Detection and Diagnosis
Discovering cardiovascular disease early is critical for stopping and reversing the progression of the disease and for increasing longevity and quality of life. With early diagnosis, treatment, and simple changes in lifestyle habits, most people can dramatically reduce their risk of cardiovascular disease.
When determining the best course of treatment, Mount Sinai Heart electrophysiologists consider your personal and medical background, including factors such as the frequency and seriousness of the arrhythmia, the risk of stroke, any underlying cause of the arrhythmia, the presence of other problems (such as coronary artery disease or valve disorders), medications taken for other conditions, your age, and your overall health.
At Mount Sinai Heart, we diagnose arrhythmias using a variety of minimally invasive techniques:
Electrocardiogram, also known as ECG or EKG, is an imaging technique that provides a snapshot of your heart's electrical activity. This non-invasive test shows heart muscle damage and how much blood and oxygen is being supplied to the heart. It can also provide clues to the size of your heart’s chambers, and if these chambers have become enlarged. We conduct the test by attaching a series of electrodes to your chest. While you lie still, the electrodes measure your heart’s electrical activity throughout your chest.
Holter Monitor and Event Monitors are battery-operated devices that you wear under your clothing for at minimum a day or two as it measures and records your heart’s activity. At Mount Sinai Heart, we use this information to help us identify suspected occasional cardiac arrhythmias that do not appear during a shorter testing period such as an EKG performed in your doctor’s office.
Signal-Averaged Electrocardiograms provide more detailed images than the standard EKG. Mount Sinai Heart cardiologists use this imaging technique to analyze the electrical details of hundreds of heartbeats so we can identify more subtle heart rhythm irregularities.
Electrophysiology (EPS) Study is a catheterization procedure that maps your electrical system. This map allows our heart rhythm experts to assess your heart’s electrical activity, map irregular heartbeats, and locate the area of the heart that is causing the problem. We can often treat an arrhythmia during the same procedure. During an EPS study, our electrophysiologists use specially insulated catheters, inserted through a vein in the groin area and guided by X-ray, to advance electrodes into the heart.
Coronary Angiograms help our interventional cardiologists diagnose heart disease after other tests such as EKG or ultrasound have been inconclusive or incomplete. We perform this procedure in a cardiac catheterization laboratory, also called a cath lab. We inject a nontoxic dye into your arteries through a catheter, and then examine your blood vessels under a fluoroscope (low-dose X-ray camera). We can move both the table you lie on as well as the camera, so we can view different angles of the heart to see if there are any blockages.
Stress Tests study how your heart operates under exertion. Mount Sinai Heart physicians perform this test while you walk on a motorized treadmill or ride a stationary bicycle at increasing levels of difficulty. As you exercise, we continuously monitor your EKG and blood pressure to see if physical activity changes your heart’s performance. This test is also called an exercise stress test. If you cannot perform these exercises, your physician may administer a drug that stimulates your heart without exercise. Stress tests are noninvasive, and aside from physical exertion, are not painful.
Magnetic Resonance Imaging (MRI) scans use non-iodine-based enhancing agents, a magnetic field, and radio waves to produce detailed still and moving pictures of heart structures. By providing images from many angles, MRIs facilitate assessment of complex cardiac anatomic abnormalities. In addition, the moving pictures help us see how your heart beats, potentially identifying problems in cardiac chamber contraction, areas of the heart muscle not receiving adequate blood supply from coronary arteries, and any heart muscle that has been damaged by heart attack. This test poses little or no risk to you.
Cardiac Computed Tomography (CT) Scans are X-ray images that use intravenous iodine-based contrast and a computer to generate high-resolution, three-dimensional images of the heart and blood vessels. CT scans enable Mount Sinai Heart physicians to evaluate the condition of your heart muscle, coronary arteries, pulmonary veins, thoracic aorta, pericardium, and the left atrial appendage, which is a muscular pouch connected to the left atrium of the heart that can be a source for blood clots. The scan also produces a calcium score, which measures the buildup of cholesterol or plaque in coronary arteries, called atherosclerosis. The test poses little or no risk to you.
Coronary Artery Calcium Scans are noninvasive tests that measure the presence and extent of coronary calcium deposits in your coronary arteries. This CT scan is an early and very reliable indicator of atherosclerotic deposits (called plaque) that can block blood flow. At Mount Sinai Heart, we use this painless procedure to help us predict your risk for future heart problems.
Nuclear Cardiology Tests produce images of the heart at work (during exercise) and at rest. These tests are a quick way to detect heart attack risk or unstable angina. Mount Sinai Heart cardiologists inject a small amount of radioactive tracer into you, and you then exercise on a treadmill or bicycle, followed by a rest period. We use a special camera to produce computer-generated, tomographic slices of the heart, tracking how much thallium reaches your arteries and heart muscle, as well as how much blood is being supplied to the heart. From this test, we can determine any blockages or blood vessel abnormalities.
Muga Studies, also called resting gated blood pool studies, evaluate your heart muscle function. We inject you with a radioactive imaging agent and use a special camera to take pictures of your heart approximately 30 minutes later. The test takes between 60 and 90 minutes.
Tilt Table Tests evaluate unexplained fainting or severe lightheadedness that may or may not be rooted in coronary problems. During the tilt table test, you lie on a table while we take your blood pressure and monitor your heart rate. Then we raise the table, simulating a change in position from lying down to standing up. This causes blood pressure to drop, so we can see how your heart responds to the change.
Viability Tests use a dobutamine stress echocardiography protocol. The test allows us to distinguish non-reversible (scar) from reversible (viable) heart muscle function. In the latter situation, patients may benefit from procedures that restore normal blood flow to specific areas of the heart. This one-hour test can also help us determine the best course of treatment.