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Angina
How is Angina Diagnosed?
To find out if you have angina, your doctor will:
• Do a physical exam
• Ask about your symptoms
• Ask about your risk factors and your family history of coronary artery disease (CAD) or other heart disease.
Sometimes, your doctor can diagnose angina by noting your symptoms and how they occur. Your doctor may order one or more tests to help make a diagnosis of angina.
The tests your doctor may order include:
• EKG or ECG (electrocardiogram). This test measures the rate and regularity of your heartbeat. Some people with angina have a normal EKG.
• Exercise stress test. This test shows how well your heart pumps at higher workloads when it needs more oxygen. EKG and blood pressure readings are taken before, during, and after exercise to see how your heart responds to exercise. The first EKG and blood pressure reading are done to get a baseline. Readings are then taken while you walk on an exercise treadmill, pedal a stationary bicycle, or receive medicine to make your heart beat faster. The test continues until you reach a heart rate set by your doctor. The exercise part is stopped if chest pain or a very sharp rise in blood pressure occurs. Monitoring continues for 10 to 15 minutes after exercise or until your heart rate returns to baseline.
• Chest x-ray. A chest x-ray takes a picture of the organs and structures inside your chest. These include your heart, lungs, and blood vessels.
• Nuclear heart scan. This test shows blood flow to the heart and any damage to the heart muscle. A radioactive dye (technetium or thallium) is injected into your bloodstream. A special camera can then see the dye and find areas where there is less blood flow. Nuclear heart scans are often taken while you are at rest and again after exercise. If you cannot exercise, a medication is given to increase the workload of the heart. The before-and-after exercise scans are compared.
• Echocardiogram. This test uses sound waves to create a picture of the heart. The picture is more detailed than an x-ray image. The test shows how well your heart chambers fill with blood and pump it to the rest of the body. An echocardiogram also can help identify areas of poor blood flow to the heart, areas of heart muscle that are not contracting normally, and previous injury to the heart muscle caused by poor blood flow. An echocardiogram can also be used with a stress test.
• Cardiac catheterization. A thin flexible tube (catheter) is passed through an artery in the groin or arm to reach the coronary arteries. Your doctor can determine pressure and blood flow in the heart's chambers, collect blood samples from the heart, and examine the arteries of the heart by x-ray.
• Coronary angiography. This test is done during cardiac catheterization. A dye that can be seen by x-ray is injected through the catheter into the coronary arteries. Your doctor can see the flow of blood through the heart and see where there are blockages.
Your doctor may also order blood tests, such as:
• A fasting lipoprotein profile to check your cholesterol levels.
• Fasting glucose test to check your blood sugar level.
• C-reactive protein (CRP) test. This blood test measures CRP, a protein in the blood that shows the presence of inflammation. Inflammation is the body's response to injury. High levels of CRP may be a risk factor for CAD.
• A test to check for low hemoglobin in your blood. Hemoglobin is the part of red blood cells that carries oxygen to all parts of your body.
