9 Hidden Risk Factors for Heart Disease

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What to Expect if You Have Symptoms

Electrocardiogram (EKG)
Leads—small sticky pads containing electrodes—are attached to your neck, chest, arms, and legs. These record your heart’s electrical impulses to determine whether your heart has been damaged.
           
Nieca Goldberg, M.D., says it’s best to get this test when you’re actually experiencing symptoms such as chest pain. She orders the test for women who have heart murmurs, abnormal baseline EKGs, or hypertension.

Calcium scoring
Reserved for people at high risk, this test uses a computerized tomography scan to detect calcium deposits in the coronary arteries. As you lie in a scanner, an X-ray machine takes pictures of your heart from all angles.

Coronary angiography
An X-ray to reveal narrowing in the heart’s arteries, this test is usually given only to those with chest pain or other signs of serious heart disease. Prior to the test, dye is injected via an IV. The dye highlights any blockages. 

Stress test
This test evaluates the heart during exertion. EKG leads are attached to your chest and a blood pressure cuff to your arm. You then walk or run on a treadmill or pedal a bicycle. A technician increases the intensity every few minutes until you feel tired, experience symptoms, or the EKG becomes abnormal. As the heart is forced to pump more blood, your doctor can see whether the blood supply is reduced in any of the coronary arteries.
           
Stress tests may be more useful in men than in women, however. “There appears to be a higher incidence of false positive stress tests in women,” says Louis Teichholz, M.D., chief of cardiology at Hackensack University Medical Center in New Jersey. This may be due to gender differences in heart rhythms as well as hormones.

Tests You May Have (or Need) in the Future

Dual X-ray absorptiometry (DXA)
The same kind of scan that measures bone density can now give a reading on your heart. The Food and Drug Administration just approved DXA to look for abdominal aortic calcifications, a risk factor for heart attacks and stroke. A heart scan can be done at the same time as the bone scan. The procedure takes about 10 seconds; there’s no need for protective shielding because the radiation dose is so low.

Ultrasonic exams
K. Craig Kent, M.D., chief of vascular surgery at New York Presbyterian Hospital, has championed ultrasonic exams to catch aneurysms and strokes before they occur. The Medicare Act covers this exam for men ages 65 and older because it’s a cost-effective way to find such problems early. But Kent thinks women—especially those who smoke and have a history of heart disease—should have it, too.        

As a wand passes over your torso and neck, images of the aorta and carotid arteries appear on a screen. Technicians look for any blockages or blood-flow interruptions. Then Doppler technology, which uses low-intensity ultrasound to detect blood-flow velocity, compares blood pressure in the arm with blood pressure in the ankle. A difference beyond a certain point could signal a blockage to the lower extremities and the need for further tests, treatments, or surgery.