Exams and Tests

The health care provider may request the following tests:

• Physical examination to include blood pressure in both arms, height and weight with a calculated body mass index (BMI), and a measured waist circumference.

• Bruits or turbulence over blocked arteries in the neck, abdomen, and legs may sometimes be heard with a stethoscope. Blocked arteries in the heart are not audible.

• Lipid profile to check levels of total blood cholesterol; low density lipoprotein (LDL), or bad cholesterol; high density lipoprotein (HDL), or the good cholesterol; and triglycerides, especially in people with diabetes.

• Blood glucose measurement to screen for diabetes, especially if the person is obese, has high blood pressure, high lipids, and/or family history of diabetes.

• Resting ECG records the rate and regularity of the heartbeat. It may show evidence of a previous heart attack. A person with multiple severely blocked arteries may have an absolutely normal resting ECG.

• Stress ECG is exercise on a treadmill or a stationary bicycle with the person's ECG, blood pressure, and respiration continuously recorded. In persons who have atherosclerosis, this test may show evidence of decreased blood supply to the heart created by the increased demand for blood and oxygen by the exercise. If the patient is not able to exercise, a chemical stimulation test can be performed.

• Nuclear stress test involves the administration of a radioactive substance into the bloodstream before taking images of the heart muscle (at rest and immediately after exercise). The images give an idea about the perfusion of the heart muscle. If a person has coronary artery disease, blood supply decreases with exercise in the area supplied by the blocked artery. The test is more sensitive than a stress ECG, and it can better predict which blocked artery is involved. This test is also much more expensive than an ECG.

• Echocardiogram is a test in which moving images of the heart can be visualized on a screen with an ultrasound probe. If an area of the heart has become weakened as a consequence of a heart attack, the damaged muscle of the left ventricle can be detected and the amount quantified. Echocardiography also reveals problems with the heart valves, any fluid around the heart, congenital connections between the 2 sides of the heart, and estimates pressures inside the heart.

• Exercise echocardiography is an alternative to a nuclear stress test. Echo only analyzes movement of the left ventricle. When lack of blood flow occurs, the ischemic area stops working. Then, with rest and resolution of ischemia, the muscle starts moving again.

• Angiography of the affected artery is advised if the symptoms are disabling and/or if the above tests suggest a high probability of significant coronary artery disease. This is an invasive procedure, performed in a catheterization laboratory by a cardiologist. A special radiopaque dye is injected into the arteries though a thin tube or catheter, which is inserted into the body under local anesthesia, usually from the groin region. Serial x-ray films are then taken to visualize the arteries for any narrowing. This is still the most specific test to evaluate coronary artery disease.