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An Overview of Diagnostic Tests Used to Confirm Cardiovascular Disease
Scott Ewing, DO will be discussing a variety of tests that a physician may order for a patient in order to determine a cardiovascular issue and heart disease.
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Scott Ewing, DO
Scott E. Ewing, DO is a native Texan. He attended Southern Methodist University and received a Bachelor of Science in Mechanical Engineering. He attended Massachusetts Institute of Technology and received an MS in Mechanical Engineering. Dr. Ewing was an engineer at Texas Instruments – Dallas for many years, working in defense systems. Dr. Ewing returned to college and graduated from the University of North Texas Health Science Center Texas College of Osteopathic Medicine in Fort Worth. He completed post-graduate training in Internal Medicine, General Cardiology, and Interventional Cardiology. Dr. Ewing is board certified in Internal Medicine, General Cardiology, and Interventional Cardiology. He serves as Medical Director of Quality at Baylor Scott & White Heart and Vascular Hospital Fort Worth on the campus of Baylor Scott & White All Saints Medical Center - Fort Worth. Transcription:
An Overview of Diagnostic Tests Used to Confirm Cardiovascular Disease
Caitlin Whyte (Host): Welcome back to Heart Speak, the podcast from Baylor Scott and White Heart and Vascular Hospital. I'm your host, Caitlin Whyte. There are a number of ways to diagnose heart disease, with each test, having its own set of advantages. So, today we are going to review some of the most common diagnostic tests that may be ordered by your primary care provider or cardiologist to help diagnose heart disease. Joining us for that conversation, is Dr. Scott Ewing, the Medical Director of Quality and an Interventional Cardiologist on the Medical Staff of Baylor Scott and White Heart and Vascular Hospital in Fort Worth. So Doctor, we're going to talk about four common types of diagnostic tests today. Let's start with the EKG or electrocardiogram.
Scott Ewing, DO (Guest): EKGs are a simple test that we perform in the office, where we look at the electrical activity of the heart. You'll recognize that test when the tech or technician in the office has you lay down on the table and they put stickies connectors on your chest and on your wrist and on your ankles and hook up a bunch of wires. They go back to a little machine that prints out a piece of paper with all the electrical activity on your heart. And we call that test an EKG or electrocardiogram. It's not a great test in terms of being able to tell you everything that's going on with the heart, but it is a good test in it is a useful test as a starting point, when looking at the heart rhythm, the heart rate, how fast, how slow is the heart going.
Usefulness of the test has to always be taken into context with what else is going on. So, for example, I would look at the test and say, Oh, you're dizzy. Maybe the EKG shows that your heart's going slow. Oh, you're having chest pain. Maybe the EKG shows changes that are consistent with maybe you've got a blocked artery in your heart. So, we always look at that EKG and the results of the EKG based on what is going on. And it doesn't always tell us everything, but it's a good starting point to tell us some useful information.
Host: Next up, tell us what heart monitors can do.
Dr. Ewing: A lot of times people come in and we are concerned about the electrical activity of the heart, but the EKG only showed a very, very brief snapshot. In fact, an EKG is only a ten second window into the electrical activity of the heart. And you can keep doing an EKG and keep taking 10 seconds snapshots, but that really doesn't get you very far. So, another way to look at the electrical activity of the heart is with a wearable heart monitor. The most common wearable heart monitor is a Holter monitor named after Dr. Holter. And it's about 50, 60 year old technology. And again, we put the little EKG, sticky things on your chest and the wires that connect to the sticky things. They go to a little box that you clip to your belt and you just wear it and you might wear it for 24 hours. You might wear it for 48 hours. The goal is to look at all your heartbeats and a normal person like you and me, the heart probably beats about a hundred thousand times a day.
And so if you wear it for one day, then we'll have about a hundred thousand heartbeats to sort through. And if you wear it for two days, there's a couple of hundred thousand heartbeats to sort through. We can look at how fast, how slow is the heart going. Are there any pauses where the heart maybe skipped some beats, are there any extra heartbeats of different varieties?
And we can count those up. How many of them, how often, what's their shape. And again, it can help us determine more information about the electrical activity of the heart, how well the heart is functioning from the electrical standpoint. If the Holter monitor, doesn't show us what we need to see, because again, you're only wearing it for one or two days and maybe your heart rhythm problem occurs less frequently than that, then we can also switch it out and you can wear a different kind of heart monitor. And these heart monitors are usually called event recorders or loop recorders, in that they don't record every heartbeat. They just know how to take snapshots of what's going on as needed. And you might wear a loop recorder or an event recorder for a week, two weeks.
We sometimes have people wear them for up to a month at a time. So, it adds to our timeframe to be able to collect and analyze and actually see that heart rhythm problem that may be occurring. And if it's occurring frequently, it's usually easy to find. If it's occurring infrequently, then we have to look harder and wear monitors for longer periods of time.
And then amazingly enough, in some cases, the heart rhythm problem occurs so infrequently that even a 30 day monitor can't see it or capture it. And in that case, because maybe we still want to find out what's going on because it still is causing a problem when it does occur, we actually have monitors that are battery powered.
And they get actually placed under the skin. They get injected through a little incision made in the chest wall. It gets placed under the skin and the battery can last about two and a half to three years. In that timeframe, we are able to continue to monitor the patient's heart rhythm. And determine what's going on from an electrical standpoint. These implantable event recorders and monitors, it's newer technology. They've been out for just the last 10 or 15 years, and they continue to get smaller and the batteries last longer. And they've reached the point where they're, maybe about the size of a Q-tip, maybe shorter in length and just injected under the skin. And the battery can last for quite a long time and help us monitor the electrical activity of the heart, because there's so many different rhythm problems that people suffer from and heart rate problems that people suffer from. And another common test that's encountered in the cardiology clinic.
Host: So, now we'll talk about stress testing. You know, I always think of someone hooked up to a treadmill, but I know there are different kinds that fall under the umbrella of a stress test.
Dr. Ewing: Stress testing is, can be a kind of a big topic to talk about. So, let me break it down into pieces. The first part is how are we going to stress the person, so to speak, to begin with. And, and like you said, the treadmill is a great, great way to provide stress and provide stress to the heart and the blood circulation of the heart, and try to induce symptoms on the treadmill.
You know, if I walk you on a treadmill, are you going to have chest pain? And that's, that can be useful information to know that your chest pain is induced by exercise. The other part of the stress test is the monitoring that goes on while you're on the treadmill. For example, you'll be hooked up to an EKG machine and the EKG will be recorded while you're walking on the treadmill. You'll also be hooked up to a blood pressure cuff and your blood pressure will be recorded while you're walking on the treadmill and believe it or not, those things can and do change while you're on the treadmill and while you're exerting yourself. And that information can be very useful to determine what's going on with the heart. And the primary reason for doing a treadmill stress test, or any kind of stress test, is to determine, is this person suffering from clogged arteries, poor blood circulation to the heart, having chest pain because of the poor blood circulation to the heart. And if they are, can we reproduce it and, and really isolate what's going on. And that's where the stress test comes in. And certainly a treadmill stress test is a great place to start. Now, that's the good news. The bad news is a plain treadmill stress test is not a great test. It only really, points out what's going on maybe 80 or 85% of the time, which may be sounds good. But in the medical world, 80 or 85% is not great.
It's just good. Well, can we make it better? And the answer is yes. And so sometimes we actually add imaging of the heart in conjunction with the treadmill stress test. And there's two ways to image the heart. One is with a ultrasound and when we take ultrasound pictures of the heart, and the other way to image what's going on is with what's called nuclear imaging, where we inject a radiotracer through an IV that's been started. And then we can use that nuclear medicine to take additional pictures of the heart. And the purpose of the imaging is to see how well the heart is working before the stress is performed. So, we would take pictures of the heart before getting on the treadmill. And that would be your baseline images in terms of how well is the heart functioning at rest. And then we would walk you on the treadmill and at peak exercise, then we would stop and actually take additional pictures of the heart. And then those pictures represent how well the heart is functioning at peak exercise. The ultrasound imaging is the less expensive way to go. And it, and it's a little bit quicker, maybe not quite as good as nuclear imaging.
The nuclear imaging technology is a little bit more involved, takes a little bit more time, requires a little bit better camera to take those nuclear pictures, but imaging really adds to the treadmill stress test and increases our usefulness from say 80 or 85% to say 90 or 95% accuracy in terms of what's going on. Is this person having chest pain because of clogged arteries? Is this person having blood circulation issues to the heart? And if they are, then it opens up the door to maybe what can we do about it? And that's of course the take you over to the hospital and do a heart cath and an angiogram, and that's a whole other conversation.
So, treadmill is certainly a great place to start. Plain treadmill stress test has usefulness. A treadmill stress test with imaging has more usefulness, but I can't stop there because some people can't walk on the treadmill. Those would be people that maybe are maybe elderly and just simply can't walk very fast. Maybe they're young, but they have a leg problem. Maybe they got a bad knee or a bad hip and walking fast on a treadmill just isn't an option. In that case, a stress test can still be performed, but we refer to that kind of stress test as a chemical stress test. And that's kind of a layman's term for, oh, we're going to start an IV and using IV medicines, we're going to convince the heart as if it's or have the heart act like it's undergoing a treadmill stress test, but we're doing it with IV medicines.
Two common types of chemical stress tests. One is using a medicine called dobutamine. Which is just a medicine that we drip through the IV and speeds the heart up as if you were walking on a treadmill, that's performed sometimes, but not very often. The more common chemical stress test is using a medicine called Lexiscan. Lexiscan is a, is a medicine that doesn't really make the heart go faster.
Lexiscan is a medicine that opens up the arteries and, and improves the blood circulation in the healthy arteries and the unhealthy arteries it doesn't improve the blood circulation and with Lexiscan, now, when you do the nuclear imaging, it gives you a good idea of what's going on at rest and what's going on at stress.
And again, offers us the opportunity to compare those pictures to determine what the blood circulation to the heart looks like. But in this case, without having the person walk on a treadmill, simply because the patient is just not a candidate for walking on a treadmill. Probably the easiest example of somebody that can't walk very well on a treadmill is somebody that maybe has lost a leg in a car accident years ago and, and they use a wheelchair and can't walk, or maybe they're quite elderly and they use a cane or a walker and they can't walk, but we still want to do the imaging. And that's where the chemical stress tests come in. And those tests, again, talking about accuracy, probably about 90 to 95% accurate in terms of what the heck is really going on.
Again, no test is perfect. Even when we get to 90, 95% accuracy, we still have to interpret the stress test in conjunction with the symptoms that the patient tells us about. The context of the symptoms, does their chest hurt while they're exerting themselves? Does their chest hurt while there, I don't know, getting into an argument with their husband or wife or getting into an argument with their boss, or maybe their chest hurts when they're eating or maybe their chest hurts when they're watching TV and the context and the results of the stress test can all be taken together and give us an idea of just what the heck might be going on with that heart?
And do we need to perform other tests and look into it further? Or maybe the stress test is the end of the road and we can reassure the patient and say, ah, no, your heart looks pretty good. Let's leave you alone and just manage your blood pressure and just manage your cholesterol.
Host: And wrapping up here, tell us about echocardiograms.
Dr. Ewing: Thank you. The echocardiogram is actually one of my favorite tests to perform because using ultrasound technology, we're actually, we're able to take pictures of the heart inside the chest, just as if the patient was a pregnant lady, we use ultrasound technology to take pictures of my baby, which is the heart. And the cold jelly is placed on the chest. And the ultrasound probe is placed on the chest and using ultrasound, we look at the heart, we look at it in real time. We can see how big the heart is, how small, how thick, how thin. We can see how well the valves open and close, do they leak? Do they, are they restricted in their motion?
Uh, lots of useful information that can be discerned from the ultrasound of the heart or the echocardiogram. You'll also hear us in the office, refer to the echocardiogram, simply as an echo. That's kind of the short term for the same thing. It's real common for my patients to sometimes confuse the term echocardiogram with electrocardiogram.
The echo is the ultrasound of the heart. The electrocardiogram or EKG is the electrical picture taking of the heart, using the EKG machine. So, two different tests, two different results, both, both very useful, the ultrasound of the heart. Is it a great test? And the answer is yes, but it's not always the greatest that it could be.
And the reason for that is that using ultrasound technology and putting the probe on the chest wall, the ribs are in the way, the chest wall tissues are in the way, the breast tissues are in the way, the lung tissue can be in a way. So, quite often we get good pictures, but not always great pictures. And luckily though we do have a backup plan when we need to get great pictures.
The way to get great pictures is to get the ultrasound probe closer to the heart. The way that we get it closer to the heart is we actually would then take the patient over to the hospital. And the reason we do it at the hospital is so that we can give the patient some sedation and make them comfortable. And they actually make an ultrasound probe that the patient can swallow. Believe it or not, they swallow the probe. It sits in the esophagus. I hold on to my end of it, which is outside the body. And that's where all the controls are. And I can use the controls to point the ultrasound probe in different directions.
If you visualize the esophagus or the feeding tube that goes from your throat all the way down to the stomach. That sits right behind the heart, right, really up next to the heart. And there's nothing in the way. There's no breast or lung or ribs or anything blocking the pictures. So, we're able to take much clearer pictures using that ultrasound probe that's in the esophagus. That's the good news. The bad news is it's a more involved test and it's done at the hospital and it's, you know, it's you get sedation because it wouldn't necessarily be the most comfortable thing to swallow the camera so to speak. Very similar in terms of how the GI doctor also would have you swallow a camera to look into your stomach.
So, from your perspective or the patient's perspective, it's the same kind of test. So, not performed all the time because we don't all the time need to get great pictures. Good pictures though, suffice 99% of the time. The good picture taking is done in the office. The great picture taken is done at the hospital and that's ultrasound technology.
Very useful. Common question that's asked though, when we do an ultrasound of the heart, is what's the blood circulation look like? What do my arteries look like? And the answer is, I don't know. An ultrasound of the heart doesn't show the arteries. It doesn't show the blood circulation. Those details are too small.
And we really can't see that information with ultrasound technology. That's what stress testing is for is to try to get an idea of how well the heart's working from a blood flow standpoint. And then at the end of the day, if we're still concerned about your heart, then we have to start talking about taking you over to the hospital and doing a heart cath or a coronary angiogram.
But you don't do that in the office. That's a, that's a hospital-based procedure. And that, that's another conversation to talk about in the hospital testing, which can be much more involved than what we're able to do with the office. Of course, my goal is to keep my patients out of the hospital. Honestly, the clinician's job is to keep all his patients or her patients out of the hospital.
And that's what we try to do with all this testing in the office is to take care of people, make decisions, get them on the right medicines, do the right risk factor modification, get them to diet, get them to exercise, and hopefully keep these people out of the hospital. That's something we strive to do every day.
Host: Well, thank you so much for joining us today. We really do appreciate your time. That's Dr. Scott Ewing, the Medical Director of Quality and an Interventional Cardiologist on the Medical Staff of Baylor Scott and White Heart and Vascular Hospital in Fort Worth. Thanks for checking out this episode of Heart Speak. To find a specialist on the medical staff at Baylor Scott and White Heart and Vascular Hospital in Fort Worth or Dallas, please visit BSWhealth.com/heartFortworth. Or call (844) 279-3627. That's (844) 279-3627. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks. And we'll talk next time.
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An Overview of Diagnostic Tests Used to Confirm Cardiovascular Disease
Caitlin Whyte (Host): Welcome back to Heart Speak, the podcast from Baylor Scott and White Heart and Vascular Hospital. I'm your host, Caitlin Whyte. There are a number of ways to diagnose heart disease, with each test, having its own set of advantages. So, today we are going to review some of the most common diagnostic tests that may be ordered by your primary care provider or cardiologist to help diagnose heart disease. Joining us for that conversation, is Dr. Scott Ewing, the Medical Director of Quality and an Interventional Cardiologist on the Medical Staff of Baylor Scott and White Heart and Vascular Hospital in Fort Worth. So Doctor, we're going to talk about four common types of diagnostic tests today. Let's start with the EKG or electrocardiogram.
Scott Ewing, DO (Guest): EKGs are a simple test that we perform in the office, where we look at the electrical activity of the heart. You'll recognize that test when the tech or technician in the office has you lay down on the table and they put stickies connectors on your chest and on your wrist and on your ankles and hook up a bunch of wires. They go back to a little machine that prints out a piece of paper with all the electrical activity on your heart. And we call that test an EKG or electrocardiogram. It's not a great test in terms of being able to tell you everything that's going on with the heart, but it is a good test in it is a useful test as a starting point, when looking at the heart rhythm, the heart rate, how fast, how slow is the heart going.
Usefulness of the test has to always be taken into context with what else is going on. So, for example, I would look at the test and say, Oh, you're dizzy. Maybe the EKG shows that your heart's going slow. Oh, you're having chest pain. Maybe the EKG shows changes that are consistent with maybe you've got a blocked artery in your heart. So, we always look at that EKG and the results of the EKG based on what is going on. And it doesn't always tell us everything, but it's a good starting point to tell us some useful information.
Host: Next up, tell us what heart monitors can do.
Dr. Ewing: A lot of times people come in and we are concerned about the electrical activity of the heart, but the EKG only showed a very, very brief snapshot. In fact, an EKG is only a ten second window into the electrical activity of the heart. And you can keep doing an EKG and keep taking 10 seconds snapshots, but that really doesn't get you very far. So, another way to look at the electrical activity of the heart is with a wearable heart monitor. The most common wearable heart monitor is a Holter monitor named after Dr. Holter. And it's about 50, 60 year old technology. And again, we put the little EKG, sticky things on your chest and the wires that connect to the sticky things. They go to a little box that you clip to your belt and you just wear it and you might wear it for 24 hours. You might wear it for 48 hours. The goal is to look at all your heartbeats and a normal person like you and me, the heart probably beats about a hundred thousand times a day.
And so if you wear it for one day, then we'll have about a hundred thousand heartbeats to sort through. And if you wear it for two days, there's a couple of hundred thousand heartbeats to sort through. We can look at how fast, how slow is the heart going. Are there any pauses where the heart maybe skipped some beats, are there any extra heartbeats of different varieties?
And we can count those up. How many of them, how often, what's their shape. And again, it can help us determine more information about the electrical activity of the heart, how well the heart is functioning from the electrical standpoint. If the Holter monitor, doesn't show us what we need to see, because again, you're only wearing it for one or two days and maybe your heart rhythm problem occurs less frequently than that, then we can also switch it out and you can wear a different kind of heart monitor. And these heart monitors are usually called event recorders or loop recorders, in that they don't record every heartbeat. They just know how to take snapshots of what's going on as needed. And you might wear a loop recorder or an event recorder for a week, two weeks.
We sometimes have people wear them for up to a month at a time. So, it adds to our timeframe to be able to collect and analyze and actually see that heart rhythm problem that may be occurring. And if it's occurring frequently, it's usually easy to find. If it's occurring infrequently, then we have to look harder and wear monitors for longer periods of time.
And then amazingly enough, in some cases, the heart rhythm problem occurs so infrequently that even a 30 day monitor can't see it or capture it. And in that case, because maybe we still want to find out what's going on because it still is causing a problem when it does occur, we actually have monitors that are battery powered.
And they get actually placed under the skin. They get injected through a little incision made in the chest wall. It gets placed under the skin and the battery can last about two and a half to three years. In that timeframe, we are able to continue to monitor the patient's heart rhythm. And determine what's going on from an electrical standpoint. These implantable event recorders and monitors, it's newer technology. They've been out for just the last 10 or 15 years, and they continue to get smaller and the batteries last longer. And they've reached the point where they're, maybe about the size of a Q-tip, maybe shorter in length and just injected under the skin. And the battery can last for quite a long time and help us monitor the electrical activity of the heart, because there's so many different rhythm problems that people suffer from and heart rate problems that people suffer from. And another common test that's encountered in the cardiology clinic.
Host: So, now we'll talk about stress testing. You know, I always think of someone hooked up to a treadmill, but I know there are different kinds that fall under the umbrella of a stress test.
Dr. Ewing: Stress testing is, can be a kind of a big topic to talk about. So, let me break it down into pieces. The first part is how are we going to stress the person, so to speak, to begin with. And, and like you said, the treadmill is a great, great way to provide stress and provide stress to the heart and the blood circulation of the heart, and try to induce symptoms on the treadmill.
You know, if I walk you on a treadmill, are you going to have chest pain? And that's, that can be useful information to know that your chest pain is induced by exercise. The other part of the stress test is the monitoring that goes on while you're on the treadmill. For example, you'll be hooked up to an EKG machine and the EKG will be recorded while you're walking on the treadmill. You'll also be hooked up to a blood pressure cuff and your blood pressure will be recorded while you're walking on the treadmill and believe it or not, those things can and do change while you're on the treadmill and while you're exerting yourself. And that information can be very useful to determine what's going on with the heart. And the primary reason for doing a treadmill stress test, or any kind of stress test, is to determine, is this person suffering from clogged arteries, poor blood circulation to the heart, having chest pain because of the poor blood circulation to the heart. And if they are, can we reproduce it and, and really isolate what's going on. And that's where the stress test comes in. And certainly a treadmill stress test is a great place to start. Now, that's the good news. The bad news is a plain treadmill stress test is not a great test. It only really, points out what's going on maybe 80 or 85% of the time, which may be sounds good. But in the medical world, 80 or 85% is not great.
It's just good. Well, can we make it better? And the answer is yes. And so sometimes we actually add imaging of the heart in conjunction with the treadmill stress test. And there's two ways to image the heart. One is with a ultrasound and when we take ultrasound pictures of the heart, and the other way to image what's going on is with what's called nuclear imaging, where we inject a radiotracer through an IV that's been started. And then we can use that nuclear medicine to take additional pictures of the heart. And the purpose of the imaging is to see how well the heart is working before the stress is performed. So, we would take pictures of the heart before getting on the treadmill. And that would be your baseline images in terms of how well is the heart functioning at rest. And then we would walk you on the treadmill and at peak exercise, then we would stop and actually take additional pictures of the heart. And then those pictures represent how well the heart is functioning at peak exercise. The ultrasound imaging is the less expensive way to go. And it, and it's a little bit quicker, maybe not quite as good as nuclear imaging.
The nuclear imaging technology is a little bit more involved, takes a little bit more time, requires a little bit better camera to take those nuclear pictures, but imaging really adds to the treadmill stress test and increases our usefulness from say 80 or 85% to say 90 or 95% accuracy in terms of what's going on. Is this person having chest pain because of clogged arteries? Is this person having blood circulation issues to the heart? And if they are, then it opens up the door to maybe what can we do about it? And that's of course the take you over to the hospital and do a heart cath and an angiogram, and that's a whole other conversation.
So, treadmill is certainly a great place to start. Plain treadmill stress test has usefulness. A treadmill stress test with imaging has more usefulness, but I can't stop there because some people can't walk on the treadmill. Those would be people that maybe are maybe elderly and just simply can't walk very fast. Maybe they're young, but they have a leg problem. Maybe they got a bad knee or a bad hip and walking fast on a treadmill just isn't an option. In that case, a stress test can still be performed, but we refer to that kind of stress test as a chemical stress test. And that's kind of a layman's term for, oh, we're going to start an IV and using IV medicines, we're going to convince the heart as if it's or have the heart act like it's undergoing a treadmill stress test, but we're doing it with IV medicines.
Two common types of chemical stress tests. One is using a medicine called dobutamine. Which is just a medicine that we drip through the IV and speeds the heart up as if you were walking on a treadmill, that's performed sometimes, but not very often. The more common chemical stress test is using a medicine called Lexiscan. Lexiscan is a, is a medicine that doesn't really make the heart go faster.
Lexiscan is a medicine that opens up the arteries and, and improves the blood circulation in the healthy arteries and the unhealthy arteries it doesn't improve the blood circulation and with Lexiscan, now, when you do the nuclear imaging, it gives you a good idea of what's going on at rest and what's going on at stress.
And again, offers us the opportunity to compare those pictures to determine what the blood circulation to the heart looks like. But in this case, without having the person walk on a treadmill, simply because the patient is just not a candidate for walking on a treadmill. Probably the easiest example of somebody that can't walk very well on a treadmill is somebody that maybe has lost a leg in a car accident years ago and, and they use a wheelchair and can't walk, or maybe they're quite elderly and they use a cane or a walker and they can't walk, but we still want to do the imaging. And that's where the chemical stress tests come in. And those tests, again, talking about accuracy, probably about 90 to 95% accurate in terms of what the heck is really going on.
Again, no test is perfect. Even when we get to 90, 95% accuracy, we still have to interpret the stress test in conjunction with the symptoms that the patient tells us about. The context of the symptoms, does their chest hurt while they're exerting themselves? Does their chest hurt while there, I don't know, getting into an argument with their husband or wife or getting into an argument with their boss, or maybe their chest hurts when they're eating or maybe their chest hurts when they're watching TV and the context and the results of the stress test can all be taken together and give us an idea of just what the heck might be going on with that heart?
And do we need to perform other tests and look into it further? Or maybe the stress test is the end of the road and we can reassure the patient and say, ah, no, your heart looks pretty good. Let's leave you alone and just manage your blood pressure and just manage your cholesterol.
Host: And wrapping up here, tell us about echocardiograms.
Dr. Ewing: Thank you. The echocardiogram is actually one of my favorite tests to perform because using ultrasound technology, we're actually, we're able to take pictures of the heart inside the chest, just as if the patient was a pregnant lady, we use ultrasound technology to take pictures of my baby, which is the heart. And the cold jelly is placed on the chest. And the ultrasound probe is placed on the chest and using ultrasound, we look at the heart, we look at it in real time. We can see how big the heart is, how small, how thick, how thin. We can see how well the valves open and close, do they leak? Do they, are they restricted in their motion?
Uh, lots of useful information that can be discerned from the ultrasound of the heart or the echocardiogram. You'll also hear us in the office, refer to the echocardiogram, simply as an echo. That's kind of the short term for the same thing. It's real common for my patients to sometimes confuse the term echocardiogram with electrocardiogram.
The echo is the ultrasound of the heart. The electrocardiogram or EKG is the electrical picture taking of the heart, using the EKG machine. So, two different tests, two different results, both, both very useful, the ultrasound of the heart. Is it a great test? And the answer is yes, but it's not always the greatest that it could be.
And the reason for that is that using ultrasound technology and putting the probe on the chest wall, the ribs are in the way, the chest wall tissues are in the way, the breast tissues are in the way, the lung tissue can be in a way. So, quite often we get good pictures, but not always great pictures. And luckily though we do have a backup plan when we need to get great pictures.
The way to get great pictures is to get the ultrasound probe closer to the heart. The way that we get it closer to the heart is we actually would then take the patient over to the hospital. And the reason we do it at the hospital is so that we can give the patient some sedation and make them comfortable. And they actually make an ultrasound probe that the patient can swallow. Believe it or not, they swallow the probe. It sits in the esophagus. I hold on to my end of it, which is outside the body. And that's where all the controls are. And I can use the controls to point the ultrasound probe in different directions.
If you visualize the esophagus or the feeding tube that goes from your throat all the way down to the stomach. That sits right behind the heart, right, really up next to the heart. And there's nothing in the way. There's no breast or lung or ribs or anything blocking the pictures. So, we're able to take much clearer pictures using that ultrasound probe that's in the esophagus. That's the good news. The bad news is it's a more involved test and it's done at the hospital and it's, you know, it's you get sedation because it wouldn't necessarily be the most comfortable thing to swallow the camera so to speak. Very similar in terms of how the GI doctor also would have you swallow a camera to look into your stomach.
So, from your perspective or the patient's perspective, it's the same kind of test. So, not performed all the time because we don't all the time need to get great pictures. Good pictures though, suffice 99% of the time. The good picture taking is done in the office. The great picture taken is done at the hospital and that's ultrasound technology.
Very useful. Common question that's asked though, when we do an ultrasound of the heart, is what's the blood circulation look like? What do my arteries look like? And the answer is, I don't know. An ultrasound of the heart doesn't show the arteries. It doesn't show the blood circulation. Those details are too small.
And we really can't see that information with ultrasound technology. That's what stress testing is for is to try to get an idea of how well the heart's working from a blood flow standpoint. And then at the end of the day, if we're still concerned about your heart, then we have to start talking about taking you over to the hospital and doing a heart cath or a coronary angiogram.
But you don't do that in the office. That's a, that's a hospital-based procedure. And that, that's another conversation to talk about in the hospital testing, which can be much more involved than what we're able to do with the office. Of course, my goal is to keep my patients out of the hospital. Honestly, the clinician's job is to keep all his patients or her patients out of the hospital.
And that's what we try to do with all this testing in the office is to take care of people, make decisions, get them on the right medicines, do the right risk factor modification, get them to diet, get them to exercise, and hopefully keep these people out of the hospital. That's something we strive to do every day.
Host: Well, thank you so much for joining us today. We really do appreciate your time. That's Dr. Scott Ewing, the Medical Director of Quality and an Interventional Cardiologist on the Medical Staff of Baylor Scott and White Heart and Vascular Hospital in Fort Worth. Thanks for checking out this episode of Heart Speak. To find a specialist on the medical staff at Baylor Scott and White Heart and Vascular Hospital in Fort Worth or Dallas, please visit BSWhealth.com/heartFortworth. Or call (844) 279-3627. That's (844) 279-3627. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks. And we'll talk next time.
Baylor Scott and White Heart and Vascular Hospital, Dallas and Fort Worth, joint ownership with physicians.