Cardiology is the medical specialty focused on the heart and the cardiovascular system. It involves the diagnosis, treatment, and prevention of conditions affecting the heart and blood vessels. These conditions include coronary artery disease, heart failure, arrhythmias (irregular heartbeats), and valve disorders. The field covers a broad spectrum, from congenital heart defects present at birth to acquired conditions like heart attacks.
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Detecting structural heart disease often starts with a simple conversation and a physical exam, but confirming the diagnosis requires looking inside the body. Because the heart is a moving pump hidden behind the ribcage, doctors rely on advanced technology to visualize its motion and mechanics. The goal of diagnosis is not just to identify the problem but to measure it precisely. Doctors need to know the exact size of a valve opening, the volume of a leak, or the diameter of a hole to plan the right treatment.
This section explains the toolkit cardiologists use to evaluate the structure of the heart. We will move from the basic tools found in any doctor’s office to the sophisticated imaging used in hospitals. Understanding these tests can take the fear out of the process. Most of these tests are quick and painless, yet they provide a wealth of information that guides your care team in choosing the best path forward.
The oldest and most reliable screening tool for structural heart disease is the stethoscope. When a doctor listens to your heart, they are listening to the sound of the valves closing. The valves snap shut, producing the classic “lub-dub” sound. If a valve is stiff or leaky, it makes a different noise, known as a heart murmur.
A murmur can sound like a whooshing, clicking, or rasping noise. The timing and location of this sound tell the doctor which valve is affected. For example, a murmur heard during the heartbeat might indicate aortic stenosis, while one heard after the beat might indicate regurgitation. While a stethoscope cannot measure the severity of the disease, it is usually the first clue that prompts further testing.
The most important test for diagnosing structural heart disease is the echocardiogram, often just called an “echo.” This is a specialized ultrasound of the heart. It uses sound waves to create a moving picture of the heart on a screen. It is completely safe and uses no radiation.
During a standard echo, a sonographer places a wand (transducer) with cool gel on your chest. They move it around to get different angles. This test allows the doctor to see the valves opening and closing in real time. They can measure the thickness of the heart walls and the size of the chambers. Most importantly, they use Doppler ultrasound to see the color and speed of blood flow. This technique shows exactly where blood is leaking or where it is moving too fast due to a blockage.
This is the standard echo on the chest surface. “Transthoracic” simply means “across the chest.” It is painless and takes about 30 to 45 minutes. It provides a general overview of the heart’s function and structure and is usually the first imaging test ordered.
Occasionally, the ribs and lungs block the view of certain heart structures. In these cases, a transesophageal echocardiogram (TEE) is needed. For this test, you are sedated, and a small, flexible probe is guided down your throat into your esophagus (food pipe). Since the esophagus sits directly behind the heart, this provides incredibly clear, detailed images without any interference. It is often used to look for blood clots or to plan complex valve repairs.
If your symptoms only happen during exercise, a resting echo might look normal. In this case, doctors use a stress test to see how your heart performs under a workload. You might be asked to walk on a treadmill while connected to a heart monitor. In a “stress echo,” images of your heart are taken before and immediately after exercise.
This helps reveal if a valve opens well enough at rest but fails to open wide enough when blood flow increases. It also shows if the pressure in the heart lungs shoots up abnormally during activity. If you can’t use a treadmill, drugs can mimic exercise’s effect on the heart.
When planning for a procedure, especially minimally invasive ones, doctors need a 3D roadmap of your heart. A cardiac CT (computerized tomography) scan uses X-rays to create detailed cross-sectional images. This is essential for measuring the exact size of the aorta or the landing zone for a replacement valve. It helps ensure that an artificial valve fits perfectly.
Cardiac MRI (Magnetic Resonance Imaging) uses powerful magnets to create images. It is excellent for looking at the heart muscle itself and measuring the volume of blood flow very accurately. It is often used to assess congenital heart defects or to see how much scar tissue is present in the heart muscle.
Occasionally, non-invasive tests may not provide a comprehensive view, necessitating the doctor to directly measure the pressures within the heart. Cardiac catheterization, or an angiogram, is an invasive diagnostic procedure. You are awake but sedated. A thin tube (catheter) is inserted into a blood vessel in your wrist or groin and threaded up to the heart.
Through this tube, the doctor can inject dye to see the blood vessels in an X-ray. They can also push the catheter across a valve to measure the pressure difference between two chambers. If the pressure is much higher on one side of a valve than the other, it confirms a severe blockage (stenosis). This test often serves as the final confirmation before scheduling a repair or replacement.
Diagnosis isn’t always a one-time event; sometimes it involves monitoring over days or weeks. If you have palpitations, your doctor might prescribe a Holter monitor or a patch monitor. These are wearable devices that record your heart’s electrical activity while you go about your normal life.
These devices help catch intermittent problems, like bursts of atrial fibrillation that might be triggered by a structural heart issue. Wearable technology, like smartwatches, is also becoming a useful tool for patients to track their heart rate and rhythm, providing data that can be shared with their cardiologist.
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No, the procedure is not painful because your throat is numbed with a spray and you are medicated to make you sleepy and relaxed. Most patients have no memory of the tube being inserted. You might have a mild sore throat for a day afterward.
You should wear comfortable clothes and running shoes. You will typically be asked to avoid caffeine for 24 hours before the test, as it can affect your heart rate. You may also need to fast for a few hours beforehand.
It depends on the device. Many modern pacemakers are “MRI-conditional,” meaning they are safe for MRI scans under specific settings. However, older devices may not be safe. Always inform the technician about any metal implants in your body.
The echo shows how the heart moves, while the CT scan shows the exact anatomy and measurements in 3D. The CT scan is crucial for sizing artificial valves and planning the specific steps of a procedure.
Contrast dye can be stressful on the kidneys, especially for older adults or those with existing kidney disease. Doctors will check your kidney function beforehand and may give you extra fluids to help flush the dye out of your system safely.
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