What Is The Best Test To Check For Heart Problems?

What is the best test to check for heart problems? To answer this question and take a deep dive into the health of my heart, I recently spent hours and hours at a medical facility in Los Angeles being put through the most advanced cardiac workup known to man—then packaged my entire experience into this special podcast episode that’s complete with physician interview videos, deep dives into the state of the art equipment that was used, and much more.

So prepare to have your mind blown by this rare glimpse into the world of heart health and to learn everything you need to know about exactly what’s going on with your ticker.

My guest on this episode, Dr. Ram Dandillaya, is a cardiologist in the Division of Cardiology at the Cedars-Sinai Heart Institute. He is board-certified in cardiovascular diseases, nuclear cardiology, cardiac computed tomography, echocardiography, and internal medicine.

Dr. Dandillaya has a clinical interest in preventative cardiology, peripheral vascular disease, and cardiopulmonary exercise testing (CPET). In addition to being a fellow of the American College of Cardiology, Dr. Dandillaya is a member of numerous societies, including the American Heart Association’s Council on Clinical Cardiology, the American Society of Nuclear Cardiology, the Society of Vascular Ultrasound, the Los Angeles and American Society of Echocardiography and the American College of Physicians. In 2009, Dr. Dandillaya was elected to a two-year term as Vice President of the Cedars-Sinai Alumni Association.

Dr. Dandillaya’s research has been published in major scientific journals and he has present abstracts at many national meetings, including annual sessions of the American College of Cardiology and American Heart Association. He is also actively involved in the teaching of fellows and residents at Cedars-Sinai Hospital.

Dr. Dandillaya’s more recent research interests include issues related to percutaneous aortic valve replacement, the role of 64-slice computed tomography and coronary calcium in coronary artery disease, and the prevention of atherosclerotic heart disease.

In this episode, you’ll discover:

Part 1: Ben’s Examination At The Clinic

-Ben’s heart ultrasound…6:06

  • Enlarged heart ventricle is common in ultrasounds (athlete’s heart, or cardiomegaly)
  • 50/50 on finding issues in “healthy” patients
  • High-carb diet can be deleterious from lipid oxidation standpoint
  • Polyunsaturated fats are huge culprits for diabetes
  • Protocol: set of diagnostics on each valve of the heart
    • Checking for function and chamber sizes
  • Ben’s health protocol:
    • Walk 5-7 miles a day
    • Sauna 3-4 times per week
    • 45-minute kettlebell, HIIT session
    • Hiking, tennis, etc.
  • Article: Athletic heart syndrome
  • Article: Echocardiography in the evaluation of athletes

-Carotid duplex scan…19:22

-Abdominal aorta ultrasound…30:43

-Endothelial Peripheral Arterial Tone (Endo PAT) test…39:50

-12 Lead EKG…50:00

-EKG while on treadmill…54:45

-Coronary calcium scan…1:09:45

  • Ben’s score is 42; small amounts of calcium
  • Many men Ben’s age do not have calcium at all
  • Spotting calcium at a young age can prevent heart disease later in life
  • BGF podcast with Dr. William Davis
  • It appears that in active, endurance athletes, elevated CAC scores are not uncommon, and that metabolic fitness appears to be protective in this respect. For example:

Part 2: Ben And Dr. Dandillaya Review The Results Of The Exam


  • Ben’s resting heart rate = 42 bpm
  • Possible “early repolarization” pattern
  • Keep copy of EKG handy to inform docs in the event of chest pain
  • Heart rate is indicative of high vagal tone
  • Tech is making EKG results more accessible via smartphone apps and the like
  • Ensure mineral levels, hydration, etc. are topped off while performing in stressful situations (such as swimming where you can pass out and die)


-Vascular ultrasounds (echocardiogram)…1:25:00

  • Ejection fraction – measure of heart’s contractility
  • Ben’s ejection fraction = 63%
  • Congestive heart failure; at risk for cardiac death, arrhythmia, etc.
  • Hypertrophic cardiomyopathy (athlete’s heart)
  • Doppler flow: blood flow patterns across the heart’s chambers
  • Ben’s levels and readings are all good across the board

Transthoracic ECG

-Carotid artery scan…1:29:40

  • Ben’s results are very good
  • Thickening of carotid arteries occurs with pollution, toxicity in the air
  • Ultrasound does not have the radiation levels of X-rays
  • Customized recommendation on the frequency of being examined

Bilateral Carotid

-Abdominal aorta ultrasound…1:32:20

  • Aorta can become aneurysmal due to lifestyle, genetics

Abdominal Aorta

-Treadmill EKG…1:33:50

  • Not done often in the COVID-19 era; danger of exercising with a mask on
  • Looking for arrhythmia, atrial fibrillation

Exercise Stress Echo

-Advanced lipid panel…1:37:50

Cardiometabolic Report

-Endo PAT test…1:52:23

  • Endothelium is a single layer of cells that goes to the blood vessels; considered to be an organ of the body
  • Nitric oxide (NO) secreted by the endothelium allows for good cardiovascular health
  • Ben’s RHI (reactive hyperemic index) = 1.48 (normal is 1.67)
  • The Strategene report (via which Ben found out he has impaired nitric oxide synthase pathways)
  • Beets, sunshine, etc. support NO levels
  • Arginine to supplement NO levels

-Coronary calcium scan…1:56:05

  • Higher the score, the higher the risk
  • Ben’s score = 42 (higher percentile for age and gender)
  • Athletic training background is a factor in the score being higher than expected

Coronary Calcium Scan

Click here for the full written transcript of this podcast episode.

Resources mentioned:

– BGF podcasts:

– Supplements

– Other resources:

– 12 Lead EKG:

– Ultrasound Echocardiogram:

– Carotid Ultrasound:

– Abdominal Aorta Ultrasound:

– Exercise EKG:

– Advanced Lipid Panel:

– Endo-PAT:

– Calcium Scan:

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Got a question for me about today’s episode? Drop a comment below, and I’ll reply!

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