Diagnosing Coronary Artery Disease
A number of tests can confirm the diagnosis or determine if you're at risk.

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Diagnosing Coronary Artery Disease

Coronary artery disease (CAD) is the most common type of heart disease and is the number one killer of men and women in the U.S.

With CAD, the arteries that fuel the heart with oxygen-rich blood become narrowed or blocked by a waxy substance called plaque. Over a period of time, plaque can harden, which can narrow the arteries and reduce the flow of blood.

The plaque can also rupture, leading to a blood clot on its surface. This can reduce or stop the flow of blood. When this occurs, your heart muscle may not get the oxygen it needs.

A common symptom of reduced blood flow to the heart is angina, or chest pain, which can feel like squeezing and pressure in the chest. Pain may also occur in the shoulders, back, neck, arms or jaw. In some cases, angina feels like indigestion.

Not everyone with CAD gets a warning or experiences symptoms. Sometimes the first sign of heart disease is when an artery is completely blocked, resulting in a heart attack. Some are so severe that they result in sudden death. That is why it is so important to check your risk factors, find out if you have heart disease and get treatment if you do.

Your doctor will evaluate you for CAD based on a number of findings, including your symptoms, risk factors and the results of several tests.

There are a variety of exams and tests that can help your doctor make the diagnosis or determine if you are at risk for developing CAD.

First, you will be asked questions about your medical history, symptoms and family history. Your level of physical activity and whether or not you smoke are also very important. Then you will have a thorough physical exam, including weight and blood pressure readings. Depending on these findings, your doctor may suggest some or all of the following:

Blood tests. Blood tests measure the levels of certain fats, cholesterol, sugar and proteins in your blood. If these levels are not normal, it could indicate a risk for CAD.

Electrocardiogram (EKG). An EKG shows how fast your heart beats and whether it is beating regularly at the time of the test. It can show if your heart's electrical pattern is normal. It can also show that there may have been a heart attack or some strain on the heart.

To get a baseline reading, the test is done as you quietly rest. Small pads are applied to your chest, arms and legs with wire leads that detect and record your heart's electrical pattern.

An exercise EKG, or stress test, is done while you're actively moving. It can show whether your heart is getting enough oxygen-rich blood to work properly while active. The stress test can reveal abnormal changes in your heart rate or blood pressure. It can also detect any abnormal heart rhythm, or disruption in electrical current to your heart. And it will look for signs of chest pain or shortness of breath.

Some people cannot keep exercising as long as they should be able to during a stress test. This could be due to anemia, lung disease, poor overall fitness or other conditions. But it could also be a sign of CAD.

In some cases, the stress test may include taking images of your heart while you're active and at rest. These pictures can help your doctor see if your heart is pumping efficiently and your blood is flowing regularly.

Echocardiography. This test is a type of ultrasound. It uses high-frequency sound waves to make a moving picture of your heart. Among other things, an echocardiogram can show how well the body's blood flows through the heart in its role as a pump, how strong it can pump blood when it beats and whether any areas of the heart itself have been injured by CAD.

Coronary angiography. Your doctor may recommend a coronary angiogram if the previous tests or other factors indicate CAD is likely. This test examines the insides of your coronary arteries. Your doctor will insert a thin, flexible tube called a catheter into a blood vessel in your arm, groin (upper thigh) or neck.

The tube is threaded into your coronary arteries, and dye is released into your bloodstream. Special X-rays are taken while the dye is flowing through your coronary arteries. Your doctor will be able to study the arteries' blood flow and see any narrow areas or blockages. This procedure is usually done in a hospital.

What's next?
If your doctor determines that you have CAD, there are a number of ways to treat it. These include lifestyle changes, medications and surgery.

Making lifestyle changes often can help prevent, manage or treat CAD. Lifestyle changes might be the only treatment that some people need. These may include a nutritious diet, proper exercise and weight control. Ask your doctor about a safe activity level before you get started. If you smoke, it's very important to quit. Your doctor can help you reach these goals.

If lifestyle changes aren't enough, you may need medication to relieve symptoms, control cholesterol, lower blood pressure and ease the strain on your heart.

Other options involve medical procedures. Angioplasty is a procedure that opens blocked or narrowed coronary arteries. Coronary artery bypass grafting uses arteries or veins from another area of your body to bypass (go around) your narrowed or blocked coronary arteries.

If you're diagnosed with heart disease, talk with your doctor. He or she can help you decide which treatment is right for you.

By Mary Small, Contributing Writer
Created on 05/03/2000
Updated on 09/05/2013
  • National Heart, Lung, and Blood Institute. What are the signs and symptoms of coronary heart disease?
  • National Heart, Lung, and Blood Institute. How is coronary heart disease diagnosed?
  • National Heart, Lung, and Blood Institute. What is coronary heart disease?
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