If there were a mammogram for heart disease, every woman would get one. But because there is no such thing -- yet -- we have to live with a confusing patchwork of individual tests. Your age, health status, family history, and other risk factors will help you and your doctor determine which tests are right for you.

Tests for Everyone

If you're 40 to 55 and have no symptoms of heart disease (such as an unfamiliar feeling in your chest or stomach, unusual shortness of breath, unusual fatigue, back pain, or lower chest discomfort), have your blood pressure, cholesterol, and triglycerides checked annually, says Antonio M. Gotto Jr., MD, dean of the Weill Medical College of Cornell University. Also make sure your weight and body-mass index (BMI) are within normal ranges.

Total Blood Cholesterol: Aim for less than 200 mg/dL.

LDL ("Bad") Cholesterol: Aim for less than 100 mg/dL.

HDL ("Good") Cholesterol: Aim for 50 to 60 mg/dL.

Triglycerides: Aim for less than 150 mg/dL.

Blood Pressure: Aim for lower than 120 over 80; normal readings range from 90 over 60 to 130 over 85.

If You Have Symptoms, You May Need These Tests

Electrocardiogram (EKG): Small sticky pads containing electrodes are attached to your neck, chest, arms, and legs. These record your heart's electrical impulses to see whether the heart is damaged. An EKG can also detect heart attacks and reduced blood flow. Goldberg says it's best to get this test when you're actually experiencing symptoms like chest pain.

Echocardiogram: Essentially an ultrasound of the heart, this test checks how the heart muscle and valves are functioning. It's similar to the ultrasound probes used during pregnancy: You lie on your left side on a table, and a probe is placed over different areas of your chest (which has been covered with gel). Goldberg says she orders the test for women who have heart murmurs, abnormal baseline EKGs, or hypertension.

Stress Test (a.k.a. Exercise Stress Test): This test evaluates the heart during exertion. EKG leads are attached to your chest and a blood pressure cuff to your arm. You then walk or run on a treadmill or pedal a bicycle. The technician will increase the intensity every few minutes until you feel tired, experience symptoms, or the EKG becomes abnormal. As the heart is forced to pump more blood, your doctor can see whether the blood supply is reduced in any of the coronary arteries. Stress tests may be more useful in men than in women, however. "There appear to be a higher incidence of false positive stress tests in women," says Louis Teichholz, MD, chief of cardiology at Hackensack University Medical Center, in New Jersey. This may be due to gender differences in heart rhythms as well as hormones. Adding a stress echocardiogram that shows the heart's motion at rest and at peak exercise increases accuracy, says Marianne J. Legato, MD, founder of the Foundation for Gender-Specific Medicine, in New York City.

Calcium Scoring: Reserved for women at high risk, this test uses a computerized tomography scan to detect calcium deposits in the coronary arteries. As you lie in a scanner, an x-ray machine takes pictures of your heart from all angles.

Coronary Angiography: An x-ray to reveal narrowing in the heart's arteries, this test is usually given only to women with chest pain or other signs of serious heart disease. Prior to the test, dye is injected via an IV. The dye highlights any blockages.

Tests You May Have (or Need) in the Future

DXA for Your Heart: The same kind of scan that measures bone density can now give a read on your heart. The FDA just approved DXA, which stands for dual x-ray absorptiometry, to look for abdominal aortic calcifications, a risk factor for heart attacks and stroke. The test is already used to find spinal fractures in osteoporosis patients, and, in fact, the heart scan can be done at the same time as the bone scan. The whole procedure takes about 10 seconds; there's no need for protective shielding because the radiation dose is so low.

Ultrasonic Exams: K. Craig Kent, MD, chief of vascular surgery at New York Presbyterian Hospital, has championed ultrasonic exams to catch aneurysms and strokes before they occur. The Medicare Act that takes effect in January 2007 will cover this exam for men 65 and older, because it's cost-effective to find such problems early. But the doctor thinks women, especially those who smoke and have a history of heart disease, should have it too. As a wand passes over your torso and neck, images of the aorta and carotid arteries appear on a nearby screen. This allows technicians to see any blockages or blood-flow interruptions. Then Doppler technology, which uses low-intensity ultrasound to detect blood-flow velocity, compares blood pressure in the arm with blood pressure in the ankle. A difference beyond a certain point could signal a blockage to the lower extremities and the need for further tests, treatments, or surgery.

Originally published in MORE magazine, September 2006.

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