Several tests can be used to diagnose chest pain
After you've been diagnosed with angina, your doctor will want more information before prescribing treatment. "Knowing the overall pattern of your chest pain, how extensive it is and when it occurs is important," says Nanette Wenger, M.D., a cardiologist at Emory University School of Medicine in Atlanta, "but we also need formal diagnostic tests to determine the extent of your heart disease and the severity of your blockage."
You're probably already familiar with some heart tests; many are part of the routine heart disease assessment adults undergo at least every five years. Others will be new to you.
Your doctor will want to get an overall picture of your cardiovascular health by looking at your risk factors for heart disease. You'll certainly be asked about your family history. "The majority of men diagnosed with heart disease before age 55 and women diagnosed before age 65 have a parent or sibling who also has or has had heart disease," says Vince Bufalino, M.D., CEO of Midwest Heart Specialists in Chicago and a former American Heart Association board member.
Your doctor will also measure your blood pressure and order a blood test to check your levels of:
- LDL (bad) cholesterol
- HDL (good) cholesterol
- blood glucose
- kidney function
- thyroid function
Sometimes, C-reactive proteina substance that indicates plaque buildupis also tested.
To determine how well blood is flowing through your arteries, your doctor will perform a resting electrocardiogram or ECG. Here, small sensors placed on your chest detect pattens of electrical activity from your heart. Abnormal patterns suggest that blood flow is restricted and that your heart is getting insufficient oxygen.
If your angina is brought on only by exercise, your ECG will probably be normal. In that case your doctor will likely ask you to undergo an exercise stress test, in which you'll walk on a treadmill or ride a stationary bike while your ECG, blood pressure and heart rate are closely monitored.
If results show you can tolerate exercise and have only mild restrictions in blood flow, testing may stop there. In some cases, however, your doctor may order additional tests.
Tests Used to Detect Blockages
24-hr Holter Monitor is a small, portable ECG device that you may be asked to wear if you don't have extensive chest pain and your doctor suspects "silent heart disease."
Pharmacological stress test is a diagnostic test in which your doctor injects a drug that mimics the effects of exercise. You may get one if you can't complete an exercise stress test. In a nuclear medicine stress test, you're injected with a mildly radioactive substance during a stress test; its passage through your coronary arteries is monitored. You may have this if you continue to experience angina even though your other tests are normal.
In coronary angiography, a tiny tube called a catheter is inserted into a vein—usually in the groin—and threaded up to the coronary arteries, where a contrast material is released. X-rays are taken to show the location and severity of any obstructions, which can be treated simultaneously. You'll likely get one if your resting ECG or stress test are notably positive for a blockage.
CT angiography is a minimally invasive alternative to coronary angiography. In this test, a CT scanner takes highly detailed images of your heart. (In some cases you may need to be injected with a contrast substance.) You may have this test if it's not completely clear to your doctor that you have a blockage.
In cardiac MRI, you lay in a long tube while powerful magnets construct detailed images of your heart. It's ideal for analyzing multiple blockages and structural damage to the heart.