A number of tests can be performed to determine your risk of a heart attack. Routine health care for adults includes, at the least, a regular physical examination, a medical history, and a blood test called a lipid profile. Your doctor may also recommend other blood tests to see if you have diabetes or pre-diabetes or problems with your kidneys or thyroid gland.
If you have two or more major risk factors for a heart attackcigarette smoking, high blood pressure, high LDL cholesterol levels, low HDL cholesterol levels, family history of early heart attacks (in a male relative before age 55; in a female relative before age 65), or older age (a man age 45 and over or a woman age 55 and over)or you already have symptoms of coronary heart disease (such as chest pain), your doctor may also do an electrocardiogram (ECG) and possibly an exercise stress test to evaluate blood flow to your heart.
If the results of the exercise stress test are inconclusive, you may need to undergo a nuclear medicine stress test or a stress echocardiogram. When a stress test is strongly suggestive of coronary heart disease, coronary angiography may be performed to determine the location and extent of blockages in the coronary arteries.
Additional tests can be done, but they are not part of the routine evaluation of heart attack risk. These include blood tests for CRP, homocysteine, lipoprotein-associated phospholipase A2 (Lp-PLA2), Lp(a), and apoB and an imaging test called a coronary calcium scan. Other imaging tests, such as coronary computed tomography angiography and magnetic resonance imaging, may be considered in some people.
Your Heart Health: Medical History and Physical Examination
In a routine physical examination, your doctor will ask about any heart-related symptoms (such as chest pain or shortness of breath) and whether you are taking any medications. The doctor will ask about your lifestyle (Do you exercise regularly? Do you smoke? What is your diet like?) and inquire about any disease-related risk factors such as diabetes, kidney disease, or depression. The doctor will also question you about your family historywhether a parent, grandparent, or sibling has been diagnosed with heart disease or has had a heart attack, bypass surgery, or angioplasty.
During the physical exam, your doctor will measure your blood pressure, check your pulse and breathing, and listen to your heart. He or she will also feel your thyroid gland (located at the front of your neck), because an under- or overactive thyroid gland can adversely affect your heart.
All adults age 20 and older should have a lipid profile at least once every five years. This simple test determines blood levels of total, LDL, and HDL cholesterol and triglycerides. The test is performed after an overnight fast of at least 10 hours. If you haven't fasted, only total cholesterol and HDL cholesterol can be accurately measured. The test results, along with the presence of other risk factors, are used to estimate your risk of a heart attack and to determine how aggressive your efforts should be to prevent a heart attack.Electrocardiogram Test (ECG or EKG)
If you have one (or no) risk factors for a heart attack and have no symptoms of coronary heart disease (for example, chest pain), an ECG will probably not be done. But if you have two or more risk factors, have symptoms of coronary heart disease, or have already had a heart attack, you should have an ECG once a year.
Exercise Stress Test
If you are at intermediate to high risk for a heart attack or have chest pain that might be angina, your physician may recommend an exercise stress test to determine whether narrowed coronary arteries are interfering with blood flow to the heart,
Coronary angiography (also known as coronary arteriography) is the gold standard test to detect blockages in the coronary arteries. It is performed when a resting ECG and a stress test indicate that portions of the heart are receiving insufficient blood.
Other Heart Attack Screening Tests To Consider
Your doctor may want to consider one or more of these screening tests. They are not routinely performed but may be advised in some people who are at intermediate risk for a heart attack.
Originally published in The Johns Hopkins White Papers: Heart Attack Prevention (2011)
Roger S. Blumenthal, M.D.
Director, Johns Hopkins Ciccarone Center for the Prevention of Heart Disease
Professor of Medicine, Johns Hopkins University School of Medicine
Simeon Margolis, M.D., Ph.D.
Professor of Medicine and Biological Chemistry, Johns Hopkins University School of Medicine