Diagnostic testing

The chest x-ray provides information about heart size, the pulmonary circulation (with characteristic signs suggesting both pulmonary artery or pulmonary venous hypertension), primary pulmonary disease, and aortic abnormalities. The echocardiogram provides much more reliable information about chamber size, hypertrophy, pericardial effusions, valvular abnormalities, and congenital abnormalities and has replaced the x-ray for evaluation of cardiac disease. The electrocardiogram (ECG) indicates cardiac rhythm, reveals conduction abnormalities, and provides evidence of ventricular hypertrophy, myocardial infarction, or ischemia. Nonspecific ST segment and T wave changes may reflect these processes but are also noted with electrolyte imbalance, drug effects, and many other conditions. Routine x-rays and ECGs are not recommended to screen for heart disease and have a limited role in the follow-up of patients with known heart disease. However, a baseline ECG is helpful in older patients.

Noninvasive diagnostic testing
Noninvasive diagnostic procedures are growing in number and application. However, they are frequently overutilized. The clinician should carefully consider what question is being asked and how the results will alter patient management before ordering these tests. They have limited applicability in screening for asymptomatic disease and should not be substituted for a careful clinical evaluation.

• • Auscultation of the chest
• Diagnostic Modalities