High Blood Pressure in Ajax: Which Heart Tests Help

High blood pressure is easy to underestimate because it so rarely announces itself. Most people with it feel well. They find out at a pharmacy machine, a routine check-up or a visit for something unrelated, and then they are handed a prescription, some lifestyle advice and, sometimes, a requisition for heart tests they did not expect.

That last part can be confusing. If the problem is the pressure in your arteries, why is anyone looking at your heart? The short answer is that the heart and the arteries are a single system, and years of extra pressure can quietly change both. Tests help your provider see whether that has happened, how much, and what to keep an eye on.

This article explains the connection in plain language and walks through the tests a provider in Ajax, Pickering or Whitby might order, with a note on what each one adds. It is general information. Which tests you need, if any, is a decision for you and your health-care provider.

Call 911 for chest pain or pressure, sudden severe shortness of breath, fainting, or stroke signs: a drooping face, weakness in an arm or leg, trouble speaking, sudden vision loss or a sudden, severe headache. A very high blood pressure reading together with symptoms like these needs emergency care, not a booked test.

What the pressure is doing

Every heartbeat pushes blood into the arteries. Blood pressure is the force of that blood against the artery walls. It rises with each beat and falls between beats, which is why it is recorded as two numbers. Your provider will tell you what range is right for you.

When pressure stays high for a long time, two things tend to happen.

The heart works harder. Pumping against higher pressure is like constantly pushing a heavier door. Over time, the main pumping chamber of the heart, the left ventricle, can respond by thickening its muscular wall. A thicker wall may become stiffer and less efficient at relaxing and filling between beats.

The arteries change. Persistent pressure can stiffen artery walls and make them more prone to the buildup of fatty plaque. That affects arteries everywhere: those supplying the heart muscle, those in the neck that supply the brain, the aorta in the abdomen and the arteries of the legs.

These changes happen gradually and often without symptoms. That is exactly why testing can be useful: it looks for effects you would not otherwise notice.

Why tests are ordered for a “silent” condition

A provider looking after someone with high blood pressure is usually trying to answer some of these questions:

• Has the pressure already affected the structure or function of the heart?
• Is there any sign of reduced blood supply to the heart muscle?
• Is the heart rhythm regular?
• Are the large arteries showing narrowing or widening?
• Are there other conditions present that change how the blood pressure should be managed?

No single test answers all of these. That is why some people are sent for one test and others for several. Having more than one test on a requisition does not mean your provider is worried; it often just means they are being thorough.

The tests, one question at a time

Durham Cardiology, the cardiology team at Rossland Diagnostic Clinic in Ajax, offers several of the tests below with a requisition from your provider. Rossland Diagnostic Clinic also offers vascular ultrasound. Each section names the question the test helps with.

“What is the heart’s electrical activity like?” — Electrocardiogram

An electrocardiogram, or EKG, records the electrical activity of the heart through small sensors on the skin. It takes five to ten minutes and needs no special preparation beyond bringing your signed requisition and OHIP card.

For someone with high blood pressure, an EKG gives a baseline picture of heart rhythm and can sometimes suggest that the heart muscle has been working under strain. It is often one of the first tests ordered because it is fast and simple.

“Has the heart muscle changed?” — Echocardiogram

An echocardiogram is an ultrasound of the heart that lets a cardiologist evaluate heart size, structure, valves and blood flow. In the context of high blood pressure, it is the test that can directly show whether the left ventricle wall has thickened and how well the heart is pumping and filling.

It takes about an hour. For more on what happens during the scan and what is being looked at, see our closer look at the echocardiogram.

“How does the heart cope with effort?” — Stress test or stress echocardiogram

If you have symptoms on exertion, such as chest discomfort or unusual breathlessness, or if your provider wants to understand your exercise capacity, they may order a treadmill stress test. This monitors your heart’s rhythm and blood pressure as the treadmill gradually increases in speed and incline.

A stress echocardiogram adds ultrasound images of the heart before and after exercise. Both tests have preparation steps, including a conversation with your physician about blood pressure medications called beta blockers. Our guide to preparing for a cardiac stress test covers those steps in detail. The key rule is simple: never stop a medication unless your doctor tells you to.

“Is blood reaching the heart muscle well?” — Myocardial perfusion imaging

Myocardial perfusion imaging is a nuclear cardiology test that shows how well blood flows through the heart muscle, at rest and under stress. It is more specialized and is typically ordered for particular clinical questions. Preparation varies by protocol, and our team provides specific instructions when the appointment is confirmed.

“Is the rhythm steady over days?” — Holter monitor

High blood pressure is linked with some heart rhythm problems. If you notice palpitations, a fluttering feeling or dizzy spells that come and go, your provider may order a Holter monitor, which records your heart rhythm for 48 hours, 72 hours or 7 days. Our Holter monitor guide explains what living with one is like.

“What about the arteries?” — Vascular ultrasound

Because high blood pressure affects arteries throughout the body, a provider may also look beyond the heart. A carotid ultrasound examines the arteries in the neck and gives information relevant to stroke risk. An ultrasound of the abdominal aorta measures the body’s largest artery for widening. These are separate from heart tests but answer related questions. We have written about each in more depth: carotid ultrasound and stroke risk and abdominal aortic aneurysm ultrasound.

Not everyone needs every test

It is worth repeating: these tests are tools, not a checklist everyone must complete. Many people with well-controlled blood pressure and no symptoms need little more than regular check-ups. Others, depending on their age, how long they have had high blood pressure, other conditions such as diabetes or kidney disease, family history and symptoms, may benefit from more information.

If you are curious why a test was or was not ordered for you, ask. A good question to bring to your provider is, “What are we hoping to learn from this test, and how might it change my care?”

Testing is one part of the plan

Tests describe what is happening; they do not lower blood pressure on their own. The day-to-day work of managing high blood pressure usually happens between appointments, through the plan you and your provider agree on. That plan may include medication, along with familiar themes from mainstream guidance such as reducing salt, staying active in ways that suit you, limiting alcohol, not smoking and getting enough sleep.

Test results can shape that plan. A normal echocardiogram may be reassuring. A finding such as a thickened heart wall may prompt your provider to adjust treatment or arrange follow-up imaging later. Either way, the results are most useful when they are discussed in person with the provider who knows your history. For many people in Ajax, that means a family doctor or nurse practitioner who coordinates any testing and referrals and keeps an eye on the bigger picture over the years.

Getting the most from your testing

A few habits make any of these appointments smoother:

• Bring a current medication list, including blood pressure pills, with doses.
• Keep taking your medications as prescribed, unless your physician specifically tells you to pause one for a test.
• Skip lotion on your chest and upper body on the day of echocardiogram, stress test and Holter appointments, as Durham Cardiology asks for those tests.
• Bring your signed requisition and OHIP card.
• If you check your blood pressure at home, bring a record of recent readings to your follow-up with your provider. Ask them how and when to measure so the readings are useful.

Key takeaways

• High blood pressure often causes no symptoms, but over time it can affect both the heart and the arteries.
• An EKG and an echocardiogram are commonly used to check whether the heart has been affected.
• Stress testing, myocardial perfusion imaging and Holter monitoring answer more specific questions and are usually ordered for particular reasons.
• Vascular ultrasound can look at arteries in the neck, abdomen and legs.
• Your provider decides which tests, if any, are right for you, and explains the results.
• Chest pain, fainting, severe breathlessness or signs of a stroke always mean calling 911.

Durham Cardiology is located inside Rossland Diagnostic Clinic at Unit 102, 300 Rossland Road East in Ajax, with free parking and ground-floor access. If your provider has given you a requisition for a heart test, call us at 905-426-3111 or request an appointment, and our team will contact you to confirm a time. You can learn more about each test on the Durham Cardiology page.