Diagnosing heart conditions Q&As
Published by Bupa's health information team, September 2008.
Answers to questions about diagnosing heart conditions
This section contains answers to common questions about this topic. Questions have been suggested by health professionals, website feedback and requests via email.
- Is there any risk from having these kinds of tests?
- What happens if I get chest pain when I'm having an exercise test?
- What will happen after the tests?
Is there any risk from having these kinds of tests?
Most of the tests used to diagnose heart conditions are very safe and won't put you at risk of side-effects. However, there are three tests that do have a risk of side-effects or complications - exercise ECG, electrophysiological tests and angiography. Your doctor will discuss the risks and benefits of having these tests with you.
Explanation
Having tests for your heart condition can benefit you by helping your doctor to choose the right treatment for you. However, not all tests are without risk. The following three tests carry a small risk of side-effects and complications.
Exercise ECG
An exercise ECG puts your heart under stress by exercising so you may develop chest pain (angina) during the test. Because of the risk of chest pain, you will be closely monitored during the test. Leads are attached to your chest, which monitor your heart rate and rhythm and there will always be someone with you. There is a very small risk of having a heart attack, developing serious irregular heart rhythms or dying as a result of the test. However, this is very rare and happens to less than one in every ten thousand people who undergo this test. Because of this very small risk this test is always carried out by properly trained staff in a place where medical help is quickly available.
Electrophysiological tests
During a diagnostic electrophysiological test, your doctor will feed wires to your heart through the veins near your groin (or sometimes the vein under your collarbone). These wires are used to map out the electrics of the heart. The test is very safe and the main risk is some bruising where the wires are inserted into your veins. Extremely rarely, a wire could puncture the heart or a blood clot could form, which could pass to the lungs (pulmonary embolism).
Therapeutic electrophysiology (ablation)
This involves making small burns or small frozen areas on the inner lining of the heart to block any abnormal electrical pathways. If you need to have this, there is a very small risk of heart block (which would need a pacemaker), stroke or heart attack. Ask your doctor to explain the risks to you for your individual circumstances.
Angiography
An angiogram is now a relatively common test and many people have the test done and leave hospital on the same day. However, the test has some risks and the complications in a small number of people can be very serious.
A few people have a reaction to the dye used in angiography, although this is unusual and often mild with the modern dyes used today. You should tell your nurse or doctor if you have had an allergic reaction to X-ray contrast dye before, or if you are allergic to shellfish, which contains iodine like the X-ray contrast dye. When the catheter is taken out of the blood vessel you may find that it bruises or bleeds enough to form a lump. This is called a haematoma and can be painful and uncomfortable for a few days. If the haematoma is very large, you may need to have a small operation to drain it. Occasionally haematomas can also become infected and you may need to take antibiotics to treat this.
Angiograms are sometimes carried out on people who already have serious heart problems and there is a small risk of more serious complications. There is a risk of having a heart attack, of having a stroke or of dying as a result of an angiogram. One or two people out of every thousand people who have an angiogram have these kinds of complication. Your risk may be higher or lower, depending on your health and your heart condition. Discuss the risks and benefits with your doctor.
Further information
- British Heart Foundation
www.bhf.org.uk
Sources
- Hill J, Timmis A. ABC of clinical electrocardiography: exercise tolerance testing. BMJ 2002; 324: 1084-1087
- Tests for heart conditions, Heart Information Series 9. British Heart Foundation, 2004
- Longmore N, Wilkinson I, Turmezei T, Cheung C. Oxford Handbook of Clinical Medicine. 7th ed. Oxford: Oxford University Press, 2007
- Information for patients undergoing an angiogram. The Royal Collage of Radiologists. www.rcr.ac.uk, accessed accessed 3 January 2008
What happens if I get chest pain when I'm having an exercise test?
Some people develop chest pains (angina) when they have an exercise test (an exercise electrocardiogram, or ECG for short). If this happens to you, tell the doctor or technician performing the test. They may ask you to stop the test. If you start to get chest pain, you can also ask for the test to be stopped yourself, but you may be asked to continue with the test if there are no changes to the ECG.
Explanation
An exercise ECG is one of the main tests used to diagnose heart problems, or to see how bad those heart problems are (for more information, please see the Exercise electrocardiogram section of our factsheet on Diagnosing heart conditions). So, some people do get chest pain (angina) during the test. The most common reason for an exercise ECG test to be stopped early is because the person taking the test becomes tired or short of breath, usually because they aren't used to the exercise.
Your doctor will consider whether an exercise ECG is a suitable test for you. For example, if you have had a heart attack very recently (within the last 48 hours), you won't be asked to take the test. If you do have the test, there will always be either a doctor or a specially trained technician there to make sure that you are safe. If you have chest pain at any time during the test it's important to tell the staff straightaway. Developing serious complications as a result of having an exercise ECG is rare.
The test usually lasts up to 20 minutes and some people do find it hard work. However, you might be surprised by the amount that you can do and it may help you feel more confident and reassured about exercising. If you are worried about taking the test, talk to your doctor or to the technician about your concerns.
Further information
- British Heart Foundation
www.bhf.org.uk
Sources
- Tests for heart conditions. Heart Information Series 9. British Heart Foundation, 2004
- Hill J, Timmis A. Exercise tolerance testing. ABC of clinical electrocardiography. BMJ 2002; 324:1084-1087
- Angina - management issues. Clinical Knowledge Summaries. http://cks.library.nhs.uk, accessed 3 January 2008
What will happen after the tests?
This will depend upon the results of the tests and the reasons why you are having them. The test results may help to rule out heart disease or they may confirm it. Your doctor will discuss your options and help you to choose the right treatment for you.
Explanation
If you are found to have heart disease, you may need further treatment. This could mean taking medicines or having surgery as well as making some changes to your lifestyle. Being told that you have heart disease for the first time can be a shock and many people find it difficult to cope with, particularly if they need to have major surgery. A diagnosis of heart disease may have an impact on all aspects of your life, from your work and social life to your relationships with the people close to you. You might feel angry, upset or frightened and your family and friends may also feel concerned and anxious for you.
Getting support and being informed can help you to deal with your concerns and make them more manageable. You may feel much more in control if you know what is happening to you and why. Think about what you need to know before you go for an appointment with your doctor and write down your questions. Sometimes it can be very helpful to take someone with you for support and to keep a note of what your doctor tells you.
There are a number of organisations that can help you with information about your condition and with finding support. Some of them can also put you in touch with other people like you, who have also been diagnosed with heart problems.
Further information
- DIPEx - Personal Experiences of Health and Illness
www.dipex.org - British Heart Foundation
www.bhf.org.uk - Chest Heart and Stroke Scotland
www.chss.org.uk - Northern Ireland Chest Heart and Stroke Association
www.nichsa.com
Sources
- Tests for Heart Conditions, Heart Information Series 9. British Heart Foundation. 2004
This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.
Publication date: September 2008
