Lack of blood flow to the heart muscle
A heart that is beating irregularly, or too fast or too slow
A heart that does not pump forcefully enough.
Echocardiogram
An echocardiogram (echo) is a type of ultrasound examination that uses high-pitched sound waves sent through a device called a transducer to produce an image of the heart and sometimes the aorta.
An echocardiogram measures how well the heart is working by evaluating blood flow, heart valves, and heart size, thickness, shape, and muscle movement.
Sticky patches or electrodes are attached to the chest and shoulders and connected to electrodes or wires. These help to record the electrocardiogram (EKG or ECG) during the echocardiography test. The EKG helps in the timing of various cardiac events (filling and emptying of chambers).
A colorless gel is then applied to the chest and the echo transducer is placed on top of it. The echo technologist then makes recordings from different parts of the chest to obtain several views of the heart. You may be asked to move form your back and to the side. Instructions may also be given for you to breathe slowly or to hold your breath. This helps in obtaining higher quality pictures. The images are constantly viewed on the monitor. It is also recorded on photographic paper and on videotape. The tape offers a permanent record of the examination and is reviewed by the physician prior to completion of the final report.
The procedure is most often performed for the following reasons : -
Evaluate a heart murmur
Diagnose and determine the extent of valve conditions
Determine the presence of abnormalities in the structure of the heart
Measure the size and thickness of the heart and its chambers
Assess motion of the chamber walls and the extent of damage to the heart muscle after a heart attack
Assess how different parts of the heart are functioning in patients with chronic heart disease
Determine if fluid is collecting around the heart
Identify the presence of tumors in the heart
Assess for and monitor congenital defects
Evaluate a patient's response to treatment or a corrective procedure
Evaluate blood flow through the heart
Assess if the heart or major blood vessels coming and going from the heart have been damaged by a traumatic injury, often done to determine a heart's condition before it is donated for transplant
Evaluate heart function and diagnose heart and lungs abnormalities in critically ill patients in an intensive care unit
Evaluate chest pain
Evaluate for presence of blood clots within heart chambers
Holter Monitor
A Holter monitor, also called an ambulatory EKG, records the electrical signals of your heart for a full 24- or 48-hour period. You wear small patches called electrodes on your chest that are connected by wires to a small, portable recorder. The recorder can be clipped to a belt, kept in a pocket, or hung around your neck. During the 24 or 48 hours, you do your usual daily activities and keep a notebook, writing down any symptoms you have and the time they occur. You then return both the recorder and the notebook to your doctor to read the results. Your doctor can see how your heart was beating at the time you had symptoms.
The purpose of a Holter monitor is to record heart signals during typical daily activities and while sleeping, and to find heart problems that may occur for only a few minutes out of the day. Also, the Holter monitor can pick up irregular heartbeats that don't cause symptoms, but are important to treat.
[ Holter monitor ]
A patient may wear a monitoring device, called a Holter monitor, for 24 or 48 hours while performing normal daily activities at home. The monitor records the heart's rhythm during this time. The device is connected with several long thin cables that adhere to the skin on the chest with several sticky pads (similar to an ECG). The cables connect to a small, portable machine that can be attached to a belt or a strap that is carried over the shoulder.
Stress Test
Stress testing provides your doctor with information about how your heart works during physical stress. Some heart problems are easier to diagnose when your heart is working hard and beating fast.
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In this test you will walk or pedal on an exercise machine while the electrical activity of your heart is measured with an electrocardiogram (ECG), and blood pressure readings are taken. This will measure your heart's reaction to your body's increased need for oxygen.
The test continues until you reach a target heart rate, unless complications such as chest pain or an exaggerated rise in blood pressure develop. You will continue to be monitored for 10 - 15 minutes after exercising, or until your heart rate returns to baseline.
This test will help the doctor evaluate the patient's cardiac condition related to : -
Irregular heart rhythms
If there is a decreased supply of blood and oxygen to the heart with exercise.
How hard the heart can work before symptoms develop
How quickly the heart recovers after exercise
The patient's overall level of cardiovascular conditioning
What his exercise target heart rate (THR) should be
Basic Facts about Stress Test
Stress testing is a painless, safe method to measure how well the heart responds to an increase in the body's demand for oxygen.
Exercise is the most commonly used method of creating this increased stress on the heart. For those who cannot exercise, a drug that simulates the effect of exercise, such as dobutamine, may be used.
The electrocardiographic (ECG) stress test is the second most-performed heart diagnostic test next to the resting, or standard, ECG.
The person taking the test may choose to stop the ECG stress test at any time.
Lipid Profile
The lipid profile is a group of tests that are often ordered together to determine risk of coronary heart disease. The tests that make up a lipid profile are tests that have been shown to be good indicators of whether someone is likely to have a heart attack or stroke caused by blockage of blood vessels (hardening of the arteries).
A lipid profile measures total cholesterol, HDL cholesterol, LDL cholesterol, and triglycerides. A physician may order a lipid profile as part of an annual exam or if there is specific concern about CVD, especially coronary artery disease
Total cholesterol comprises all the cholesterol found in various lipoproteins such as high-density lipoproteins (HDL), low-density lipoproteins (LDL), and very low-density lipoproteins (VLDL).
HDL helps to take cholesterol away from the cells and transport it back to the liver for removal. It is thus called "good" cholesterol as persons with high levels of HDL may have a lower incidence of heart disease.
LDL contains the greatest percentage of cholesterol and is responsible for cholesterol deposits on the walls of the artery resulting in coronary artery disease. LDL is thus known as the "bad" cholesterol. The cholesterol/HDL ratio is derived by dividing the total cholesterol by the HDL. This ratio helps in assessing the risk of heart disease in individuals.
Triglycerides are neutral fats found in the tissue and blood. Triglycerides containing lipoproteins may also contribute to the disorders related to coronary heart disease.
What are the desirable lipid profile values ?
Lipid profile values can be evaluated from the table below : -
Adult values
Desirable
Borderline
High risk
Cholesterol
< 200 mg/dl
200-240 mg/dl
240 mg/dl
Triglycerides
<200 mg/dl
200-400 mg/dl
400-1000 mg/dl
HDL-cholesterol
60 mg/dl
35-45 mg/dl
<35 mg/dl
LDL-cholesterol
130 mg/dl
130-160 mg/dl
160 mg/dl
Cholesterol/HDL
4.0
5.0
6.0
What preparations are required ?
The patient needs to be fasting for 12-14 hours before drawing the sample. He should also be on his normal diet pattern. Intake of alcohol on the previous night should be avoided.
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Stress testing is a painless, safe method to measure how well the heart responds to an increase in the body's demand for oxygen.
