The ADA suggests that primary-care physicians assess their patients' heart disease risk factors annually and prescribe cardiac testing accordingly. Cardiac testing may include an electrocardiogram (ECG), a stress test, or an echocardiogram.

Electrocardiogram (ECG, or EKG)

An ECG measures the electrical impulses put out by the heart and creates a visual representation, or tracing, of them. The test is used to check for irregularities in heart rhythm or rate and to detect signs of coronary artery disease or heart damage.

For a resting ECG, you will be asked to lie flat on a table while sensor patches (leads) are attached to ten various points on the body. The sensors are attached to wires that transfer your heart's electrical impulses into the ECG unit where a tracing is generated. The test is very brief, taking only about five to ten minutes from start to finish. Your physician will then review the tracing for abnormalities that may indicate an artery blockage or other heart problems.

Exercise Stress Test

As the name implies, an exercise stress test evaluates how your heart and cardiovascular system perform under the pressure of exercise. Your heart is again monitored with ECG leads and a blood pressure cuff. A pulse oximeter (a small, painless clamp that uses light to measure the level of oxygen in your bloodstream) is attached to a finger or other site with sufficient blood flow. Baseline levels of your heart function are taken at rest before the stress test begins.

A stress test is usually performed on a treadmill or stationary bicycle. The level of exertion, or stress, is increased periodically until the patient reaches a specific heart rate. Each time the stress increases, vital signs are measured. The test will be stopped if chest pain, dangerously high blood pressure, or other danger signs develop. The whole procedure typically takes about fifteen to twenty minutes, and your heart will continue to be monitored after the exercise portion ends until vital signs return to baseline levels.

Echoes and Scans

Your primary-care provider may also recommend other tests that assess cardiac function and structure, including nuclear perfusion and echocardiography. The nuclear perfusion test, sometimes called a thallium scan or a Cardiolite scan, uses a trace amount of radioactive material injected into the bloodstream. The radioactive material is absorbed by cardiac muscle and allows better visualization of the heart structures using a special camera.

Poor absorption is associated with inadequate blood flow (perfusion) and may indicate that the arteries leading to that portion of the heart are diseased. A Cardiolite scan also allows the physician to visualize coronary arterial disease (CAD) and areas of tissue death signifying a previous myocardial infarction, or heart attack.

Echocardiography, or “echo,” uses ultrasound to see the heart. A small wand, called a transducer, is passed over the chest and sound waves emitted by the transducer bounce off the structures of the heart. The resulting image is displayed on a video screen. Blood flow is also visible.