1. Heart Disease (Coronary Artery Disease) Slideshow Pictures
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Medical Author:

John P. Cunha, DO, FACOEP

John P. Cunha, DO, FACOEP

John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

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Medical Editor:

Daniel Lee Kulick, MD, FACC, FSCAI

Daniel Lee Kulick, MD, FACC, FSCAI

Dr. Kulick received his undergraduate and medical degrees from the University of Southern California, School of Medicine. He performed his residency in internal medicine at the Harbor-University of California Los Angeles Medical Center and a fellowship in the section of cardiology at the Los Angeles County-University of Southern California Medical Center. He is board certified in Internal Medicine and Cardiology.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Upon hearing about the patient's symptoms, the primary healthcare provider or the provider in the emergency department will immediately think of angina and other heart problems. Time is of the essence - treatment will probably begin as the evaluation continues.

An electrocardiogram (ECG) will be done.

• This painless test checks for abnormalities in the beating of the heart.
• Electrodes are attached to the chest and other points on the body. The electrodes read the electrical impulses linked to the beating of the heart.
• The ECG looks for signs of a heart attack or of impaired blood flow to the heart.
• For many patients with angina, the ECG result is normal.

The patient may have a chest x-ray. This will show any fluid buildup in the lungs. It can also rule out some other causes of chest pain.

There is no blood lab test that can tell with certainty that someone is having angina. There are certain blood tests that suggest that a person may be having a heart attack. These tests may be done if a heart attack is suspected.

While these tests are going on, the healthcare provider will be asking questions to help with the diagnosis.

• The questions will be about the symptoms and about the patient's medical history:
• previous operations,
• medications,
• allergies, and
• habits and lifestyle.
• The physical exam will include listening to the heart and lungs and feeling the heart through the chest.

If, after these tests, the healthcare provider suspects the patient may have coronary heart disease, additional tests will be performed to confirm the possibility.

• Exercise stress test: An ECG is taken before, during, and after exercise (usually walking on a treadmill) to detect inadequate blood flow to the heart muscle indirectly by changes on the ECG. This usually is done only for stable angina.
• Thallium stress test: This is a more complex and expensive test that injects a radioisotope into the circulation and indirectly detects parts of the heart that may not be getting enough blood during "stress" (usually walking on a treadmill, or after administration of a drug that mimics exercise in those unable to walk on the treadmill). This information indicates more accurately whether any of the coronary arteries may be narrowed, causing inadequate blood flow to the heart muscle or ventricle. Again, this is usually done only for stable angina.
• Dobutamine echocardiogram stress test: This is done for people who cannot walk on a treadmill. A drug called dobutamine stimulates and speeds up the heart, creating an increased demand or need for blood flow tot he left ventricle or muscle. If the muscle shows a slowing of function on the ultrasound image of the heart muscle, then it indirectly indicates inadequate blood flow to the muscle.
• Coronary angiogram (or arteriogram): This test of the coronary arteries is the most accurate but also the most invasive. It is a type of x-ray. A thin, plastic tube called a catheter is threaded through an artery in the arm or groin to one of the main coronary arteries. A contrast, or harmless dye is injected into the arteries. The dye depicts the arteries directly and shows any blockage more accurately than the above or more noninvasive procedures.

The healthcare provider will make the decision about whether these tests or any treatment need to be done on an urgent basis. If so, the patient will be admitted to the hospital. If not, the tests will be scheduled for the next few days, and the patient may be allowed to go home.

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