Tests to check heart health

Your doctors may use different tests to check how well your heart is working before, during and after cancer treatment. How often you have tests depends on the type of treatment and whether you already have heart problems.

  • Blood tests – to check for signs of heart problems and the effect of any medicines you are taking.
  • Electrocardiogram (ECG) – to check the rate, rhythm and electrical activity of the heart.
  • Ultrasound of the heart (echocardiogram) – uses soundwaves to build up a detailed picture of the heart and how well it is pumping.
  • MUGA (multigated acquisition) scan – uses a small injection of radioactive dye to show how well the heart is pumping and measures the amount of blood pumped out of your heart every time it beats.
  • CT coronary angiogram – uses an injection of dye to show the blood flow through the coronary arteries.
  • CMR scan – an MRI scan of the heart that shows a detailed picture of your heart and how well the heart is pumping.
  • 24-hour ambulatory blood pressure monitor – a device you wear at home which records your blood pressure at regular intervals.

What are tests to check heart health?

Your doctors may use different tests to check how well your heart is working before, during and after your cancer treatment. How often you have tests depends on the type of treatment and whether you already have heart problems. Your doctor or nurse will explain any tests that you need. Some people find it helpful to have a relative or friend come with them to the test.

You can find more information and videos of people having heart tests on the British Heart Foundation website.


Blood tests

Blood tests help check how well your heart is working. They are also used to monitor the effects of any heart medicines you take. The most common blood tests used to check heart health are:

  • Cardiac troponin test –This can help show whether your heart muscle has been damaged.
  • Natriuretic peptide tests (for example, B-type natriuretic peptides or BNP) – This can help show whether you have heart failure. A normal level means that you don’t have heart failure. If the level is high, you will need further tests such as a heart ultrasound (an echocardiogram).
  • Urea and electrolytes (U&Es) tests – These give information about the function of your heart and the effect of any medicines you are taking.


Electrocardiogram (ECG)

This test records the rate, rhythm and electrical activity of the heart. It can detect heart rhythm problems, and can sometimes show if someone has had a heart attack in the past. It can also show if the heart is enlarged or thickened.

Small sticky pads (electrodes) are placed on your chest, arms and legs. Wires connect the pads to an ECG recording machine, which picks up the electrical signals that make your heart beat. The electrical activity is recorded and printed on paper. The test takes about five minutes and is painless. You need to lie still during the ECG, as moving can affect the results.

An ECG can also be recorded over 24 to 48 hours. This is called Holter monitoring or ambulatory ECG monitoring. You have electrodes put on your chest and the wires attached to these will be taped down. The wires go under your clothes to a small portable recorder on a belt around your waist. While you are wearing the ECG recorder, you can do everything you would normally do except have a bath or shower. When the test is finished, you return the recorder to the hospital. Your doctor will check the results.

I’ve had pretty much every type of ECG going and they’re all as painless and minor as each other.

Amy


Ultrasound of the heart (echocardiogram)

An echocardiogram (echo) uses sound waves to build up a detailed picture of your heart. It is like the ultrasound scan used during pregnancy. It gives information about:

  • the structure of the heart
  • the heart valves
  • how well the heart is pumping.

You will be asked to lie down, usually on your left side. When you are comfortable, some gel is rubbed on your chest. A probe is then placed over different areas of your chest. This probe gives off pulses of sound waves, which echo against the structures of the heart. These echoes are picked up by the probe. They are shown as pictures on the screen of the echo machine.

The test can take from 15 to 60 minutes. It is usually painless, but it may cause some discomfort if you have had recent surgery on the left-side of your chest. Your doctor can give you painkillers to help with this.

Trans-oesophageal echocardiogram (TOE)

Some people will have a trans-oesophageal echocardiogram (TOE). This test takes more detailed pictures of the heart from inside the gullet (oesophagus). The gullet is the tube that connects your mouth to your stomach. It lies behind your heart. This means a TOE can get a closer and clearer picture of the heart valves.

Before you have a TOE, you may be given drugs to make you feel sleepy (sedation). Your doctor will gently pass a small, flexible ultrasound probe through your mouth and into the throat. You will then be asked to swallow.

The test usually takes around 20 minutes. It can feel uncomfortable, but it should not be painful. You can usually go home after the sedation has worn off.


Multigated acquisition (MUGA) scan

This scan shows how well the heart is pumping and measures the amount of blood pumped out of your heart every time it beats.

It may be used to check for heart changes caused by some types of chemotherapy or targeted therapy treatment.

During the scan, your doctor will give you two injections into a vein in your arm. The second injection is a small amount of radioactive dye. If you are pregnant or breastfeeding, talk to your doctor before having this test.

A special camera then takes images of your heart. This measures how the dye is pumped through your heart.

The test takes about an hour and usually isn’t uncomfortable. You may be asked to avoid close contact with children and pregnant women for a few hours after.


Computerised tomography (CT) coronary angiogram

A CT scan takes a series of x-rays, which build up a three-dimensional picture of the inside of the body. A CT coronary angiogram helps show the blood flow through the coronary arteries.

Before this test, you may be given a tablet or injection of a drug that slows your heartbeat slightly. A slower heartbeat makes it easier to get clear scans. You will also have a dye injected into a vein in your arm. This dye helps show how blood is moving through the heart.

You lie on a bed which is moved inside the scanner. The scanner is shaped like a large doughnut. The total time of the test is about 90 minutes, but the scan itself only takes 15 minutes.

A small amount of radiation is used during this test. If you are pregnant, talk to your doctor before having this test. Radiation can also increase your long-term risk of developing cancer. However, the benefits of having the test usually outweigh the risk.


Cardiac magnetic resonance (CMR) scan

This is a magnetic resonance imaging (MRI) scan of the heart. An MRI scan uses magnetic waves to build up detailed pictures of areas of your body. A CMR scan gives information about:

  • the structure of the heart
  • the heart valves
  • how well the heart is pumping.

The scanner is a powerful magnet. It may not be suitable for people with metal implants, such as a pacemaker or surgical clips. If you have ever worked with metal or in the metal industry, you should tell your doctor, as tiny fragments of metal can sometimes lodge in the body. Before the scan, you will need to remove any metal belongings including jewellery.

For some cardiac MRIs, the doctor will inject a dye into a vein in the arm. The dye helps to give a clearer picture of the heart muscle and the blood flow through and around the heart. Your doctor can tell you more about this.

During the scan, you will be asked to lie still on a couch. The couch is moved inside a tunnel-shaped scanner that is open at both ends. The scanner is noisy, but you will be given earplugs or headphones.

The scan can take up to an hour, but you will be able to speak to the person operating the scanner. Some people feel a bit claustrophobic inside the scanner. If you are worried about this, tell your doctor before having the scan. You may be offered a mild sedative drug to help you relax.


24-hour ambulatory blood pressure monitor

Some cancer drugs can cause high blood pressure. Your cancer doctor or nurse will check your blood pressure regularly. But sometimes they may want to monitor it over a longer time.

This can be done with a portable (ambulatory) blood pressure monitor. You wear it for 24 hours while you continue your normal routines. A blood pressure cuff (a band) is wrapped around your upper arm. A tube goes from the cuff, under your clothes, to a small monitor on a belt around your waist.

The cuff inflates around your arm and records your blood pressure. It does this automatically at regular times. For example, it could happen every 30 minutes during the day and every hour at night. The monitor records your blood pressure measurements and the time they were taken. After 24 hours, the monitor is removed. The information is collected for your doctor to check.

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