"Just go to the hospital to simply see a 'chest tightness', why did the doctor let me do so many tests, is it 'excessive treatment'?" Patients who have been to the hospital to screen for cardiovascular and cerebrovascular diseases may have this experience, blood draws, laboratory tests require a bunch of items. But you may not know that these cardiology examination items prescribed by doctors to patients are "each performing its own duties", the so-called "professional specialization", these examination items are not something that can be done or not.

Today, cardiologists will take you to know 9 commonly used examination items, and how doctors use them to see the heart "clearly".

There are more than a dozen items for the "physical examination" of the heart

In addition to traditional blood tests, such as blood lipids, blood sugar, liver and kidney function, BNP, etc., there are also electrocardiograms, cardiac ultrasound, coronary CT and angiography.

However, there are many examination items, and there are many doubts..."Doctor, recently I feel a little chest tightness and shortness of breath, the hospital took blood to test blood biochemistry, and then let me do color ultrasound and electrocardiogram, and also suggested that I do another CT, do I need to do so many tests?" How much money does this have to cost! Perhaps some patients complain like this.

In fact, the various examination items and contents of the cardiology department have different functions and meanings, and only by understanding their necessity can we understand why these examinations are done.

In order to confirm the diagnosis of a disease, multiple tests are often required to work together. In addition, even if it is a disease, the diagnosis method is not limited to one. The doctor will follow the principle of "only choose the right, not the expensive", and choose the appropriate examination method according to each patient's complaints, symptoms, etc., and the ultimate goal is: early detection, early treatment, and early recovery!

This is an "instruction manual" about the heart

The heart is located in the chest cavity, adjacent to the lungs on both sides. The outermost part of the heart is wrapped by the pericardium, and the inside is not solid – there are 4 chambers and their appendages. If you think of the heart as a house, it is a "small detached house" with four rooms (two atria and two ventricles), perfect water pipes, and electrical circuits.

Room Left atrium, left ventricle, right atrium, right ventricle

Doors and windows mitral valve, aortic valve, tricuspid valve, pulmonary valve

Wall Atrial septum, ventricular septum, free wall myocardial tissue that makes up the chambers of the atrioventr

Water pipes coronary arteries and their branches, venous vessels at all levels

9 common tests to "see through" the heart

1. Blood biochemistry The examination content mainly includes blood sugar, blood lipids, myocardial enzymes, liver function, renal function and troponin, brain natriuretic peptide, etc.

2. ECG When the heart is damaged or necrotic due to ischemia, the electrical activity of the heart will also be abnormal, and it will be visually reflected on the ECG with an amplified "waveform". This allows the diagnosis of conditions such as arrhythmias, myocardial ischemia, myocardial infarction, and myocardial hypertrophy.

3.24-hour Holter aka "Holter". Compared with ordinary static electrocardiograms, 24-hour ambulatory electrocardiograms can continuously monitor the patient's electrical activity, helping to detect conditions such as arrhythmias and asymptomatic myocardial ischemia that are usually hidden.

4. 24-hour ambulatory blood pressure Blood pressure can be said to change all the time, and 24-hour ambulatory blood pressure can grasp the comprehensive blood pressure changes within a day. The program helps screen for occult hypertension and nocturnal hypertension, as well as in grading hypertension, determining the type of circadian rhythm of hypertension, and evaluating the effectiveness of antihypertensive drugs.

5. Exercise plate test is also called "exercise load test". Some patients with coronary heart disease are as normal as healthy people in a quiet state, and only by increasing the workload of the heart and increasing the oxygen consumption of the myocardium can the underlying lesion be stimulated. During the examination, the subject is asked to carry the relevant monitoring equipment, run from step to run on the treadmill, slowly increase the intensity of activity, and then observe the changes in the electrocardiogram and blood pressure of the center of this process. Exercise plate tests are also frequently used to guide safe exercise in healthy people and people with heart disease.

6. Cardiac ultrasound is equivalent to the doctor's "see-through eye", which can dynamically display whether the heart structure is strong, whether the valve closure is tight, whether the myocardial contraction and relaxation is normal, and whether the blood flow is smooth.

7. Carotid ultrasound This examination can clearly show the lumen of the carotid artery, accurately measure and locate whether there is thickening, plaque, stenosis and occlusion of the intima, and provide a basis for the early prevention of atherosclerosis.

8. Coronary CT can simulate the patient's coronary system through CT imaging, so it can be observed whether the blood vessel is blocked or ruptured. Coronary CT can also measure coronary stenosis, calcified plaque, and coronary wall in patients. When we suspect that a patient has coronary heart disease, coronary CT is an important option. If the test results are normal, no further testing is required.

9. Coronary angiography The enhanced version of coronary CT integrates diagnosis and treatment (stent implantation or coronary balloon dilation can be completed at the same time during the contrast examination). Coronary angiography requires a catheter to be sent into the patient's coronary arteries, so that the location, extent and extent of the lesion can be more intuitively determined, which is regarded as the "gold standard" for the diagnosis of coronary heart disease. However, coronary angiography is a "traumatic" test.

Text/Wang Fang (Beijing Hospital)