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Stress echocardiography is an alternative to the nuclear stress test. Many people prefer this test because it does not use a radioactive agent.

• Echocardiography is a type of sonar that uses sound waves to bounce off walls and valves, creating an image of the heart as it beats.
• The movements of the ventricular walls are compared during stress and at rest. Wall motion drops during stress if the coronary artery supplying that part of the heart has significant obstruction.
• Like the other stress tests, the heart is stressed either by exercise on a treadmill or by administration of a drug.

Electron beam (ultrafast) CT scan (EBCT) is a new and noninvasive but somewhat controversial test. By measuring the amount of calcium deposited in the plaques of coronary arteries, it can detect blockages of only 10-20% of an artery, which may not show up in other tests.

• Generally, such minor blockages are treated medically; lifestyle changes and risk factor modifications are recommended to prevent worsening of the blockage.
• Because elderly people frequently have calcium in their coronary arteries without significant narrowing, EBCT is of limited value in this age group.
• The advantage of EBCT comes in screening young people with one or more heart disease risk factors.

Coronary angiography by cardiac catheterization is the best way to evaluate coronary heart disease.

• You will go to a hospital or an outpatient catheterization lab (for same-day surgery).
• Under guidance of an x-ray camera, a long, thin plastic tube (catheter) is threaded into the opening of your coronary arteries from a blood vessel in either your groin (femoral artery) or your arm (brachial artery).
• Once the catheter reaches the coronary artery opening, it injects a small amount of iodine dye, which makes the coronary arteries visible on the x-ray screen.
• Pictures of the coronary arteries are then recorded in a computer for later review. The images show the diameter of the coronary arteries and any blockages narrowing them.
• Coronary angiography is an invasive test. In experienced hands, the risk of complications is less than 1%.
• It is the only test that helps a cardiologist to determine precisely whether to treat you with bypass surgery, a less-invasive technique such as angioplasty or stent placement, or just medications.

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