Cardiology tests
La domanda
Electrocardiogram, echocardiogram, CT scan, MRI: how do you make sense of it all?
Risposta: Cardiovascular prevention now makes use of increasingly accurate tools, capable of detecting at an early stage any abnormalities and risk factors that may compromise the health of the heart and blood vessels. Advances in medicine have, in fact, made tests available that provide detailed information on the structure and function of the cardiovascular system, enabling a more thorough understanding of conditions that may remain asymptomatic for a long time. This progress represents a vital resource, particularly when integrated into a personalised prevention programme based on a comprehensive assessment of the patient.
The range of diagnostic tests available in cardiology is now extensive and sophisticated. However, the decision to use them must always be guided by the clinical judgement of the cardiologist, in order to avoid inappropriate or potentially harmful tests.
Electrocardiogram (ECG): This assesses the heart’s electrical activity, enabling the analysis of its rhythm, conduction, and any signs of ischaemia, hypertrophy or arrhythmias. It represents the first step in diagnosis: it is cost-effective, rapid and of great clinical value for basic screening at any age, although it provides only a limited recording at the time it is performed. Every citizen should have at least one electrocardiogram carried out from a very young age.
Colour Doppler echocardiogram: Assesses the structure, volumes, thicknesses and mechanical function of the heart walls and valves. It is a key test for diagnosing valvular defects, cardiomyopathies, the after-effects of a heart attack and heart failure. As it is based on ultrasound, it is completely harmless, painless and radiation-free.
Coronary CT angiography (CTA): This allows direct visualisation of the anatomy and patency of the coronary arteries, identifying soft or calcified plaques. It is particularly useful in low- to intermediate-risk patients with atypical symptoms to rule out coronary artery disease, with a high negative predictive value. However, as it involves the use of ionising radiation and iodinated contrast medium, it must never be used as a routine diagnostic test or for indiscriminate screening, but should only be prescribed in carefully selected cases.
Cardiac Magnetic Resonance Imaging (CMRI): This provides advanced tissue characterisation of the heart muscle with millimetre-level precision. It is the test of choice for investigating complex conditions such as myocarditis, inflammatory processes, amyloidosis, genetic cardiomyopathies and cardiac masses. It requires complex equipment and takes longer to perform than other tests. In Italia today, waiting lists for this scan are growing rapidly.
The correct sequence of tests is never random: it is the specialist who must determine the most appropriate test and diagnostic pathway to address the clinical question arising from the patient’s clinical assessment and medical history.