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Diagnosis

Your doctor can diagnose coronary artery disease (CAD) by first talking to you about your symptoms, medical history and risk factors and then performing a physical exam. In addition, a number of diagnostic tests may be ordered.

Diagnostic Tests

He or she may also order a number of diagnostic tests. No single test can determine if you have coronary artery disease.

If you go to the emergency room with chest pain, some of these tests will be ordered immediately. These tests will seek to find out if you are having angina or a heart attack. If you have a stable pattern of angina, other tests may be done to determine the severity of your disease.

If your doctor thinks you have coronary artery disease, he or she will probably do one or more of the following tests:

Blood Tests

These tests check for levels of certain fats, cholesterol, sugar and proteins called troponins in the blood that help determine if you have risk factors for coronary artery disease or if you are having a heart attack.

ECG/EKG Waves

Electrocardiogram (EKG or ECG)

This is a painless, noninvasive test in which patches with electrodes are attached to your skin to measure electrical impulses produced by your heart.

These impulses are recorded as waves displayed on a monitor or printed out on graph paper. The test can reveal evidence of a previous heart attack or one that is in progress. EKGs also capture heart rhythm.

Holter Monitor

This is a portable device that records all of your heartbeats over an extended period, usually either 24 or 48 hours. You wear small patches with electrodes on your chest that are connected by wires to a small, portable recorder. The recorder can be clipped to a belt, kept in a pocket, or hung around your neck. During the time you're wearing a Holter monitor, you do your usual daily activities. This is used to monitor heart rhythm for an extended period of time.

Stress Test

During a stress test, you exercise to make your heart work harder and beat faster. An EKG is recorded and blood pressure is monitored during exercise. The technician will ask you about the presence of symptoms such as chest pain or shortness of breath.

Sometimes imaging is also done. This can be done with an echocardiogram as described above or by using a radioactive dye and X-ray equipment to image the heart's motion with exercise. If imaging is performed with your stress test, resting images (without exercise) are compared to stress images (after exercise) to look for changes in heart function that are related to blood flow patterns.

Echocardiogram

This test uses sound waves to create a moving picture of your heart.

  • Provides information about the size and shape of your heart and how well your heart chambers and valves are functioning.
  • Identifies areas of poor blood flow to the heart, areas of heart muscle that aren't contracting normally, and previous injury to the heart muscle caused by poor blood flow.

The test is noninvasive and is performed by placing a probe on your chest wall. It is the same technique used in sonograms in pregnant women.

Coronary Catheterization

To see the blood flowing to your heart, your doctor may perform a coronary catheterization. This involves injecting a dye into your arteries in what is called an angiogram.

The dye is delivered through a long, thin, flexible tube called a catheter that is threaded through a leg artery into the coronary arteries. This is called catheterization.

AngiographyThe dye outlines areas of blockages on x-ray images. If a blockage is found and needs treatment, a balloon can be pushed through the catheter and inflated to open the artery or arteries in question. A stent or tiny wire mesh tube can then be inserted to keep the artery open.

This procedure is done in the hospital.

Watch Video Animation

To watch a video animation of a coronary angiography, click here.

CT Scan

A computerized tomography (CT) scan uses X-rays and computers to get detailed pictures of the body. Coronary artery calcification CT scans can detect calcium in the coronary arteries which may indicate the presence of coronary artery disease. A CT coronary angiogram uses x-ray dye (contrast) to look at blood flow patterns within the coronary arteries to detect blockages. This provides information similar to the catheter based angiogram, above, but is not as invasive. While the technology is being perfected, CT scanning has not yet replaced conventional angiograms.

Contact Information

Cardiovascular Medicine
Division of the CardioVascular Institute
Beth Israel Deaconess Medical Center
330 Brookline Avenue
Boston, MA 02215
617-667-8800

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