A stress test is usually performed on a treadmill, while the heart activity is being monitored.  The main purpose of a stress test is to see if there is any evidence of blocked arteries.  If there are blockages, and not enough blood gets through during exercise, changes occur in the EKG's being recorded.  Sometimes, a nuclear scan is done as well, to gather additional information about the blood flow.  A stress test can also provide valuable information about fitness level, arrhythmias, and blood pressure response.

Exercise is very good for the heart, but it's not a guarantee that you won't develop a heart condition.  In fact, because you're active, it's especially important to make sure that your heart can safely tolerate the activity. Many people with coronary problems never have chest pain.

The first stage of a stress test is only 1.7 mph. If you're okay after 3 minutes at that speed then the speed increases.  So just about anyone can take a stress test.  

Fortunately, there are now other ways to test the heart.  For example, a nuclear scan can be done in conjunction with an injection of a medicine called Persantine.  This medicine opens up the arteries around the heart so that any blocked arteries, which can't open, can be visualized on the scan.

I get an EKG done every year, and it's always been normal.  So I guess I don't have any blockages, right? 
 

That's not necessarily so.  An EKG is very helpful for many things, but because it only shows the heart activity at rest, it can't really rule out coronary problems. 

But if my stress test is normal, then I don't have to worry about having a heart attack, do I? 
 

Even a stress test isn't 100% definitive.  Certainly someone with a normal stress test is at lower risk than someone with an abnormal one.  But plaque in an artery can sometimes go from an undetectable 20% blockage to a critical 99% blockage overnight, much like a volcano erupting.  Unfortunately, this sort of situation is almost impossible to predict or prevent.  Controlling blood pressure and cholesterol and taking aspirin can help, however.

I heard there's a new kind of CAT scan that can detect blockages at an early stage.  Is that the solution? 
 

Yes and no.  The test, called Ultrafast CT, can detect calcifications in the coronary arteries before significant blockages develop.  But there are some drawbacks to the test.  

First of all, it's considered experimental and generally not covered by insurance.  

Second, it's not clear what can be done about arteries that have minor blockages.  

Angioplasty or bypass surgery certainly isn't the answer for these early lesions.  Watching one's cholesterol is certainly appropriate, but that's a good idea for anyone, regardless of what their scan shows.  So yes, the test can be useful, but it sometimes creates more questions than answers.

An echocardiogram is a wonderful test for showing the heart valves and the heart muscle function.  But the arteries are too small and moving too quickly to be seen with ultrasound.

I get a lot of palpitations.  I've had 24-hour Holter monitors, but my symptoms don't occur every day, and they never seem to happen when I have the Holter on.  How can my problem be diagnosed? 
 

The traditional 24-hour monitor is a good place to start in diagnosing arrhythmias.  But like the toothache that disappears when you see the dentist, the problem might not appear when you want it to, on the day you're wearing the monitor.  Fortunately, there are other devices, called "event monitors" that can be helpful.  There's one wristwatch device, for example, that can be worn for up to 2 weeks, and can be activated by the wearer whenever the symptoms occur.  In more extreme cases, there's even an implantable monitor that can be placed under the skin and left there for several months!   

There are some ways to tell, although they're not foolproof.  A carotid artery doppler test is a non-invasive way to check for blockages in the major arteries leading to the brain.  An EKG and a Holter monitor can look for any evidence of atrial fibrillation.  This type of arrhythmia, because it results in areas of stagnant blood in the heart, can predispose to strokes.

I've been told that I have to take antibiotics whenever I go to the dentist because I have Mitral Valve Prolapse (MVP).  Is that really necessary? 

Maybe not.  Recent American Heart Association guidelines state that not everyone with MVP needs to take antibiotic prophylaxis.  It depends on the type of prolapse you have.  If you haven't had an echo-doppler recently, you should have it re-evaluated. 

Angina means pain or discomfort, coming from the heart, generally due to blocked arteries, and usually occurring with exertion.  Not all chest pain is angina, and not all people with blocked arteries have pain.

If angina comes from blocked arteries, does that mean everyone with angina should have angioplasty or bypass surgery to open them up?  

Not necessarily. Only in people with certain "high-risk" characteristics (e.g. unstable symptoms, triple vessel disease, poor heart muscle function) has it been proven that we can prolong life by these methods.  Many other people do fine for many years or even decades, just by taking aspirin, cholesterol-lowering medication, etc.  Invasive procedures are not always necessary.

I recently had a heart attack, even though I've always been told my cholesterol was OK.  How is that possible? 
 

Cholesterol is very important, but it's only one of many "risk factors" that can lead to a heart attack.  Smoking, diabetes, high blood pressure, HDL level,  obesity, lack of exercise, as well as age, gender and genetics are some of the other risk factors.  The more risk factors you have, the greater your chance of having a heart attack.  

After my heart attack, my doctor put me on cholesterol-lowering medication, even though my cholesterol was always pretty good.  Does that make any sense?
 

Actually, it does.  Once you've had a heart attack, a "pretty good" cholesterol isn't good enough.  At that point, your cholesterol really needs to be perfect; i.e. usually less than 180, or an LDL ("bad cholesterol") under 100. 

Dizziness can be caused by many different things, including inner ear problems, fast or slow heart rhythms, high or low blood pressure, as well as various medications.  Most of the time it turns out not to be anything serious, but it should always be checked to rule out the more serious causes.

Heart disease is the leading cause of death among women.  They do tend to have heart trouble at a somewhat older age than men do, but they catch up quickly.

"Good cholesterol", as HDL is known, is a very important factor in preventing heart disease.  The higher the level, the better.  Unfortunately, going on a low fat diet may lower your total cholesterol, but it won't raise the HDL. In fact, HDL often goes down on a low fat, high-carbohydrate diet.  Mono-unsaturates like olive oil may help, as will fish oils.  Losing weight and exercising regularly can also help.  Medication may raise it, but often not by very much.

The patient's age, activity level,  gender, as well as their medical condition and the possibility of future surgery are some of the determining factors for the implantation of a tissue valve or a mechanical valve.

In 80-90% of the cases, most tissue valves continue to operate, depending on the age, activity level and the health of the patient.  They are more commonly used in the elderly, because of a less active lifestyle and slower metabolisms, and in women of child-bearing age.

Most mechanical valves last the lifetime of the patient but require the constant use of anti-coagulants.  In the rare case of a mechanical valve failure, it is usually fatal. Additionally, the mortality and incidence of disease associated with a long term anti-coagulant therapy is significant. The typical patient is young, non child-bearing through to the age of 65.

There are many factors to take into consideration when deciding to have a valve replacement procedure.  While many people are able to participate in activities they had not be able to perform when their condition worsened, the failure of some recently introduced products that emphasize that we cannot create the perfect heart valve to replace what you already have.  You need to be thoroughly aware of the choices available to you.

The risk from cholesterol medications is really quite low.  Only about 1% of people on these medicines show elevated liver enzymes in the blood.   But even in these people, the problem goes away once the medicine is stopped. Serious or permanent problems are extremely rare.

My doctor wants to put me on blood pressure medication.  But I'm afraid that the medicine will affect my sex life.  What should I do?
 

This is certainly a legitimate concern, as many blood pressure pills can have sexual side effects in men and women.  But many of the newer medicines are no more likely than a placebo to do so.  In any event, leaving yourself at risk for a heart attack or a stoke isn't the answer.  

First, talk to your doctor about lowering your blood pressure by weight loss, exercise, and increased intake of fruit, vegetables, calcium and fiber.  (Moderate salt restriction is advisable, but salt doesn't play as big a role as many people think.)  If your pressure is still high, try the medication.  Most people do not experience any side effects from the newer medications.  If you do, discuss it frankly with your doctor.  There's a good chance your medicine can be changed to something totally different.  Just because you have a side effect with one medicine doesn't mean you'll react to all of them.

The only definite "no-no" is that you can't take Viagra if you're on nitroglycerine or any other type of nitrate.  For everyone else, it seems to be safe.  But sex itself, like any form of exertion, can pose risks for someone with a heart problem.  So if you have a heart problem, and you've been very sedentary, sexually or otherwise, check with you doctor before starting any form of exercise.

I really can't afford the medications my doctor prescribed for my heart.  What can I do? 
 

Unfortunately, many of the newer heart, blood pressure and cholesterol medications are quite expensive.  Sometimes there are less expensive alternatives that are just as good.  However,  your doctor may not prescribe them for you unless you ask.  So be sure to have a frank discussion with him or her about the problem.  Also, many drug companies give free medications to people with limited incomes.  Ask your doctor or contact the drug companies yourself.

What about using over-the-counter and herbal products to lower my cholesterol?  Do they really work?
 

Sometimes.  Many preparations (including Metamucil) contain soluble fiber, which can lower cholesterol up to 10%. Garlic products can help, but usually not by very much.  Niacin is very effective, but only in very high doses (usually more than 1000 mg per day).  In those doses, it tends to have more side effects than prescription drugs. Of course, no drug, prescription or herbal, is a substitute for a proper diet!