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As an artery narrows over time, the symptoms tH

causes may increase in frequency and/or severity.


Healthcare providers may inquire about changes in exercise
tolerance (How far can you walk before getting symptoms?
Is it to the mailbox? Up a flight of stairs?) And whether
there has been an acute change in the symptoms.
Once again, patients may be asymptomatic until a heart
attack occurs. Of course, some patients also may be in
denial as to their symptoms and procrastinate in seeking
care.

Stress Testing
If the baseline EKG is relatively normal, then monitoring the EKG
tracing while the patient exercises may uncover electrical changes
that may indicate the presence of coronary artery disease. There
are a variety of testing protocols used to determine whether the
exercise intensity is high enough to prove that the heart is normal.
Some patients are unable to exercise on a treadmill test, but they
can still undergo cardiac stress testing by using intravenous
medication that causes the heart to work harder.
Stress testing is done under the supervision of medical personnel
because of the potential of provoking angina, shortness of breath,
abnormal heart rhythms, and heart attack.

HOW IS HEART DISEASE DIAGNOSED?


The diagnosis of heart disease begins with obtaining a
history that the potential for coronary artery disease exists.
Risk factors need to be assessed, and then testing may be
required to confirm the presence of heart disease.
Heart Disease Tests
Not every patient with chest pain needs heart
catheterization (the most invasive test). Instead, the
healthcare provider will try to choose the testing modality
that will best provide the diagnosis, and if coronary artery
disease is present, decide what impairment, if any, is
present.
Electrocardiogram (ECG or EKG)
The heart is an electrical pump, and the electrical impulses
it generates can be detected on the surface of the skin.
Normal muscle conducts electricity in a reproducible
fashion. Muscle that has decreased blood supply conducts
electricity poorly. Muscle that has lost its blood supply and
has been replaced with scar tissue cannot conduct
electricity. The electrocardiogram (EKG) is a noninvasive
test used to reflect underlying heart conditions by
measuring the electrical activity of the heart.
Some people have "abnormal" EKGs at baseline but this
may be normal for them. It is important that an
electrocardiogram be compared to previous tracings. If a
patient has a baseline abnormal EKG, they should carry a
copy with them for reference if they ever need another EKG.

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Echocardiography
Used with or without exercise, echocardiography can assess how
the heart works. Using sound waves to generate an image, a
cardiologist can evaluate many aspects of the heart.
Echocardiograms can examine the structure of the heart including
the thickness of the heart muscle, the septum (the tissues that
separate the four heart chambers from each other) and the
pericardial sac (the outside lining of the heart).
The test can indirectly assess blood flow to parts of the heart
muscle. If there is decreased blood flow, then segments of the hear
wall may not beat as strongly as adjacent heart muscle. These wal
motion abnormalities signal the potential for coronary artery
disease.
The echocardiogram can also assess the efficiency of the heart by
measuring ejection fraction. Normally when the heart beats, it
pushes more than 60 % of the blood in the ventricle out to the body.
Many diseases of the heart, including coronary artery disease, can
decrease this percentage (the ejection fraction).
Perfusion Studies
Radioactive chemicals like thallium or technetium can be injected
into a vein and their uptake measured in heart muscle cells.
Abnormally decreased uptake can signify decreased blood flow to
parts of the heart because of coronary artery narrowing. This test
may be used when the patients baseline EKG is not normal and is
less reliable when used to monitor a stress test.

To Be Continued in Next Edition.


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Antibiotic Use
Tied to Crohn's,
Ulcerative Colitis
eople who are prescribed a large
number of antibiotics tend to have
a higher risk of inflammatory
bowel disease (IBD), a new study finds,
providing more evidence that antibiotics
may be disturbing bacteria in our
intestine.
"It's n o t th a t a n tib io tic s c a u se
inflammatory bowel disease, but that it
further supports the hypothesis that

changing the gut flora may b


disadvantageous," co-author D
Charles N. Bernstein, who studte
bowel disorders at the University c
Manitoba, told Reuters Health
Previous stud ies hav e linke
antibiotic use and IBD, whic
includes C rohn's d isease an
ulcerative colitis. In the currei
study, Canadian researchers foun
12 percent of people diagnosed wit
the two conditions had bee
prescribed three or more antibiotic
two years before compared to seve
percent without the disease. Th
difference was consistent over
five-year period.

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