Your health care provider will diagnose your heart disease by talking to you about your symptoms, reviewing your medical history and risk factors, and performing a physical exam. Also, diagnostic tests may be used to appropriately diagnose the cause of your symptoms and help your health care provider evaluate the best form of treatment for you.
Explore the tests listed below to learn more:
Ambulatory Blood Pressure MonitorAmbulatory blood pressure monitor helps cardiologists determine if you have blood pressure problems. It will record your blood pressure for 24 hours while you go about your activities of daily living.
An EKG, or electrocardiogram, records the electrical signals in your heart. It's a common and painless test used to quickly detect heart problems and monitor your heart's health.
EKGs are often performed in a doctor's office, clinic or hospital room. EKG machines are standard equipment in operating rooms and ambulances. Some personal devices, such as smartwatches, offer EKG monitoring. Ask your health care provider if this is an option for you.
An EKG is a painless, noninvasive way to diagnose many common heart problems in people of all ages. Your health care provider may use an EKG to determine or detect:
- Abnormal heart rhythm, or arrhythmias
- If blocked or narrowed arteries in your heart ― coronary artery disease ― are causing chest pain or a heart attack
- Whether you have had a previous heart attack
- How well certain heart disease treatments, such as a pacemaker, are working
You may need an EKG if you have any of these signs or symptoms
- Chest pain
- Dizziness, lightheadedness or confusion
- Heart palpitations
- Rapid pulse
- Shortness of breath
- Weakness, fatigue or a decline in ability to exercise
The American Heart Association doesn't recommend using EKGs to assess adults at low risk who don't have symptoms. But if you have a family history of heart disease, your health care provider may suggest an EKG as a screening test, even if you have no symptoms.
If your symptoms tend to come and go, they may not be captured during a standard EKG recording. In this case, your health care provider may recommend remote or continuous EKG monitoring.
There are two monitor types
- Holter monitor — a Holter monitor is a small, wearable device that records a continuous EKG, usually for 24 to 48 hours.
- Event monitor — this portable device is similar to a Holter monitor, but it records only at certain times for a few minutes at a time. You can wear it longer than a Holter monitor, typically 30 days. You generally push a button when you feel symptoms. Some devices automatically record when an abnormal rhythm is detected.
Coronary CT Angiogram
A coronary CT angiogram uses advanced CT technology and an injected dye to obtain high-resolution 3D pictures of the moving heart and major vessels. The 3D pictures are used to detect blockages in the coronary arteries.
During a coronary CT angiogram, X-rays pass through the body and are picked up by detectors in the scanner, producing 3D images. These images enable physicians to determine whether plaque or calcium deposits are present in artery walls.
An echocardiogram uses sound waves to produce images of your heart. This common test allows your health care provider to see your heart beating and pumping blood. Your health care provider can use the images from an echocardiogram to identify heart disease.
Your health care provider may suggest an echocardiogram to:
- Check for problems with the valves or chambers of your heart.
- Check if heart problems are the cause of symptoms such as shortness of breath or chest pain.
- Detect congenital heart defects before birth (fetal echocardiogram).
Depending on what information your health care provider needs, you may have one of several types of echocardiograms:
- Transthoracic echocardiogram — in this standard type of echocardiogram:
- A sonographer spreads gel on a device, a transducer.
- The sonographer presses the transducer firmly against your skin, aiming an ultrasound beam through your chest to your heart.
- The transducer records the sound wave echoes from your heart.
- A computer converts the echoes into moving images on a monitor.
If your lungs or ribs block the view, you may need a small amount of an enhancing agent injected through an IV line. The enhancing agent, which is generally safe and well-tolerated, will make your heart's structures show up more clearly on a monitor.
- Transesophageal echocardiogram — if your health care provider wants more detailed images or it's difficult to get a clear picture of your heart with a standard echocardiogram, your health care provider may recommend a transesophageal echocardiogram.
In this procedure:
- Your throat will be numbed, and you'll be given medications to help you relax.
- A flexible tube containing a transducer is guided down your throat and into the tube connecting your mouth to your stomach (esophagus).
- The transducer records the sound wave echoes from your heart.
- A computer converts the echoes into detailed moving images of your heart, which your doctor can view on a monitor.
- Doppler echocardiogram — sound waves change pitch when they bounce off blood cells moving through your heart and blood vessels. These changes, or Doppler signals, can help your health care provider measure the speed and direction of the blood flow in your heart.
Doppler techniques are generally used in transthoracic and transesophageal echocardiograms. Doppler techniques also can be used to check blood flow problems and blood pressure in the arteries of your heart that a traditional ultrasound may not detect. The blood flow shown on the monitor is colorized to help your health care provider pinpoint any problems.
- Stress echocardiogram — some heart problems, particularly those involving the arteries that supply blood to your heart muscle, or the coronary arteries, occur only during physical activity. Your health care provider may recommend a stress echocardiogram to check for coronary artery problems. However, an echocardiogram can't provide information about any blockages in the heart's arteries.
In a stress echocardiogram:
- Ultrasound images of your heart are taken before and immediately after you walk on a treadmill or ride a stationary bike.
- If you're unable to exercise, you may get an injection of a medication to make your heart pump as hard as if you were exercising.
A heart scan, also known as a coronary calcium scan, is a specialized X-ray test that provides pictures of your heart that can help your health care provider detect and measure calcium-containing plaque in the arteries.
Plaque inside the arteries of your heart can grow and restrict blood flow to the muscles of the heart. Measuring calcified plaque with a heart scan may allow your health care provider to identify possible coronary artery disease before you have signs and symptoms. Your health care provider will use your test results to determine if you may need medication or lifestyle changes to reduce the risk of heart attack or other heart problems.
Your health care provider may order a heart scan to better understand your risk of heart disease or if your treatment plan is uncertain.
A heart scan uses a specialized X-ray technology called "multidetector row" or "multislice" CT, which creates multiple images of plaque deposits in the blood vessels. The imaging test provides an early look at plaque levels.
Plaque is made up of fats, cholesterol, calcium and other substances in the blood. It develops gradually over time, long before there are any signs or symptoms of disease. These deposits can restrict the flow of oxygen-rich blood to the muscles of the heart. Plaque also can burst, triggering a blood clot that can cause a heart attack.
When is a heart scan used?
A heart scan can guide treatment if you have a low to moderate risk of heart disease or if your heart disease risk isn't clear. Your health care provider can tell you if you could benefit from having a heart scan based on your risk factors.
A heart scan also may motivate people at moderate risk to make important lifestyle changes and follow treatment plans.
When is a heart scan not used?
A heart scan requires exposure to radiation. While the exposure is generally considered safe, the scan isn't recommended if the risk of radiation exposure outweighs any potential benefit.
According to guidelines from the American College of Cardiology and the American Heart Association, a heart scan may not be recommended for these people:
- Men under 40 and women under 50 because it's unlikely calcium can be detected at younger ages.
- People who have a low risk of heart disease because detectable calcium is highly unlikely if you don't have a family history of heart attacks at an early age.
- People who already have a known high risk for heart disease, especially heavy smokers or those with diabetes or high cholesterol because the heart scan will likely not provide any additional information to guide treatment.
- People with symptoms or a diagnosis of coronary artery disease because the procedure won't help health care providers better understand the disease progression or risk.
- People who already had an abnormal coronary calcium heart scan.
You will get:
- A CT heart scan
- A calcium score showing your risk of coronary artery disease
- Follow-up advice
- Stress test
A stress test, also called an exercise stress test, shows how your heart works during physical activity. Because exercise makes your heart pump harder and faster, an exercise stress test can reveal problems with blood flow within your heart.
A stress test usually involves walking on a treadmill or riding a stationary bike. While you exercise, your heart rhythm, blood pressure and breathing are monitored. Or you'll receive a drug that mimics the effects of exercise.
Your health care provider may recommend a stress test if you have signs or symptoms of coronary artery disease or an irregular heart rhythm, or arrhythmia. The test also may guide treatment decisions, measure the effectiveness of treatment or determine the severity if you've already been diagnosed with a heart condition.
Your health care provider may recommend a stress test to:
- Diagnose coronary artery disease — your coronary arteries are the major blood vessels that supply your heart with blood, oxygen and nutrients. Coronary artery disease develops when these arteries become damaged or diseased — usually due to a buildup of deposits containing cholesterol and other substances, or plaques.
- Diagnose arrhythmias — heart arrhythmias occur when the electrical impulses that coordinate your heart rhythm don't function properly, causing your heart to beat too fast, too slowly or irregularly.
- Guide treatment of heart disorders — if you've already been diagnosed with a heart condition, an exercise stress test can help your health care provider find out how well treatment is working. It also can be used to establish your treatment plan by showing how much exercise your heart can handle.
- Determine the timing of cardiac surgery, such as valve replacement — in some people with heart failure, stress test results can help your health care provider determine whether you need a heart transplant or other advanced therapies.
Your health care provider may recommend a test with imaging, such as a nuclear stress test or echocardiographic stress test, if an exercise stress test doesn't pinpoint the cause of your symptoms.